If you are like me, I found that EHR Implementation May Lead to Revenue Loss in Health Affairs, March, 2013 confirmed the obvious in many respects to those of us that have been through an EHR implementation in an orthopedic practice. Beyond volume and revenue loss, physician satisfaction and happiness are also impacted negatively in nearly every practice. This is especially true during the implementation and stabilization phase of an EHR transition.
My personal experience has been that EHR implementation in an orthopedic practice always has substantial negative short term implications. This includes revenue loss associated with decreased volume, but also revenue loss that can be affected by charge capture issues if not monitored closely. If workflows and staffing are not evolved and optimized to assist your surgical providers, they may never recover lost volume. has this been your experience? The negative financial effects of an EHR implementation in orthopedics can be mitigated substantially by improving surgical conversion rates via the enhancement of staff utilization, workflows, and via the employment of new methods of service delivery.
When contribution margins of orthopedic specialties are extremely high relative to other subspecialties, the need to get orthopedics “right” in your practice or health system is critical. Sub-specialties such as sports medicine can have contribitions 40% higher than other sub-specialties. When margins are this high, there is no business reason to lose cases for any number of reasons and cost control needs to be of secondary importance. This is often a hard reality to accept considering your substantial investment in your EHR on the front end. Beyond financial reasons, access can also become a very patient centered reason to enhance your workflows and service delivery.
My personal opinion is that orthopedics should be treated differently in an EHR implementation due to the volumes that are seen and due to its financial importance to a healthcare system. A templated and standardized approach that may work best across a healthcare system usually does no work and must be adjusted quickly in the stabilization and optimization phase. You cannot expect workflows that worked pre-EHR to allow for physicians to see 40, 50, or higher amounts of patients in a day if you place the vast majority of the burden on a physician or do not change your access and triage strategies.
In summary, you can fix EHR specific problems, but you must look at your entire package of service delivery. The implementation of an EHR creates a sense of urgency that can allow you to drive incredibly positive changes in how you design your service delivery for the future.
We would enjoy hearing your thoughts on this topic and learning what has worked for you!