Case Study

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Associates in Medicine

The first time that Associates in Medicine (AIM) attempted to convert to electronic medical records, in 2005, they were unsuccessful. Plagued by poor training and unfulfilled expectations, the project was abandoned. With their second attempt at EHR, they chose Aprima. With a lot more preparation and research, the practice is having a much smoother transition than with their first attempt. In the months since implementing, AIM has experienced an increase in their E&M allowable by as much as 30% per a visit, which is projected to add up to an additional $40,000-60,000 per a provider simply by more accurately billing their E&M codes using the Aprima E&M coder.

The difference lies in Aprima Electronic Health Records (EHR), especially its E&M coding support, along with the groundwork laid in preparation for this implementation.

Starting Over

After their first unhappy experience with an EHR, AIM – an eight-doctor internal medicine practice in Houston, Texas – was anxious not to repeat that mistake again. Still, regulatory and market forces were pressing inexorably in that direction. So, in 2008, the practice hired Jack Rubin to locate an EHR that would interface well with the practice and manage its implementation, among other duties.

First on the list of priorities was usability for the physicians. The eight of them brought a wide range of computer skills to the project, and Rubin needed to find a system that would not intimidate even the least computer proficient physician.

Flexibility was the second priority. “We wanted something that wouldn’t leave our doctors trapped in any one format,” Rubin says. “The system needed to be so easy to customize that our doctors could change their content on the fly.” After a long search, Rubin presented his physicians with three EHR packages to choose from. They picked Aprima.

The Secret to a Solid Start

Rubin chose a phased implementation of the Aprima system, starting with the Practice Management (PM) piece in November 2011. After a few months’ hiatus while the practice relocated its offices, they picked up with the Aprima EHR implementation beginning in June 2012.

Rubin put the delay to good use, spending that time providing one-on-one training for the physicians and preparing them to start using Aprima. By breaking up the training, doing it in small, focused pieces over their lunch hours or on the afternoon when no patients were scheduled, AIM was able to complete the implementation without blocking off significant portions of any of their physicians’ schedules, minimizing the impact on cash flow.

As expected, some doctors became comfortable using Aprima more quickly than others, but they are now all using the system successfully.

Big Returns on More Accurate E&M Coding

AIM physicians who have used the optional E&M coder to check their E&M coding level saw a 10-30% increase in their allowable for established patients during the first several months of the practice’s implementation. With each physician seeing about 2500-3200 established patients each year, it is projected that, if this keeps up, that AIM will see as much as $60,000 in increased billing per a year per a physician for coding their E&M codes more accurately.

This case provides a good side-by-side illustration of how the E&M calculator can pay off. AIM doesn’t require all providers to use the system in the same way. At the time of the study, more than half of the AIM physicians used the coder for assistance on many of their patients. In a comparison of the two groups (see table), the difference is stark: increases of 5-21% in average allowable for doctors using the coding support, versus +2.8% to -4% change for the other group of physicians over the same period.

Average Provider Allowables per Visit for Established E&M Codes

E&M codes chart

The Bottom Line

At the end of the first year using Aprima, AIM projects 5-10% increased revenue from more accurate coding and a reduction in costs related to eliminating many chart and form expenses. The practice has achieved meaningful use for all eight physicians, even though their implementation didn’t begin in earnest until June. “I love the Meaningful Use dashboard!” he says. “Nothing is more helpful at determining our Meaningful Use status. It shows me our status in real time and it’s easy to follow. Right now, I see all green for all of our core measures.”

From a management point of view, Rubin appreciates the extra management tools Aprima offers almost as much as the increased revenue. Aprima’s tracking feature enables him to see what’s going on in the practice, from monitoring the medical assistants’ productivity to checking how many radiology tests are pending.

After a catastrophic first attempt, AIM found the switch to an EHR much easier with Aprima. He has some advice to help other practices do it right the first time, “Get your doctors’ hands dirty as soon as possible, but they will need guidance. Train them on the basics, have them set their defaults and get them to practice charting weeks ahead of your Go Live date.”