Track 1: EHR Implementation and Adoption

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David N. Gans, MSHA, FACMPE Vice President
Practice Management Resources Medical Group
Management Association Impact of Electronic
Health Records on the Financial Performance of
Medical Group Practices
Track 1 EHR Implementation and
Adoption September 9, 2008 AHRQ Annual
Conference 2008 Bethesda, MD
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Impact of EHR on Medical Practice
One accurate measurement is worth a thousand
expert opinions. Rear Admiral Grace Hopper
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Learning Objectives

• Understand how Electronic Health Records affect
  the economic performance of medical group
  practices
• in the perception of medical practice
  administrators who describe how electronic health
  records impacted their practices
• by cross sectional comparison of medical groups
  with and without electronic health records
• by longitudinal assessment of practices that
  implemented an electronic health record in the
  past two years

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Perception of medical practice administrators who
describe how electronic health records impacted
their practices

Name, credentials Organization Date
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MGMA 2007 Electronic Health Record Survey

• Survey frame of medical practices that responded
  to a 2005 national information technology survey
• Voluntary response by medical practice
  administrators
• 570 practices responded describing their health
  record system, including 285 practices that had
  an electronic health record

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Summary of Study Findings

• The study identified 285 practices where EHR
  implementation is in process or is fully
  implemented.
• Respondents described increased operating costs,
  reduced productivity, and other surprises and
  challenges during the first 6 to 24 months of the
  implementation
• After the first 6 to 24 months, the benefits of
  EHR adoption exceeded costs and most practices
  wondered how they ever conducted business without
  an EHR

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Types of EHR
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Perceived Impact of EHR on Practice Costs
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Perceived Impact of EHR on Practice Productivity
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Testimonials on EHR Return on Investment

• We are definitely receiving a ROI on our EHR but
  during the first year it cost us much more than
  it saved us. Physician productivity is actually
  higher but they used it to get out of the office
  earlier (quality of life) versus actually seeing
  more patients.
• Expensive to start, but ROI should be under three
  years. It is the only way left to significantly
  impact practice expenses.
• A robust EHR, carefully selected and
  painstakingly implemented can be a huge benefit.
  Its ROI includes reduction in staff, increased
  billing, faster A/R, better documentation and
  patient safety and pay-for-performance
  initiatives.

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Cross sectional comparison of medical groups with
and without electronic health records

Name, credentials Organization Date
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MGMA Cost Survey Report

• MGMA Cost Survey Report
• Survey frame of MGMA Medical Practices
• Conducted annually with similar questionnaire
  format and definitions since 1979
• Voluntary response by medical practice
  administrators
• 2008 report based on data submitted by 1695
  medical practices, representing the financial
  performance of 29,215 FTE physicians
• 2008 report included information from 544
  practices with an electronic health record

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Cross Sectional Analysis

• Identify medical groups with an EHR and practices
  with a paper medical record
• Categorize practices by specialty and ownership
• Determine the mean for key revenue and expense
  measures
• Use the T-test to measure significance

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Impact of EHR on Multispecialty Groups
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Impact of EHR on Physician-Owned Multispecialty
Groups with Primary Care Only
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Impact of EHR on Family Practice
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Impact of EHR on Cardiology Groups
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Impact of EHR on Orthopedic Surgery Groups
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Longitudinal assessment of practices that
implemented an electronic health record in the
past two years

Name, credentials Organization Date
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Longitudinal Analysis

• Identify family medicine and multispecialty with
  primary care groups that indicated the practice
  installed an EHR in 2006 and reported information
  for the 2007 Cost Survey
• Identify if practice also participated in the
  2005 Cost Survey
• Determine the change in revenue and expense for
  each practice
• To control for environmental change, perform the
  same calculation for family medicine and
  multispecialty with primary care groups that
  indicated the practice had a paper medical
  record.

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Mean Two Year Change in Financial Performance for
Primary Care Practice
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Observations

Name, credentials Organization Date
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Observations

• Allowing for sufficient time for installation and
  change in processes, practices with an EHR appear
  to have
• Greater revenue
• Increased expenses
• More profit
• Than practices with paper medical record
• The difference may be significant, but more study
  is needed.

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Questions?
David N. Gans, MSHA, FACMPE Vice President,
Practice Management Resources Medical Group
Management Association dng_at_mgma.com
mgma.com
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About MGMA

• Our missionTo continually improve the
  performance of medical group practice
  professionals and the organizations they
  represent
• MGMA has
• 22,000 members
• Who manage and lead 12,500 organizations
• With 270,000 physicians

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Biographical Summary David Gans

• David N. Gans, FACMPE
• Vice President, Practice Management Resources
• Medical Group Management Association
• Mr. Gans administers research and development at
  the Medical Group Management Association (MGMA)
  and its research affiliate, the MGMA Center for
  Research. In addition to his management
  responsibilities, Mr. Gans serves as the
  associations staff resource on medical group
  practice management. He is an educational
  speaker, author of a monthly column in MGMA
  Connexion, and provides technical assistance to
  the associations members in all areas of
  practice management.
• Mr. Gans received his Bachelor of Arts degree in
  Government from the University of Notre Dame, a
  Masters of Science degree in Education from the
  University of Southern California, and a Master
  of Science in Health Administration degree from
  the University of Colorado. Mr. Gans is retired
  from the United States Army Medical Service Corps
  in the grade of Colonel, U.S. Army Reserve. He
  is a Certified Medical Practice Executive and a
  Fellow in the American College of Medical
  Practice Executives.
• Address Medical Group Management Association,
  104 Inverness Terrace East, Englewood, CO 80112
• Phone [phone], ext. 1270
• E-mail dng_at_mgma.com

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