ROI Reality, or Sales Pitch

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ROIReality, or Sales Pitch?

• Robert J Lamberts, MD
• Evans Medical Group
• Evans, GA

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Practice Summary

• Primary Care
• Internal Medicine/Pediatrics
• Family Medicine
• Suburban Augusta, GA
• 4 Full-Time Physicians (5th to come)
• 3 Equal-Share Partners
• Practice Founded 1991

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Patient Demographics

• 14,000 Active Charts
• 31 Patients lt18 Yrs of Age
• 20 Patients gt50 Yrs of Age
• 53 Female
• 58 Adults Married

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Payor Breakdown

• 19 Capitated
• 17 Medicaid
• 13 Medicare
• 3 Uninsured
• 47 Commercial (non-cap)

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Patient Visits

• 19,200 Office Visits in 2004
• Average 1600 per month
• 2005 Average 1990 per month (Increase of 23)
• Office Hours
• 830-430 Scheduled Appts
• 730-9 AM/530-7 PM Walk-In Visits
• 20 Visits as Walk-Ins

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Revenue Sources

• 72 From Office Visits
• 9 From Preventive Care
• 6 From In-House Labs
• 6 From Immunizations
• 2 From Hospital/Nursing Home (Hospitalists See
  Adult Inpatients)

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Practice Growth
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Electronic Health Records

• July, 1996 Went live with Logician
• Paperless in 1998
• Initial investment in 1996 was 80,000 for 2
  physicians
• Subsequent investments
• Replacing Servers
• Replacing Workstations
• More Licenses

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So what about our ROI?
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Initial calculation

• For 80,000 loan, payment would be 2000 per
  month
• We worked an average of 20 days per month
• Therefore need to generate 100 extra per day to
  financially justify it (regardless of overhead
  savings)
• This amounted to 2 extra patients per day

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If that is true

• Last year we saw 91 patients per day
• In 1999 (earliest year we have data), we saw 51
  patients per day
• This is an increase of 40 patients per day
• This means we are generating 2000 more per day,
  40K/month, 480k/year
• This is a 2000 return on our initial investment

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Another way of figuring it
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Backwards ROI

• Chart Pulls estimated at 3 per pull
• In 2005, we had 62,683 patient documents
  generated
• This equates to 180,049
• Dictation we do none at this time
• Estimate dictation of ¼ of our encounters
• Estimate 0.10 per line, 50 lines per note
• Gives 30,000 saved
• Grand total of 210,049 saved last year

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What is wrong with this?

• Other costs have gone up
• Too many assumptions (cost/chart pull, dictation
  costs, etc).
• Does not account for certain increased costs
• Have spent far more than the initial 80,000

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So what is the Bottom Line in ?

• Impossible to calculate
• Butwe have definitely seen success
• Provider numbers increased by 150
• Patient Volume increased by 100 since 1998
• Collections increased by over 100 since 1999
• New office buildingmore than triple original
  square feet
• My income up by 50

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Revenue (Gross Charges Collections)
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Not the Only Measure Of Return

• Quality of Care
• Quality of Service
• Quality of Life

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Quality of Care
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Vioxx
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Quality of Service
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What if

• Patient is seen in the office at 9 AM and given
  an antibiotic for bronchitis
• At 11 AM, patient calls back to your office and
  states I saw Dr. X today and was given an
  antibiotic, but I lost it and dont know the name
  of it. Can you call it in to my pharmacy?

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The Paper-office Answer?

• Find the chart. What if you cant find the chart?
• Find the physician. What if the physician is not
  available?
• Unfulfilled. What if the patient cannot wait and
  does not leave a callback number?
• Keep looking. What if the chart isnt done no
  information on any meds, waiting for dictation
• 10 Minutes (at least) in a non-EHR office

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In the EHR-Enabled Office

• Nursing (or front office) pulls up the completed
  9 a.m. patient note and says oh, it was
  Zithromax, Ill call it into your pharmacy.
• Patient does not call this message in because the
  prescription was faxed directly to the patients
  pharmacy
• Elapsed time 30 (or Zero) seconds

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Which Patients are Happier?
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Quality of Life

• Less time in office (work 4 days/week)
• Remote access go home earlier
• Less frustration charts are never lost
• Increased income (physician collections of
  approximately 500K per physician last year)
• Streamlining workflows easier to refer
  patients, send prescriptions less wasted time.

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Summary

• Measuring ROI is a numbers game that can be
  manipulated to say just about anything
• Better measured by looking at a real situation
• ROI not just a financial concept. What kind of
  return do you want to see?