Electronic Health Reporter

By Aaron Perreira, director of integrated marketing, Kareo.

Over 70% of independent medical practices agree that the time demands of electronic health records (EHR) data entry detracts from care delivery. Simultaneously, 69% of independent practices state that integrated technology solutions are needed to improve the efficiency and profitability of their practices. This interesting “love/hate” relationship between independent practitioners and technology was shared in the recent 2019 State of the Independent Practice Industry Report, published by Kareo, a cloud-based medical software company.

The report was based on a nationwide survey designed to uncover the current challenges and expectations of independent practitioners in several areas of their practices, including care delivery, billing, patient engagement and regulatory compliance. Attitudes regarding the role of technology emerged in each of the areas surveyed.

Providers are increasingly reliant on their EHRs to manage their day-to-day clinical operations and maintain regulatory compliance. For many practices, the use of EHRs began when the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was signed into law by President Obama on February 17, 2009. The HITECH Act was created to motivate the implementation of electronic health records by providing monetary incentives for being able to demonstrate meaningful use of electronic health records.

At that time, the market was flooded with more than 700 EHR vendors looking to capitalize on the EHR gold rush. Many practices adopted EHRs at that time, however since then, as the regulatory standards and consumer requirements for EHR technology continued to evolve, an increasing number of software providers have failed to keep up with technology and have fallen out of the race. This has left many providers tethered to antiquated, ineffective systems. More established practices (in practice for 10 or more years) appear to be more gun shy in that they likely adopted their EHR several years ago and had to suffer through poor implementations of costly but under-performing software that didn’t deliver on the value that was promised.

Despite government mandate, penalties and incentives, only 64% of respondents are currently using an EHR today. This low figure likely represents both the entry of newer practices that haven’t yet implemented their EHR platform and the fact that some practice specialties such as mental health, are more likely to still be using paper-based records and haven’t made the switch to electronic records.

The drive toward EHR, however, is significant. The survey shows 17% of providers plan to acquire EHR technology for the first time in 2019, and a quarter of practices are looking to switch technology vendors. This means that over 40% of independent practices could be using a new EHR within the next 12 months. This is important since to participate in MACRA and enjoy the significant financial benefits of quality measures, practitioners must be using a 2015-certified EHR. For those who do, electronic health records systems not only simplify MIPS compliance, but leading EHRs include a range of features that help reduce provider workload and streamline the delivery of patient care.

While the adoption of EHR has had its ups and downs, the use of billing and practice management solutions has been widespread. More than 80% of practices currently use or plan to soon implement some form of billing and/or practice management solution. The survey suggests that a significant number of practices are migrating to a new generation of technology for this function since 24% of survey participants indicate that they plan to change billing/practice management solutions in 2019. This suggests that the move to greater integration and automation is underway in this important practice function as well. This is critical since getting paid is becoming more challenging as practices are seeing declining reimbursements from third-party payers (more than 60% agree), increasing patient payment responsibility, and the complexities of the value-based payment model.

The 63% of practices that find their patients more frequently paying for services directly state that as many as 95% of patients are predicted to NOT fully pay o? medical bill balances in 2020.¹ Without e?ective tools and processes for patient collections and patient communications, this trend can present a risk to the independent practice. Yet with that said, patient engagement software is still growing in its adoption – 52% of respondents are currently using patient engagement software. While this is a low adoption rate for such a critical workflow, the fact that 20% of respondents plan to acquire patient engagement technology over the next 12 months shows movement toward improving the patient experience.

Newer technology solutions such as mobile apps and telemedicine, which enable better patient access, are also on the rise. Interestingly, practices expecting to grow this year are statistically more likely to add a mobile solution in the coming year. Regarding telemedicine, CMS has recently expanded their reimbursement to providers utilizing telemedicine services and the uptake of this technology continues to grow. Usage is currently at 22% among healthcare providers. In another study, patients were found to have a strong affinity for progressive practices, with 79% of respondents stating they were more likely to select a provider that allows them to conduct healthcare interactions online or on a mobile device.² Seventy-eight percent of participants want better access to mHealth and telehealth tools.³

The dependence of independent practices on technology to improve efficiency and profitability will only increase. Equally important is making sure that technology platforms are designed to accommodate the needs and limitations of this critical segment of the healthcare arena.

¹ Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full, TransUnion Healthcare, June 26, 2017

² Engaging patients to decrease costs and improve outcomes, Medical Economics, Jan 2015 https://www.medicaleconomics.com/medical-economics/news/engaging-patients-decrease-costs-and-improve-outcomes

³ Patients Want More Access to Telehealth, mHealth Treatment, Patient Engagement HIT, Feb 2017