Cardiovascular Business News asked Sean Benson, co-founder and vice president of consulting with ProVation Medical, of Wolters Kluwer Health, to discuss the specific EHR needs of ambulatory surgery centers (ASCs) that specialize in cardiology.
He said that ASCs have traditionally lagged in their EHR adoption because of a general dissatisfaction with the abilities of various EHRs to address specialty-specific functional needs. However, more vendors are offering cardiology-specific documentation and coding capabilities that could help advance EHR adoption rates among ASCs.
Cardiovascular Business News: What is the difference between ASCs and other ambulatory-care providers in terms of their EHR needs?
Sean Benson: The reality is that while ASCs and other ambulatory care providers share a need for an EHR with features to manage documentation, patient consent, patient demographics and the exchange of discharge data with referring physicians, that is where their similarities end. Unlike their physician practice counterparts, ASCs do not issue orders, regularly diagnose or research medical evidence to support care decisions. Nor are ASCs generating clinical documentation beyond procedure notes.
In the past, it's been difficult for ASCs to find the EHR for their unique needs. Times have changed, however. Today, increased competition for ASC market share means more vendors are offering systems and applications tailored to their needs. Subscription-based services also are growing in popularity, meaning ASCs can go paperless without making a sizable upfront capital investment.
CVB: What are the benefits of going paperless?
Benson: Operating in a paperless environment can increase regulatory compliance and patient volume. It also can speed the revenue cycle and deliver greater profitability. In fact, when managed correctly, going paperless can deliver ROI in under two years and generate ongoing annual savings of $10,000 and higher per provider.
CVB: Where can providers expect to see savings?
Benson: Typcally, the greatest savings are derived from the elimination of costs associated with the management of paper charts. In fact, Grieger et al, in a 2007 study in the Journal of the American College of Surgery, found that 63 percent of the savings realized from operating in a paperless environment were the result of a reduction in chart pulls alone. Other identified savings included the elimination of costs for creating new patient charts, reduction in time spent filing and the reduction or elimination of transcription costs.
Automation also enables procedures to be billed at the highest appropriate reimbursement levels. Because documentation is complete, it helps mitigate the risk of lost revenues due to paybacks and speed the revenue cycle by eliminating delays that occur with missing or incomplete documentation.
CVB: What are some of the unique needs of ASCs that offer cardiology procedures?
Benson: First and foremost is cardiology-specific procedure documentation and coding, which is highly complex.
CVB: Can you give examples of complex cardiology-specific documentation issues?
Benson: They include:
- A heart catheterization can entail five or more individually codeable components, which can create coding gaps.
- A physician performing dual catheterizations can easily omit the right cath from dictation.
- Likewise, a physician might easily fail to note left ventriculography or the indication for renal arteriography during left cardiac catheterization.
- A cardiologist inserting a stent and performing an angioplasty may fail to note that the procedures were done in separate arteries.
- A cardiologist may fail to note a congenital finding.
CVB: Do you think the government's stimulus package to adopt EHRs will encourage more ASCs to adopt EHRs?
Benson: The monies from the ARRA will spur adoption, as well as the increased competition and more flexible options available. And for ASCs that offer cardiology procedures, the combination of ASC-specific EHRs and specialty-specific documentation and coding is a win-win situation.