Be prepared for the unexpected costs associated with EHR adoption

Late last month, the Centers for Medicare and Medicaid Services began issuing Medicare electronic health record (EHR) incentive payments to eligible providers. For physicians who were able to attest their compliance with the Meaningful Use requirements, that could mean an $18,000 annual incentive payment--which sounds like a nice pile of money to get started on EHR adoption.

However, at a House Small Business subcommittee on healthcare and technology hearing last week, panel members were told that many practices are finding the experiences of installing EHRs more work than they initially had bargained for. In some instances, the incentive payments were overshadowed by high up-front--and sometime unanticipated--costs.

Take Olympia, Wash.-based Sasha Kramer, MD, a board-certified dermatologist with a solo practice. She currently employs two and a half employees--seeing an average of 100 to 125 patients per week. Two years ago, she told the House panel, she purchased an EHR system at a cost of more than $41,000. She received $19,964 through a grant funded by the Washington Health Information Collaborative for Health Information Technology, and using business cash reserves, paid $25,000 for the remaining amount.

There was the time factor to consider: she spent over 80 hours selecting the vendor and then another 80 hours training staff. During the EHR implementation period, she initially saw one patient per hour so that she and the office staff could learn how to use the new system. "It took about four weeks before I was able to return to my normal routine of four to six patients per hour," Kramer said.

A year and a half after implementing an original system, she was notified by her software vendor that it had been acquired by another company. This meant that the new vendor's products would not support her current network platform and essentially, it was back to square one.

Kramer now is looking at a new system that will cost in excess of $27,000, with $6,000 in annual charges, which will come out of her business cash reserves. "It's not just the financial investment. I will again have to take time away from my patients to implement and train my entire practice on this new system," she explained.

She is not alone. Kramer--noting that many other early adopters may be encountering the same problems--called for more flexibility in the Meaningful Use deadlines (an issue that the Office of the National Coordinator has been asked to review this week). She noted that she and other physicians may face financial penalties in 2015 under Meaningful Use--through no fault of their own--because of vendor changes.

In the long run, it all will come down to addressing these unexpected expenses to make sure practices remain viable as they adopt EHRs--and continue to provide care to their patients. - Janice