Editor's Corner: Too soon to tell if EHRs provide good ROI

There’s been a lot of hoopla about the role of electronic health records in patient safety, Meaningful Use, data sharing and security.

But the elephant in the room is always "do EHRs provide a good return on investment? Will EHR users make more money?" It seems, based on recent research, that the answer might be yes.

First, there’s the study that EHRs are adept at increasing a provider’s charge capture. By using their EHR’s automation and enhanced coding capability, pediatric primary care physicians saw an $11.49 increase on average, per-patient collections and an $11.09 increase on average, per-patient charges, as well as an improvement in collection ratios. The researchers determined that the increases were due to more orders for ancillary services, improved documentation, forced completion of records and reduced coding errors. They concluded that the investment in EHRs would be recouped.

Then there’s the study on scribes. The small study focused on the growth in using scribes, whether the use was a positive experience and whether, as a workaround, they hinder the industry from improving EHR design and eliminating the need for scribes in the first place. But the authors also pointed out that scribes created more detailed documentation, and that they became documentation experts, enabling the physicians to increase their billings and reimbursement.

Of course, using one’s EHR to increase billings and reimbursement can represent a number of issues.

For one, the increase in reimbursement doesn’t necessarily translate to better care, as the authors of the pediatric charge capture study pointed out.  It may just be better charting that’s leading to the rise in charges. But arguably, if some of the increases are due to more ordering--say, because that electronic clinical decision alert reminded the doctor that the patient hadn’t received this year’s flu shot--that is better patient care.

It also doesn’t address the ramifications on third-party payers and patients. If providers using EHRs are now “right coding” and billing for everything to which they’re entitled, insurers and patients are paying more for the services. On the other hand, if providers weren’t being fully compensated before moving to EHRs, then insurers and patients were paying less than they were supposed to--and there’s no way for providers to make up that shortfall.

It doesn’t eliminate the fact that the data in EHRs are easily manipulated to increase billings and collections. There’s a big difference between capturing all that a provider is allowed to bill for and crossing the line into upcoding and other fraud and abuse. We just don’t know how much of the latter is occurring, or how much is intentional and how much is user error.

And being able to increase billings certainly doesn’t take away from the fact that adopting an EHR can create administrative overload, a decrease in revenues during implementation, stress, workflow issues that impact operations and burnout.

But it is heartening to see that now that we’ve had several years to assess EHRs, that in addition to some of their other benefits, they’re not necessarily a financial waste. Providers may be able to recoup their costs.

Still, recoupment is not the same as a significant return on investment. And it doesn’t factor in reimbursement as a whole, which is changing due to health reform and the requirement to use EHRs to participate in various programs and avoid monetary penalties.

We may need more time to see how much they’re really worth. - Marla (@MarlaHirsch and @FierceHealthIT)