The Hybrid, the Stimulus & You

Though the end product is 100% digital, the features on one practice's hybrid EMR may differ greatly from another practice's.

"When the stimulus came out, a lot of people asked if we would be qualified. In all of the conversations I've had, we take the doctor's revenue and say, look, the incentive money is half a percent or one percent of your revenue, is it worth it from a productivity standpoint? Is it going to slow you down by more than one percent? And they get it," says Evan Steele, chief executive officer of SRSsoft. "If somehow HHS creates a standard for systems that will help physicians experience productivity gains, then we will build that," he says.

Byron Tabbut, MD, president of the 30-provider Wheaton (IL) Eye Clinic "took the plunge" and began using a hybrid EMR two years ago. He says the cost savings have been so great that the federal incentives (and eventual penalties) may not be enough to get him to switch to a government-approved EMR.

"We did an intensive ROI analysis before we jumped into these waters and it's been pretty accurate until now. We expected it to pay for itself in two to three years, and we're right on track for that," says Tabbut. The practice has been able to fold its medical record department into another department, reducing the number of FTEs from nine to three.

"Honestly, the stimulus leaves me pretty cold. They are trying to set protocols and standards for people to meet, but they are not considering usability as part of those standards. It comes down to workflow for me. If I'm having physicians and myself bogged down with an EMR product that's very costly, not only financially, but in terms of time, we're not too excited about that," says Tabbut.

Unfortunately for Tabbut, and others like him who prefer the hybrid model, the industry does not look to be trending in that direction, says Sarah Corley, MD, chief medical officer at NexGen Healthcare and a practicing physician.

"If you look at the stimulus and CMS incentives, you'll see that they are emphasizing meaningful use and reporting quality measures, and you really cannot do that without using an electronic health record," she says. Corley says the main impediment facing physicians who want to use the hybrid model will be their inability to extract structured data points from the system. "These requirements are about a lot more than just being able to write prescriptions. They require medication history and other functionality," she says.

Corley says that while physicians who decide to use dictation or scan-based EMRs, like a hybrid, can get the 2% incentives for e-prescribing and PQRI, they will have to decide if they also want to qualify for the approximately $44,000 per physician in stimulus money. "That is enough money to cover at least the software portion of most EMRs. I think they'll have to decide whether it's worth the extra effort," she says.

Both Tabbut and Benoit say they may have to reevaluate their current systems once the government settles on the final rules for the stimulus incentive money and the penalties. Tabbut adds, however, that a 2% dock in reimbursement payments still may not be enough to give up the hybrid.

"Maybe if they cut payments by 25%. Because, expenses aside, there is no way that we could type, interact with patients and computers simultaneously, and still maintain the patient volume that we need to stay in business," says Tabbut.

—Kathryn Mackenzie