EHR Implementation Reduces Practice Productivity, Increases Reimbursement

Although practices saw a decrease in patient visits during the 2 years after electronic health record (EHR) implementation, they reported an increase in revenue during that same time period, according to a study in the Journal of the American Medical Informatics Association.

Researchers from Drexel University tracked the practice productivity and reimbursement of 30 ambulatory practices for 2 years after EHR implementation and compared the findings with pre-implementation baselines.

“A major reason for the slow uptake of EHRs—and delayed access to the benefits of EHR—has been financial concerns about the impact of EHR implementation on practice productivity and reimbursements,” the authors wrote. “The bottom line news is good: practice revenues increased during EHR implementation despite persistent productivity losses.”

Overall, EHR implementation reduced practice productivity by 18 patients per physician per quarter, for approximately 108 patients lost per quarter. However, the authors point out that not all practices reported productivity losses. Some practices recovered and their productivity returned to baseline, but 6 practices were still having productivity losses, which dragged down the average.

As for reimbursement, the researchers found that reimbursement per physician per quarter increased in the first year after EHR implementation and then flattened. The increase in reimbursement was not due to charging more per visit or receiving more reimbursement for the same level of charges. Instead, practices were billing more ancillary procedure codes.

“EHR implementation had a significant effect on the total number of ancillary procedures compared to the pre-implementation baseline,” the authors wrote. “Practices were billing an additional 94 procedures per quarter after EHR implementation.”

Although the practices in the study were seeing fewer patients, which could be seen as a negative, the investigators suggest that because the practices experienced an increase in reimbursement, it is possible they were taking better care of patients. However, they admit that there is no concrete data to this affect, although it would be consistent with other studies that found EHRs are associated with greater patient safety and higher quality measurement scores.

“While the productivity losses are consistent with field reports, they also reflect a type of efficiency—the practices are receiving more reimbursement for seeing fewer patients,” the authors wrote.