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The Fiscal Cliff of Primary Care

Posted on December 20, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Hello Health blog has a really interesting article up discussing what they called the Primary Care Fiscal Cliff. The thing I like most about the post is the data they provide on what’s happening with primary care doctors. Take for example this list of statistics:

  • Primary care practice income rose just $500 from 2008-2011
  • Operating expenses of a practice continues to rise each year
  • Primary care physicians can spend an average of 13 hours a week of uncompensated care worth over $30,000 in lost revenue a year
  • The cost of a traditional electronic health record can easily exceed $20,000 in the first year with a 5-year projected cost approaching $50,000 per physician

I’m not sure that the US government’s fiscal cliff has much relationship to the primary care doctor fiscal cliff (except for the possible Medicare cuts), but it’s very safe to say that primary care doctors are in a real financial predicament.

In the Hello Health post they suggested from their own research that practice finances and EHR are the two issues keeping primary care physicians up at night. I’m sure these findings won’t be a surprise to any primary care doctors. Plus, it’s worth noting that the finances of a primary care practice are tied to an EHR in many ways.

I have often questioned how much influence the government EHR incentive money has had on getting doctors to adopt EHR. Whenever I do, I usually get a response from a primary care doctor saying that they wouldn’t be implementing an EHR if it weren’t for the EHR incentive money and that they were depending on the EHR incentive money to help cover the new EHR expense.

In my recently started EHR benefit series I’m hoping to expand the thinking when it comes to EHR revenue implications. There are still tens of thousands of primary care doctors that need to implement an EHR or replace their existing EMR. Understanding the financial ties to EHR will help a practice ensure a more successful EHR implementation.

At the core of the question is whether EHR software is a financial benefit or a financial loss. The cop out answer to that question is that it depends on how you implement the EHR and which EHR you implement. I wish someone would take the time to study the top 20 EHR companies and evaluate how practices have done pre-EHR implementation and post EHR implementation. Plus, they’d need to take into account the cost of an EHR. That type of study would produce a lot of interesting EHR data.

My gut feeling having participated in numerous EHR implementations and heard from thousands of other EHR implementations is that the result is usually a wash. In most EHR implementations I don’t think there’s a net financial gain or loss. There are outliers on both sides of that spectrum, but I think for most it has some pros and some cons.

With that said, I think there are long term benefits to a practice that has an EHR. While the immediate financial returns may not come, I think that the EHR in a practice is going to be essential for many of the financial gains a practice wants to achieve in the future. The most obvious example is becoming part of an ACO. Can you really get the financial benefits of being in an ACO without an EHR? I think the answer will likely be no. You need the EHR data to obtain and report on the ACO improvements your practice achieves.

Jubilee Health Community and NoMoreClipboard Combine Forces To Help Diabetes Patients

Posted on I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

According to the U.S. Department of Health and Human Services, 20.8 million people in the United States are affected by diabetes. This amounts to around seven percent of the population, which is a fairly large percentage. Many of those with diabetes likely have no health insurance

Jubilee  Health Community and NoMoreClipboard PHR are working together to help uninsured manage diabetes, according to a recent press release. The objectives of this include:

  • Explore the use of a PHR by rural, uninsured patients with diabetes
  • Improve patient health outcomes by providing patients with a PHR to share and track daily glucose readings
  • Improve diabetes care management by sharing health information between a clinician and patients using a PHR.

28 diabetes patients of Jubilee Health Community were given a smartphone-enabled version of the NoMoreClipboard PHR about a year ago to assist them in managing their diabetes. Immediate feedback was given when glucose values were entered, and lab results were input within about 72 hours.

These patients and their use of the PHR were monitored over the course of a year, and that findings were interesting. Here are some of the stats that were listed in the press release:

  • 37.5 percent of the patients remained actively engaged and regularly entered blood glucose readings via NoMoreClipboard
  • Of those 37.5 percent of patients, 28.6 had improved A1C levels and reported feeling better
  • Those that did not actively use the PHR, 21.4 percent had no improvement or increased A1C levels
  • Of those that did not stay engaged, one of the patients whose A1C level increased suffered an MI.

Diabetes is linked to a host of other health problems, which include adult blindness, kidney failure, non-traumatic amputations, and heart disease and strokes. Obviously, there is a great need for some additional help for these patients, and this PHR seems like it could really do a lot of good. The sample size might not be the greatest to glean the most accurate results on the effectiveness of the PHR, but it does give some insight to indicate it would be worth trying. I think it’s great that some of those who used the PHR regularly did see improvement.

Jeff Donnell, president of NoMoreClipboard, offered some commentary concerning the value of electronic patient engagement:

This project reinforces the value of electronic patient engagement in helping underserved patients manage chronic conditions. Providers are often skeptical that populations including seniors and safety net patients will be able to cross the digital divide and use a PHR. Our experience with rural and urban underinsured patients make it clear that these individuals are looking for tools to help them take a more active role, and they will use those tools when they provide benefit.

In general, I feel like when people are accountable and regularly track information concerning their health (whether it be for diabetes, trying to lose weight, etc.) there will be an increase in their health and well-being. The problem is, it can be very hard to stay on track with systems like this –which is evidenced by the fact that over 60 percent of the people didn’t remain active at the end of the trial period. It raises the question, what can be done to convince people to keep track of their health on things like the NoMoreClipboard PHR?