CASE STUDY: St. Cloud Medical Group

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1 CASE STUDY: St. Cloud Medical Group Executive summary Greenway Medical Technologies retained the services of Arcadia Solutions to analyze the value of the Greenway PrimeSUITE electronic health record (EHR) and practice management solution for one of its customers, St. Cloud Medical Group in Minnesota. The following study includes a full review of the EMR selection process, implementation, feedback from practice staff and providers, and an analysis of the total financial benefit received to date for St. Cloud s adoption of PrimeSUITE. According to Arcadia s analysis, St. Cloud s investment has yielded a significant return for the enterprise. An increase in average Evaluation and Management (E&M) coding level, reduced staffing needs, and Medicare incentive funds for the attestation of providers to the meaningful use of a certified EHR all contributed to an annual financial benefit of nearly $2 million for the enterprise. Overview: St. Cloud Medical Group St. Cloud Medical Group is a multi-specialty practice that serves four locations in the central Minnesota area two in the city of St. Cloud itself, and one each in the nearby towns of Cold Spring and Clearwater. The enterprise was founded in 1928 and has since grown to 59 billable providers (44 MDs, 12 PAs and 3 CNPs) and 75 nurses. St. Cloud Medical offers both primary and specialized care and provides care through more than 30,000 annual patient visits, offering the following seven specialties: Family Medicine, OB/GYN, Surgery, Pediatrics, Occupational Medicine, Physical Medicine and Rehabilitation, and Express (urgent) Care. The practice began implementation of Greenway PrimeSUITE as its fully integrated EHR/practice management solution in Currently, every specialty documents in PrimeSUITE except for Occupational Health, which encompasses two providers in St. Cloud s South Campus location. The remainder of St. Cloud s providers have fully converted to PrimeSUITE. CASE STUDY: St. Cloud Medical Group April 2013 Page 1 of 10

2 From an enterprise perspective, we ve had some major wins Continuity [across our locations] has been a huge benefit for our quality of care. Kristen Flygare Director of Operations Choosing an EHR Goals for adoption There are of course many reasons for healthcare providers to switch from a paper-driven workflow to electronic health records. Practices that implement an EHR experience improved data capture and access, which in turn promotes greater care continuity, quality, safety and satisfaction. Switching to an EHR also enables the practice to transform former chart-storage areas to revenue-generating treatment or testing space that can handle more patients and/or additional billable providers. Additionally, billing efficiency increases sharply for practices that opt for an electronic solution. In fact, the Center for Information Technology estimated that providers may increase revenues by more than $10 per outpatient visit through fewer rejected claims due to the increased sophistication of CPT and ICD-9 coding provided by electronic health records such as Greenway PrimeSUITE. 1 Yet another impetus for healthcare providers to implement an EHR is the incentive payment program offered through the Centers for Medicare & Medicaid Services (CMS). Practices that achieve meaningful use of a certified EHR as defined by CMS standards can qualify for these incentive payments to help them in their transition to an EHR. 2 Evaluation process: Why Greenway Under the direction of an internal steering committee, St. Cloud Medical carefully sifted through a number of EHR options in search of a fully integrated solution that suited their needs as a multi-specialty, multilocation ambulatory practice. After months of careful deliberation, St. Cloud Medical s team selected Greenway and its PrimeSUITE solution as the practice s new integrated clinical and practice management system. We interviewed several members of St. Cloud Medical s staff and administration about the decision to implement Greenway PrimeSUITE, including Elaina R. Lee, MD, and Kimberly L. Tjaden, MD, who were part of the steering committee. The team stated that they selected Greenway for the following reasons: 1 CITL. The Value of Computerized Order Entry in Ambulatory Settings. 2 For more information on meaningful use, visit the CMS website. CASE STUDY: St. Cloud Medical Group April 2013 Page 2 of 10

3 Straightforward, easy system to learn Clean, easily navigable program Progress note doesn t look like a data dump as in other systems Excellent reporting capabilities Able to generate employee meaningful use audits through PrimeSUITE s Meaningful Use Dashboard Offered best customer service and responsiveness Competitive pricing Implementing Greenway PrimeSUITE Training Greenway developed a system of best-practice standards for training providers and staff prior to go-live. For providers, Greenway recommends a two-part chart training that spans eight hours in total. Each half of the training can be completed on separate days to accommodate busy provider schedules. We ve achieved a higher level of patient care and satisfaction thanks to information being more readily available with Greenway PrimeSUITE. Melissa Stang Reception Supervisor Though it is recommended that all staff attend universal desktop training, additional practice management training is specialized and varies by role. Practice administrators decide the appropriate training sessions for their staff. Dr. Tjaden, a Family Medicine specialist, had this to say about Greenway s pre-go-live training: The Greenway training staff was excellent. Sometimes we wanted to do more than they thought was reasonable, and they reigned us in. They were easy to converse with and able to bring the information down to our level. Go-Live To accompany St. Cloud Medical s large staff (which includes 44 front desk clerks), Greenway PrimeSUITE was rolled out incrementally over the course of nine months. The practice management solution went live in July 2010, while patient charts remained on paper. During the practice management go-live, 12 members of Greenway s go-live support team provided on-site assistance to ensure that front office staff understood the registration and disposition workflows. In October 2010, clinical go-live began for some providers. A rotation of two Greenway resources remained on-site during a series of go-lives that fully transitioned St. Cloud Medical to electronic charts. The go-live period was completed in April CASE STUDY: St. Cloud Medical Group April 2013 Page 3 of 10

4 This go-live plan, while aggressive, was described as solid and realistic by members of the St. Cloud implementation team. Reception Supervisor Melissa Stang, who was a receptionist during the 2010 go-live, had this to say about Greenway s training and support: Greenway definitely had a solid training plan on their end. They did everything possible to get us as comfortable as we could be for that first day of go-live. In our interviews with staff members who were present for the go-live period, one common theme that emerged was praise for Greenway s support team. Greenway s resources were described as solid, patient and knowledgeable by interviewees. Kristen Flygare, St. Cloud Medical s Director of Operations, complimented the resource continuity provided by Greenway: We had pretty much the same resources throughout the whole process, so we didn t have to reorient new resources each week. We had consistent people who knew what services our medical group offered and could pick up where they left off. That was very nice; not every EHR organization provides that benefit. For additional comments from St. Cloud staff, see the Staff Feedback and Experience section. Results Greenway PrimeSUITE has enabled St. Cloud Medical to make significant accomplishments that benefit the enterprise both in terms of clinical care and financial bottom-line. Here are just some of the ways in which the automation has benefited their enterprise: Transcription services reduced from 12 FTEs to one Medical Records staff reduced by five FTEs The organization retired physical patient charts and moved them offsite; planning to use the additional space to house new providers eprescribing recently went live for St. Cloud to very positive provider feedback Express Care is now able to access charts; previously, they had to work off a worksheet that was later attached to the patient chart Paper/supply expenses are significantly reduced with new paperless workflow Financial benefits One quantifiable benefit of St. Cloud Medical s PrimeSUITE adoption has been an overall increase in billing revenue. Many providers actually under-bill their Evaluation and Management (E&M) codes out of concern that their claims will be rejected. PrimeSUITE addresses that problem by analyzing the data in the patient s note and suggesting a billing code, which is often higher than providers expect. St. Cloud is a classic example of an enterprise that was, on the whole, under-coding. Even adjusting for a reduced patient load as providers ramp up on the new system, the increase has been significant. CASE STUDY: St. Cloud Medical Group April 2013 Page 4 of 10

5 A 17% increase in average billing level, coupled with a reduction in transcription and medical records staffing needs, combine for significant financial benefits for St. Cloud Medical nearly $2 million a year. In 2012, St. Cloud Medical Group saw 8.6% fewer patients than it did in 2009 (the last full year prior to go-live). In spite of the reduced patient load, revenue from billed E&M codes actually increased by 5.3%. 3 In other words, St. Cloud earned more E&M revenue while seeing fewer patients, due to superior coding documentation and support in PrimeSUITE. The aggregate revenue increase, unsurprisingly, comes as a result of a significant increase in billing per encounter. Using 2013 Medicare rates as a reference, St. Cloud was able to bill an average of $89.14 per patient appointment in 2012 up from $75.92 in A large portion of this increase stems from the increase in established patient Level 4 codes (99214). In 2009, just 18% of all established patient codes were billed at a or higher, with the vast majority (73%) of codes billed at a Level 3 (99213). In 2012, however, 57% of all established patient codes were billed at a Level 4 or higher. In monetary terms, St. Cloud Medical Group made $1,056,031 more in Level 4 and 5 codes in 2012 than in E&M fee rates drawn from Medicare Physician Fee Schedule for Minnesota. CASE STUDY: St. Cloud Medical Group April 2013 Page 5 of 10

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7 If the organization were to maintain its average revenue per patient appointment while ramping up patient loads to 2009 levels, it would see an impressive 17.4% increase over its 2009 E&M revenue, equivalent to $454,822 by Medicare fee schedule rates for Minnesota. This increase in average billing level, coupled with a reduction in transcription and medical records staffing needs, represents a significant financial benefit for St. Cloud Medical. Further, the enterprise attested 36 providers for Medicare meaningful use incentives in 2011, equivalent to an incentive yield of $648,000. If St. Cloud Medical keeps its attestation rates constant over the next two stages of meaningful use, it is anticipated that the organization will see an additional return of $720,000 during that time. CASE STUDY: St. Cloud Medical Group April 2013 Page 7 of 10

8 Staff feedback and experience Feedback from St. Cloud Medical s staff was uniformly positive every interviewee maintained that, given the option, they would choose Greenway as their vendor again. Following are some of the comments from their providers and administrative staff: I was part of the original steering committee, and we did a very thorough job of conducting due diligence in our [EHR] selection process and looking at all of our options. We liked the way the PrimeSUITE application looked; notes don t look like a data dump like you see in other systems. We felt Greenway would provide the best customer service and responsiveness; they seemed like a company that was more interested in what individual users thought, while other companies treated us like a grain of sand on their big beach. I believe Greenway was the best choice at the time, and I think it still is the best choice for us I would choose Greenway again today. Dr. Elaina Lee, Pediatrician When our steering committee asked for my opinion during the vendor selection process, we saw several different vendors and I thought and still think that Greenway was the best choice for us. It s just a really clean, easy-to-use program. Hover over links, and they ll tell you where they re going, screens aren t crowded or busy, and it s just very user-friendly. One of my favorite features in the PrimeSUITE application is the Meaningful Use Dashboard, where you pull up each provider and see how well they re doing [at fulfilling requirements for MU incentives]. It s great because it s so easy to use and you just see, Oh, you re only at 45% fulfillment of this metric, what s going on here? Abby Zenzen, LPN, Greenway specialist and super-user I like that we re able to run reports and employee audits to make sure each member of our team is hitting their requirements. I think we ve achieved a higher level of patient care and satisfaction thanks to information being more readily available with Greenway PrimeSUITE. Melissa Stang, Reception Supervisor From an enterprise perspective, we ve had some major wins. The biggest one was probably for our Express Care. They didn t use charts prior to Greenway; a patient would walk in at 8 p.m. and they treated the patient for whatever they walked in for without having any documentation on the patient s past medical history. CASE STUDY: St. Cloud Medical Group April 2013 Page 8 of 10

9 Now they don t need a paper chart they work in Greenway PrimeSUITE like the rest of the providers. So they know if that patient was in a month ago, if they need a tetanus shot, what antibiotics they like and don t like. It has made a dramatic difference for that portion of our business. The other big win is that with our four locations, we no longer have to carry our charts between them. That continuity has been a huge benefit for our quality of care. Kristen Flygare, Director of Operations I believe the system is as good as any out there. I think our implementation plan was great and we got everyone up to par in a good timeframe. We just went live with eprescribing and that has been great for the providers a real time saver! Summary Dr. Kim Tjaden, Family Medicine Judging by the feedback from St. Cloud Medical Group s providers and management, they are pleased with the decision to select Greenway PrimeSUITE as their EHR. The enterprise has benefited significantly with the presence of PrimeSUITE and St. Cloud Medical s new, state-of-the-art digitized workflow. The organization has been able to significantly reduce transcription and medical records services, and has begun retiring physical charts in anticipation of hiring new providers who can utilize the additional space. Providers have also been able to bill for visits at a higher level as a result of PrimeSUITE s documentation and coding capabilities. Greenway s training, implementation and support received high reviews from interviewees, and their customer service has also received praise from St. Cloud Medical. Arcadia Solutions concludes that the system deployment of Greenway PrimeSUITE solution to the St. Cloud Medical Group was successful. Greenway effectively managed a large-scale software rollout to a multi-specialty, multi-location enterprise, and the results have been very positive for the organization. Weighted E&M Revenue Increase Decreased Transcription Services Reduced M/R Services Meaningful Use Incentives ANNUAL Financial Benefits for St. Cloud Medical s Adoption of Greenway PrimeSUITE $454,822 $600,000 $225,000 $648,000 $1,927,822 CASE STUDY: St. Cloud Medical Group April 2013 Page 9 of 10

10 About Arcadia Solutions Founded in 2002, Arcadia Solutions has emerged over the past decade as an innovative and nationally recognized leader in the healthcare consulting industry. With a focus on both healthcare provider and payer solutions, Arcadia has a unique cross-industry perspective on health IT and healthcare transformation. Arcadia works with its clients to design, develop and implement business strategies and health IT solutions that improve the quality of care, reduce costs, and advance the industry in this new era of reform. Throughout its engagements, Arcadia consultants and industry experts maintain a focus on the data-driven results that help clients achieve the vision of efficient, high-performing healthcare. About Greenway and PrimeSUITE Greenway Medical Technologies delivers innovative software and business service solutions designed to enable healthcare providers to operate at their peak efficiency and deliver coordinated, effective care. The Greenway PrimeSUITE platform includes a certified and fully integrated electronic health record, practice management and interoperability solution, along with revenue cycle management, clinical research services and other value-added solutions. Thousands of care providers across primary care and more than 30 specialties and sub-specialties use cloud-based, remotehosted or on-premise Greenway solutions in enterprises, physician practices, clinics and other care venues nationwide. Greenway, the Greenway logo and PrimeSUITE are registered trademarks and the phrase smarter solutions for smarter healthcare is a trademark of Greenways, Inc. Other marks are the property of their respective owners. CASE STUDY: St. Cloud Medical Group April 2013 Page 10 of 10