INVESTING IN OCCUPATIONAL MEDICINE CLINIC MANAGEMENT SOFTWARE How to project your Return on Investment (ROI), The SYSTOC Model October 2013 UL and the UL logo are trademarks of UL LLC 2013
INVESTING IN OCCUPATIONAL MEDICINE CLINIC MANAGEMENT SOFTWARE How to project your Return on Investment (ROI) - The SYSTOC Model Background Occupational medicine clinics are constantly challenged to manage their expenses. They frequently rely on efforts to optimize workflows, minimize time and dollars spent on processing paperwork, and control employee turnover. They also invest in new equipment, software and alternative staffing models. Capital investments in hardware and software tend to receive the most scrutiny because they are not perceived as generating incremental revenue. Consequently, the return on such investments is difficult to compute. The model below projects cost savings for an average-size occupational health clinic using reasonable assumptions that involve typical workflow, efficiency targets and staffing costs. Assumptions Workflow considerations There is significant diversity in the types of encounters that occur daily in an occupational medicine clinic. Some injuries and illnesses require more time and attention than others. Some encounters create workflow interruptions, such as the need to perform an X-ray or obtain lab results. The model presented here features a typical first injury treatment encounter as a reasonable assumption for a considered workflow component. If your clinic experiences higher than average acuity, greater savings would result. Efficiency targets This model uses a conservative time-savings target of 20% throughout the workflow process. Broader time efficiencies result in greater savings. Staffing costs The model reflects reasonable costs based on national averages for staff including receptionists, program directors, clinical nurses (R.N.), case management nurses (R.N.) and physicians (M.D.), as used in many clinics nationally. When staffing costs are higher, so are savings projections. Summary: Using the above assumptions, the model suggests mid-sized clinics can save an average of $74,256 a year within 6 months of implementing SYSTOC to help manage their clinic workflow, patient charting and billing operations. The SYSTOC Savings Value Chain: Registration $4,680 + Treatment $50,856 + Discharge $1,560 + Post-visit $17,160 = Total Savings $74,256 2 UL and the UL logo are trademarks of UL LLC 2013
The model takes into consideration the following activities: REGISTRATION TREATMENT DISCHARGE WORKFLOW POST-VISIT - Greet patient - Check patient ID - Collect and input patient data, reason for visit (or have patient enter using tablet PC or kiosk) - Consent/privacy forms - Verify employer and payer - Triage patient - Check vital signs - Get information on complaint - Obtain history - Post-accident drug screen (if required) - Exam by physician or mid-level practitioner - X-ray and other diagnostics - Explain recommended treatment plan - Prescribe and dispense medications - Complete all relevant documentation and coding - Schedule re-examination - Check with patient to ensure directions are understood - Obtain patient signature - Print out discharge paper - Supply/collect patient satisfaction survey - Call, fax and/or email employer with patient status and work restrictions - Provider dictation/chart notes - Nurse case management - Manage referrals and track downstream revenue (diagnostics, PT, specialists, sleep study, additional case management, primary care follow-up, etc.) - Report drug screen results - Patient welfare check - Process paperwork for billing - Contact insurer/tpa if necessary -Generate and send bills - Collections Details supporting the SYSTOC Savings Equation 1 INITIAL WORK INJURY ENCOUNTER-99203 2 PRE-SYSTOC WITH SYSTOC ESTIMATE 20% INCREASED EFFICIENCY 3,4 REGISTRATION Clerical or MA $15/hour 5 $3.75/encounter = $23,400/year SAVINGS = $4,680/year 15 minutes/encounter 6 TREATMENT Physician/mid-level $95/hour 20 minutes/encounter Nurse $35/hour 15 min./encounter DISCHARGE Clerical $15/hour 10 minutes/encounter POST-VISIT Nurse case manager $40/hour 15 minutes/encounter Clerical $15/hour 15 minutes/encounter $32/encounter = $199,680/year $8.75/encounter =$54,600=/year $2.50/encounter = $7,800/year $10/encounter = $62,400/year $3.75/encounter = $23,400/year SAVINGS = $39,936/year SAVINGS = $10,920/year SAVINGS = $1,560/year SAVINGS = $12,480/year SAVINGS = $4,680/year TOTAL ANNUAL SAVINGS: $74,256 7, 8 3 UL and the UL logo are trademarks of UL LLC 2013
Footnotes: 1. Assume 3 treatment encounters per hour = 24 injury treatment encounters/eight-hour day = 120/week = 6,240/year. 2. 99203 (Level 3) is the most frequently used CPT code for new office visits. Required documentation includes detailed history and exam and low complexity medical decision-making OR 30 minutes physician time. (Source: American Medical Association and www. emuniversity.com) 3. 20% of 60 minutes = 12 minutes/hour = 96 minutes/day. 4. Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals ; Commonwealth Fund, July 2012. Findings: Electronic health record performs numerous tasks previously done by staff, reducing the number of employees or redirecting them to other responsibilities. For example, less staff time needed for chart review, abstracting and note transcription (one hospital calculated monthly transcription costs after EHR adoption declined 75% and copy paper orders declined 27%), billing and patient scheduling. 5. National Association of Occupational Health Professionals (www.naohp.com); American College of Occupational and Environmental Medicine (www.acoem.org); American Nurses Association (www.ana.org); www.salary.com. 6. National Association of Occupational Health Professionals productivity standards. 7. Assumes payroll of $371,280 with 30% overhead and $530,400 revenue. 8. Does not include record storage and transcription costs. Estimated salaries for some key positions based on national data (sources cited in footnotes): Clerical/receptionist... $30,000/year $14/hour Medical assistant... $31,500/year $15/hour Staff nurse... $70,000/year $35/hour Nurse practitioner... $92,000/year $45/hour Physician (M.D.)...$196,000/year $95/hour Clinic manager... $80,000/year $40/hour Additional references used for this analysis: Unraveling the IT Productivity Paradox Lessons for Health Care; S Jones, et al.; newly IT-enabled processes that support teamwork, care coordination and innovative approaches such as interactive patient portals have the potential to yield greater convenience, access and quality for patients and physicians at a lower cost the definition of greater productivity; N Engl J Med, 366:2243-2245, June 14, 2012; www.nejm.org/doi/full/10.1056/ NEJMp1204980. Medical Practice Efficiencies and Cost Savings; savings are primarily attributed to automating time-consuming paper-driven and labor-intensive tasks including transcription, chart pull, storage and re-filing costs, coding and documentation, patient data and error-prevention alerts, disease management and patient education; www.healthit. gov/providers-professionals/medical-practice-efficiencies-cost-savings. National perceptions of EHR adoption: barriers, impacts and federal policies; presented at National Conference on Health Statistics; J Patel, et al.; in this study, EHR adopters experienced overall more efficient practice, clinical benefits, better patient care, enhanced data confidentiality and availability of records at point of care; Centers for Disease Control and Prevention; www.cdc.gov/nchs/ppt/nchs2012/ SS-03_JAMOOM.pdf. 4 UL and the UL logo are trademarks of UL LLC 2013
From promise to reality: achieving the value of an EHR; V King, et al.; implementing an electronic health record can transform the clinical process and patient care, among other positive outcomes. Hospitals can help physicians adopt the new technology by showing how it can enhance patient care and improve outcomes. An EHR implementation project should be a multidisciplinary coordinated effort; Healthcare Financial Management, 65(2), 51-56, 2011. The business case for implementing electronic health records in primary care settings in the United States; S Kumar and K Bauer; there are many things a health care service provider can do to influence revenue, and one of the most important is implementation of electronic health records. EHR systems hold substantial promise for improving the quality of health care in the United States while decreasing costs; Journal of Revenue and Pricing Management, 10(2), 119-131, 2011. Do Electronic Medical Records Increase Revenue? (author not cited); the key ingredient for success lies in the willingness of the practice to critically examine existing workflow and make recommended adjustments to optimize workflow efficiency. If these efforts can be supplemented with other revenue acceleration and denial management techniques, the practice can see significant improvements in every revenue cycle key performance indicator (KPI) ; 2009; www.articlesbase.com/medicine-articles/do-electronic-medical-records-increase-revenues-768294.html. A cost-benefit analysis of electronic medical records in primary care; S Wang, et al.; estimated net benefit from using an electronic medical record for a 5-year period was $86,400 per provider; Am J Med. 114:397 403; 2003 by Excerpta Medica Inc. Example of Savings SYSTOC Generates for Occupational Medicine Clinics: 1. During patient re-check, all information acquired during the initial visit is easily accessible in the electronic health record, eliminating the need to prepare, label, store/archive, search for, pull and update paper charts. 2. Accurate, consistent employer and medical records improves customer satisfaction, supports care quality and expedites coding, billing and reimbursement. 3. Anyone with access to the software via isystoc can view the medical record in real time. This helps eliminate the lost-file shuffle, improves care quality and medical record security (no paper records to get lost or go home with the provider), and supports early, safe post-injury return to work. 4. On paper, program directors have to prepare spreadsheets and run multiple reports to demonstrate contributions and downstream revenues to parent organizations. SYSTOC automates this process. Example: One SYSTOC user manually collected information from seven different family practices; with software the process takes minutes rather than hours to accomplish. 5. With enactment of the new Medical Examiner Registry, the Department of Transportation (DOT) and Federal Motor Carrier Safety Administration are paying much closer attention to the quality of DOT exams, which now must be performed by certified medical examiners. With SYSTOC, qualified examiners have easy access to the patient s history, improving the quality of exams, satisfying DOT requirements and giving provider s a means of differentiating themselves from competitors. http://nrcme.fmcsa.dot.gov/ 5 UL and the UL logo are trademarks of UL LLC 2013
6. Reduces coding errors/misunderstandings. For example, for every code one level below what it should have been, one program was leaving $50-80 dollars on the table before taking corrective action. 7. SYSTOC helps expedites documentation using templates and custom reports, and it streamlines chart review, lab, radiology and drug screen results reporting. This article is for general information purposes only and is not intended to convey legal or other professional advice. 6 UL and the UL logo are trademarks of UL LLC 2013