The sweeping changes to be enacted from last year's Affordable Care Act will not fully go into effect until 2014. However, medical practices must put into place several work flow changes that cost us real money now and the investments that we have made and will make leave us asking ourselves at the end of the day: Will the change will be good for our patients and our practice?
I'm sure at some point, we have all asked ourselves this question. The sweeping changes to be enacted from last year's Affordable Care Act will not fully go into effect until 2014. However, medical practices must put into place several work flow changes that cost us real money now and the investments that we have made and will make leave us asking ourselves at the end of the day: Will the change will be good for our patients and our practice?
For my practice, the data has been collected and the reports have been finalized. The only task left for me to complete to gain meaningful use designation for 2011 is to put into place an interface with my EHR software that will allow my practice to successfully upload immunization data to our state registry. One drawback to this interface is that it is expensive. For my EHR software, the cost is $995 for the interface purchase, plus a recurring annual fee that is due not only for this year, but for the years to come.
After all is said and done, my practice is set to collect the full $18,000 from CMS this year. Adding up the costs of the additional paper required for distributing visit summaries to the patients, additional costs for wasted ink cartridges, plus the immunization interface will leave me with a net balance of just over $15,500 for this year. With the additional funds, I plan to upgrade my practice's database server which will cost me just shy of $7,000 after the hardware has been purchased plus the fee for my IT department to update the new server. This will then leave a balance of $8,000 and with that money I have planned to hire a new LPN for my office to manage the patient contacts and supervise the data collection for the years to come. Certainly having an additional LPN will improve my work flow efficiency and will also allow me to have an extra nurse to cover my other three nurses on their days off, sick days, unplanned absences, etc.
Now enter 2012. I will be all set to start the data collection process on January 1 and should have no problem with earning meaningful use designation for that calendar year. Of course I will not have the additional costs of the server upgrade and software interface purchase for the immunization registry, however I will still be left with the extra costs for paper and ink. I will have the new employee's salary to pay and the projected earnings for 2012 will not cover these costs. How do I cover my costs for the 2012 year? One of two ways will suffice. Either I take a pay cut and continue seeing patients at my current pace, or I can sacrifice vacation days and stay in the office and try to be even more productive and see more patients. I certainly cannot see more patients per day at my present pace without sacrificing quality of care.
For 2013 and the years to follow, the earnings for meaningful use designation begin to decrease further. I will still have the same costs for software updates and support, the same new nurse's salary to pay and I will still have the additional supplies to purchase. As the pending promise of inflation looms around the corner, I know that paper and ink costs are sure to increase and the overall reimbursements that my practice is projected to collect will at best stay current, if not decrease as our legislators assume the task of trimming our nation's deficit. We do not know what will happen to Medicare reimbursements as long as the flawed SGR formula remains in place either.
At the end of the day, I know that my patients will still have the same high quality of care provided. My staff will still be paid their salaries and at the same time, I will do my best to put into place routine performance bonuses plus covering raises and still providing the same level of benefits.
Those of us in private practice still have the unanswered task of deciding whether or not to participate in the planned ACO programs as well. My personal opinion regarding meaningful use and the ACA is that the changes ahead of us will not only cost us more money, but will potentially decrease our present work flow efficiency and the net effect of both will cause physician salaries to decrease. After the five-year meaningful use period has passed and after the ACA goes fully into effect, only then will we be able to adequately decide whether or not the costs to our practice has actually been worth the efforts and certainly worth the potential bonuses to be received.
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