Reshaping the healthcare delivery network.

Challenges that most healthcare organizations face today include: falling bond ratings and the scarcity of capital resources; delivery of consistently high-quality care despite budget cuts; changes in payer mix due to unemployed patients, the uninsured, early retirees, and an increase in patients postponing care; increasing competition from nontraditional competitors; the need to prepare for healthcare reform without knowing what form it will take.

The Practice Impact of Electronic Health Record System Implementation Within a Large Multispecialty Ophthalmic Practice.

IMPORTANCE: Given the lack of previous reports examining the impact of electronic health record (EHR) system migration in ophthalmology, a study evaluating the practice and economic effect of implementing an EHR into an ophthalmic practice is warranted. OBJECTIVE: To examine the clinical and economic impact of EHR system implementation into a large multispecialty ophthalmic practice. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case-control study was conducted comparing the pre-EHR and post-EHR time periods at the Cole Eye Institute, Cleveland, Ohio. Eight months were spent prior to implementation personalizing and customizing the system to enable advanced charting functions (July 1, 2011, to March 1, 2012). The periods were compared regarding total revenue, total visit volume, revenue per visit, coding volumes, and the number of diagnostic tests and procedures performed. In addition, the total costs of the EHR implementation and the expected return in EHR incentive payments were evaluated. Data analysis was performed from April 1, 2011, through April 5, 2013. MAIN OUTCOMES AND MEASURES: Net revenue, patient volume, revenue to volume ratio, diagnostic and procedure volume, capital and implementation costs, EHR incentive payments received, and coding volumes (including eye and evaluation and management [E/M] codes). RESULTS: A total of 28,161 patient encounters were identified (13,969 in the pre-EHR period and 14,191 in the post-EHR period). No significant change was identified with total net fiscal revenue between the periods (median, -$44,372 per month; 25th to 75th interquartile range [IQR], -$103,850 to $83,126; P = .42). No significant change in patient volume (median, +217.0; IQR, -511.5 to 812.0; P = .57) or revenue per visit volume (median, -$7; IQR, -$9 to -$1; P = .20) was identified. The volume of diagnostic tests and procedures billed was unchanged after conversion (median, +93; IQR, -20 to 235; P = .13). Overall use of eye codes declined (-15.7%) and use of E/M codes increased (14.7%) following EHR implementation (P < .001). The composition of eye codes showed a 2% change toward comprehensive codes over intermediate codes after implementation, but only the composition of new E/M codes increased (42.6%) (P < .001 for both values). Total capital costs amounted to $1,571,864, and personnel costs amounted to $1,514,334. A cumulative amount of $983,103 from meaningful use attestation is expected by 2016. CONCLUSIONS AND RELEVANCE: The analyses conducted in this study did not identify significant differences in revenue or productivity following EHR conversion in this clinical setting. The EHR incentive payments did not offset costs of implementation.

Follow-up: orthognathic surgery. Is there a future? A national survey.

BACKGROUND: The authors recently documented a significant decrease in orthognathic surgical cases performed by both plastic and oral surgeons in Ohio over a recent 5-year period. The main reason noted was related to third-party reimbursement. This is a potentially serious issue that may affect the quality of health care for patients with dentofacial deformities. Therefore, an expanded survey was conducted to determine whether this was indicative of a national trend. METHODS: A three-page questionnaire was sent nationally to plastic surgeons and oral surgeons who were members of the American Society of Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons, respectively. Surveys requested information regarding changes in the number of orthognathic operations over a 5-year period (1999-2003) and reasons for these changes. RESULTS: Of the 3273 surveys sent, 883 were returned, representing an overall response rate of 27 percent. Of the 883 returned, 771 (87.3 percent) were completed by oral surgeons and 112 (12.7 percent) were completed by plastic surgeons. The majority surveyed (70.0 percent) noted a decrease in the number of orthognathic procedures performed over a 5-year period, and 443 (77.3 percent) stated that the decrease was attributable to problems with insurance. Professional reimbursement per hour was calculated based on data collected from consecutive operations performed at the authors' institution. These data demonstrated that reimbursement per hour is significantly lower when orthognathic surgery procedures were compared with other standard plastic surgery operations. CONCLUSIONS: Orthognathic surgery may rapidly be becoming a cosmetic procedure. This has the potential of creating a two-tier system whereby only those who can afford it will undergo orthognathic correction.