5 Hidden Costs to Account for When Budgeting Your EHR Implementation

One of the biggest problems practice owners and provider organizations are running into when implementing EHR systems is unanticipated costs. Learn how and why to budget for this problem by reading on.

First ICD-10, Now This? Getting Your Budget Ready for EHR Implementation

As if the ICD-10 transition was not enough, many practices and providers are being strongly encouraged to also transition to electronic health records (EHRs).

Like ICD-10, EHR implementation promises strong gains in an effort to modernize medicine. For one, the government will provide incentives in the form of increased reimbursements. For another, patient care promises to become more consistent and thorough, particularly when moving from provider to provider.

Regardless of the benefits, the here-and-now of EHR implementation promises to be a challenge. Looking exclusively at the problem of hidden expenses, providers are going to have to budget extra money and time in order to cope with unexpected costs.

Because of the likelihood of this problem, the HealthIT.gov website recommends adding to your budget with emergency provisions and anticipatory funds. How much? Several years ago in 2012, the Modern Medicine Network recommended squirreling away an additional 50 percent on top of your current expected EHR implementation budget.

That number may not be precise, but providers are going to have to set aside quite a large chunk of change in order to meet budget bloat head on. Here are just some of the things they will need to account for:

EHR Software

Hardware Costs

EHR software needs something to run on, and your organization’s current systems and hardware may not be up to snuff. At the very least, you are likely to invest in a few extra workstations and an increase to your networking capabilities, including an internet bandwidth upgrade.

For many providers, a full-scale replacement of computing systems may be in order. That means new, faster computers and a full suite of networking and application hosting servers, as well as all the wiring and installation costs that come with it.

All said and done, some providers are going to be saddled with a huge bill before they can even run their Best EHR Software. Plenty of others are lucky enough to get away with minimal hardware upgrades, but you have no way of knowing which category you fall into until your software is finally running as it should be.

Estimated added baseline cost: $5,900 on average

IT Staff and Outside Support

Most vendor service contracts include some amount of system support and troubleshooting, especially during the initial installation phase. Even with this help, your organization is likely to need some IT support of their own once the training wheels are removed.

Also consider that some support services are not provided by vendors, or that the support may not be available at all hours. These factors in addition to the inevitable IT staffing upgrade that will occur during full EHR implementation can increase providers’ tech payrolls into the foreseeable future.

Estimated added baseline cost: $3,094 on average


Training the entire staff will be necessary, with separate training goals based on their role within the EHR system. Physicians alone needed two weeks of training before they were able to satisfy the Meaningful Use requirements, according to one study.

On top of that, front-house staff will need to know how to use EHR systems for things like billing and patient registration. You will also need an IT department with many staff members who know the EHR system backwards and forwards. All of these training hours add to lost productivity and overtime wages, the single-most anticipated expense when it comes to labor.

Decreased Patient Loads and Increased Staffing Needs

Every moment spent troubleshooting or learning the EHR system is a moment taken away from patient care. Once implementation is complete, these bumps are expected to smooth out, but full EHR implementation for some organizations could take one to two years.

To make up for the lost productivity, new staff may be needed just to handle the leftover administrative and patient-end responsibilities. The combination in decreased patient loads and increased labor costs is predicted to be the most variable and unpredictable for providers implementing EHR.

Network Security

With more sensitive patient data traveling through their networks, providers are going to have to invest in robust network security solutions and IT expertise so that all that data will be protected. Anyone who fails to do so and who could be found negligent could potentially face HIPAA violation fines.

Conclusion: Form a Contingency Plan, Allocate Extra Budgets, Prepare for the Worst

The purpose of outlining all of these potential costs is not to deepen your despair. Instead, you should take this information to heart and plan positively and proactively by preparing a contingency plan.

Set aside extra budgetary funds that provide for a significant cushion when unexpected costs arise. If you feel like you cannot come up with such a budget, request help from your local Regional Extension Center (REC), which is designed to provide advisory knowledge and support for EHR implementers.

Finally, develop a strategic plan that accounts for setbacks like lost productivity for two or more years into the future. Keep in mind that you may need to upgrade your systems by that point as well.

With all these elements in place, your provider organization should have a substantial safety net to prevent you from falling on your face should you stumble. Remember that everything should get smoother as adoption increases and systems are refined. Many providers and government organizations even expect for EHRs to provide some ROI in the not-too-distant-future. So spend now and be grateful later that you did.

Why and how must you immediately begin preparations for the ICD-9 to ICD-10 conversion?

Last year, the much debated ICD-9 to ICD-10 conversion deadline was delayed another year and set to October 1, 2015. However, numerous provider groups and stakeholders have been pushing for another delay, which would be the third in total, stating that the conversion will result in unmanageable financial pressure on the already challenged practices.

This article summarizes how ICD-10 differs from ICD-9, what the Congress had to say about the deadline, and in what way must you prepare for the conversion.

CureMD ICD-9 Into ICD-10

The new codes

The first question that most providers have is about the specific changes in the code sets. Here’s a summary:

* 68,000 diagnosis codes as opposed to just 13,000 in ICD-9

* A maximum 7 alphanumeric characters per code as opposed to 3-5 in ICD-9

* Very specific, more complex, and more flexible codes

* Lateral codes as well (different codes for right and left)

* 87,000 procedure codes as opposed to 3,000 in ICD-9

* 7 alphanumeric procedure code characters in contrast to 3-4 numbers in ICD-9

* With detailed methodology descriptions, procedure approach mechanisms, more detail, and flexibility

The Meeting

Last week, the Energy and Commerce Committee’s Subcommittee on Health held a public forum to discuss the ICD-10 deadline. The meeting panel comprised of experts and stakeholders from across the industry, and included doctors and EHR vendors.

The Response

Despite opposition from a few stakeholders who held the view that small practices wouldn’t be able to manage the new codes, the majority voted in support of the October 1 deadline.

The way forward

The response by the congress via the meeting is clearly tilted towards ensuring that the deadline holds. If you were anticipating a delay, and haven’t yet started working on the conversion; you can still manage. Here’s how:

  1. Contact your EMR and Practice Management vendor and enquire your system’s readiness for the conversion. Ensure that their software possesses the necessary updates and ICD-9 to ICD-10 conversion mapping tools to make certain that your system is ready for, and will facilitate the conversion.
  2. In the case that your vendor is not ready, immediately begin looking for a new system. This is because from October 1, your claims will not be processed on ICD-9 codes.
  3. Delegate an ICD-10 expert (from you staff, or hire a professional) to train your staff, and to devise and execute plan for the conversion in line with your practice workflows.
  4. Consider Outsourcing Medical Billing if your ICD-10 expert (and yourself) feel that your current staff will not be able to manage claims processing on the new code set.
  5. Get in touch with payers and clearinghouses to determine their readiness.

The target for completing these steps (apart from staff training which could be ongoing) should ideally be March 15.

  1. Next, you must begin internal testing of the new codes between March and April, to check how well your staff will manage the new codes. Ideally you should be done by this till the end of June at maximum; and make the necessary workflow adjustments to fix errors in which the process proceeds.
  2. After internal testing in June, you need to begin external testing with clearinghouses and payers to determine how well your test claims (with ICD-10 codes) will do once out of your practice.

It is imperative to identify and correct any slow or disruptive processes in every stage of your conversion process. Doing so will enhance the efficiency of your practice, and help make certain that you are ready and equipped for the ICD-9 to ICD-10 conversion by October 1.

Assessing dual coding costs

Healthcare organizations will have to use both ICD-9 and ICD-10 for a considerable amount of time in 2014 in order to complete a successful transition to the new system.

Health IT vendors which support dual coding will be the ones who will stand out, although care providers may not be able to afford it.

Medical coders need to be trained for ICD-10 as well. However, they are not the only ones who require training. Physicians need to be trained on documenting correct ICD-10 code specificity. If this doesn’t happen, dual coding will not be beneficial in any way.time to plan

Dual coding is a way to test medical coders’ knowledge and documentation. However, the testing process must not be hampered by mistakes that could be addressed through awareness campaigns. Dual coding must be used to locate unforeseen problems which require time and money before it can begin.

Medical coding productivity is showing a 50% decrease in initial ICD-10 testing. This means that in the time required to process two test ICD-10 claims, coders should be able to process four real reimbursement claims. But it is not the case. Add to this the time spent to clarify queries from physicians and coders find themselves unable to prepare ICD-9 claims.

It really depends on a healthcare organization to do a cost-benefit analysis to see whether it needs extra medical coders to accommodate ICD-10 testing or is okay with longer reimbursement cycles. It is also important to realize that medical coders are not sure if they are using the right ICD-10 codes since the system is new for them as well.

The Hospital of the University of Pennsylvania has formed a team of 10 ICD-10 superusers to ensure coding accuracy. Each member uses the same records for coding and then all of them compare results with each other to discuss possible variances and the reasons for them. After the discussion, they reach a consensus on the correct ICD-10 codes required for the procedures and how they can unanimously agree to it.

But while it may sound great, it is adding more time and cost to the dual coding process. Compare this to the financial hit health organizations will have to take after October 1 if they are unprepared and it looks negligible.

It may be a good investment to allow medical coders to play with the ICD-10 system before the deadline to improve documentation. Care providers have real cases to test for ICD-10 through clearinghouses and payers and which will automatically tell them a lot about their HIT resources.

But once care providers have the much discussed ICD-10 data, what will they do with it? They can use it to add to internal medical research, assess financial impact, predict DRG shifts and reimbursements after the October 1, 2014 deadline.

Someone will have to invest time and resources in analyzing dual coding data. The Healthcare Information Management (HIM) department might be able to do that or consultants will be required for it. All of this time and money spent will be considered investments after October 1 but practices will not figure this out unless they start assessing dual coding costs right now.


Ideal features for the next generation EHR

Electronic Health Records (EHRs) are shaping the future of the healthcare industry in more than one way. They allow physicians to improve their workflows, reduce inefficiency and save time while on the other hand, help improve patient satisfaction, engagement and promote self-service. EHRs also make it really easy for government authorities to keep a close check on the industry and exercise better control over it. They allow for better data reporting, more streamlined analytics and better reporting for those who are managing large practices.

One of the industry leaders when it comes to Electronic Health Records is CureMD.

Let’s take a look at some of the ideal features for next generation EHRs.

  1. Compliance: Next generation EHRs are able to comply with latest government regulations and requirements. They are able to support the implementation of ICD-10 and help practices meet Meaningful Use requirements.
  2. Ideal support: Most EHR vendors suffer from poor after-sales support. Users of the product are not satisfied with the support and training provided by their vendors. However, an ideal EHR excels in this area and is always willing to help.
  3. No software maintenance: Next generation Electronic Health Record (EHR) software is based on the model of cloud computing and do not require any software maintenance. The EHR vendor automatically updates the software from the back end and no front end changes are required.
  4. Complete security: Modern day EHRs are equipped with state-of-the-art security and encryption features which prevent hackers and intruders from accessing vital patient data.
  5. Electronic prescribing: The most ideal EHRs of present day and age are equipped with the facility of e-Prescribing which makes it easy for physicians to send prescriptions just with a few clicks to any of the supporting pharmacies.

These are some of the features of an ideal, next generation Electronic Health Record software which are transforming the industry in a way like never before.


ICD-10 A Dose of Reality

ICD-10 will have possible 68,000 alpha numeric codes, the growth is flexible and the shifting from ICD-9 is mammoth task which only has 14,000 codes with digital codes, and the space of growth isn’t flexible. The fact is whether the implementation of ICD-10 is a mammoth task or not, the delay in the implementation of new efficient approaches/methods/standards results in damaging of your business operations.icd10s

Though the cost for transfer to ICD-10 is around $285,000 for a ten-physician practice according to a study commissioned by eleven trade groups that includes Medical Group Management Association, American College of Physicians and the American Medical Association but this cost is better than the cost you may incur as a result of the delay.

Yes, you will need highly trained professionals adept with ICD-9 codes to go through tremendous amount and energy of training to even come close to making them skilled at using ICD-10. The American Health Information Management Association (AHIMA) prepared a comprehensive manual to assist healthcare providers with the ICD-10 transition process (in 2011). The fact of the matter is the sooner you start to implement the change the better it is for you.

An imperative phase of transition is planning, which involves determining your vulnerabilities and training requirements. To do this, you need to perform a risk analysis. The scheduled-training part of the planning process should not ideally take you more than 2-3 months prior to using ICD-10.

Implementation phase requires that you conduct rigorous staff training. Coders and other non-clinical staff members can take real advantage from training on medical terminology because to get familiar with ICD-10 you will need a broader foundation of knowledge.

A key phase of the implementation process requires that you monitor and adjust to the changes that are taking place in the transition to ICD-10. In this phase, the time required to make changes should be quicker and improvements should be made in real-time. Monitoring of reimbursement statistics in claim and denials, rejections and efficiency should be done with care. By doing so, you’ll be at the top of your game.

ICD-10 transition is not a piece of cake, but a dose of reality—it’s a laboriously time consuming and strenuous phase. Ultimately, this transition will result in an efficient healthcare management and will lay grounds for further improvement in ICD-11.