We often get questions regarding charting deadlines related to Meaningful Use and MACRA/MIPS.  Does my chart note have to be done in 24 hours?  Does it have to be done within one year?  The short answer is there is no 24 hour deadline, but documentation is best captured while the visit is fresh in your mind.

We like to share the following Medscape article from a healthcare attorney that answers these questions, citing the Medicare Claims Processing Manual.

The author states two good points.

1. Medicare has no immediate deadline to capture your documentation, but you must bill within 1 year of the visit and you cannot bill until your documentation is complete (ie. signed).
2. Documentation of a visit should be captured as quickly as possible to ensure accuracy and to avoid future liability.

The key word above is “capture” your documentation.  When you use Fenton Transcription’s EMR Charting via Dictation service, you are performing your charting by dictating.  In an ideal workflow, you have dictated all of your visits by the end of the day.

Even though there is no such thing as the  24 hour charting deadline, dictating your charts as you see patients accomplishes all of the following goals:

1. Capture your visit information while it is fresh in your mind, reducing liability from forgotten information or scrutiny in compliance auditors asking why your charts weren’t completed days/weeks/months after the visit.
2. Complete your charting process faster than both self-typing and voice recognition.  You can dictate 200 words per minute.  Median dictation length for providers using our EMR Charting service is under 2 minutes.
3. Finish your work day with the comfort of having your charting done.  No more after hours or weekend charting.

Here’s a link to the full article on Medscape.  You may need to create a free Medscape account to read:

What’s Medicare’s Deadline for Charting?

The author’s citations include links to CMS sources for the information.

So your Practice Fusion EMR, free since its inception over a decade ago, now wants you to pay a subscription fee for your usage.  Here at Fenton Transcription we do charting for folks using many, many different EMRs.  We have been involved with practices who were adopting an EMR for the first time and those migrating from one EMR to another.  Here are some perspectives based on our experience.  You can skip to the bottom line if you don’t want to read the rest.

COST:

First off, the cost of the Practice Fusion is $99/month per Clinician.  For details and how it will work, check out our overview here:  Practice Fusion Subscription Cost

At this price, Practice Fusion remains the cheapest of the high-quality EMRs.  Here are some cost comparisons of other popular programs, based on data available on the web as of 3/15/2018:

eClinicalWorks — $449/month per Clinician.  Pay for additional services (PM, Marketing, Billing, etc.).

Kareo — $300/Month for physicians, $150 for NPs/PAs.  Pay for additional services.

Amazing Charts — $1495/year plus $1495 startup cost.  $300/year for data backup.  Price drops 2^nd year.

Hello Health — $2000+ in startup costs, plus they try to charge your patients for enhanced Portal access.

There are a variety of other pricing schemes, including price per user, price per encounter, and sliding scale prices based on using the manufacturer’s PM/Billing services.  The EMR options we see that are cheaper than Practice Fusion’s new model are offered as a side option to other services, or they are open source, which means you will need an expert to help you deploy them well or face a massive learning curve.  Generally, it appears the EMR market has entered a consolidation phase, and we will soon see worthy players in the small practice market start being snapped up as with Practice Fusion and Allscripts.

PERFORMANCE/TECHNOLOGY:

Practice Fusion is cloud based.  We think it is key for anyone adopting software as a service (SaaS) to focus on the cloud only.  The last thing you need in a small business is to have to manage or worry about your own computer hardware and software installations and supporting them.  With well-built cloud based software, you can access your EMR from any connected device.  Practice Fusion has been a front-runner here since day one.  If you think about migrating, stick to cloud based solutions.

Practice Fusion has perhaps the best, most responsive interface of all the EMRs we work in.  When they switched from their classic interface to the new HTML5 based interface a few years ago it was painful to deal with change and retrain our team.  But the result now is vastly increased responsiveness to clicks and fast load times as you navigate the EMR.  Others are working to emulate this, as well they should.  Even if you think your Practice Fusion is slow, we can assure that compared to many other systems on the market, it’s lightning fast.  Be sure to test the responsiveness of other systems if you’re shopping.

FOCUS:

As you can see from the price comparison above, many of the small practice targeted EMRs come from PM and Billing companies. In many cases these started out as a side project to help support their existing customers.  The smaller ones tend to lack current certifications and the depth of features you see in the larger, high-quality EMRs.

Practice Fusion is just an EMR company.  Their sole focus has been and continues to be to make an EMR product that will attract and retain customers.  Their revenue model has been and is still entirely dependent on having as many users as possible, and the only way to do that is to continue to offer a product that beats out others.  It should be noted that they also have a back end Big Data play, which is true of many EMRs.  This motivates them further to increase the number of encounters recorded each day.  They need you to be a happy, productive user of the system.

The company claims that the new revenue model will allow them to accelerate development and continue to expand the EMR with new features and tools for the users.  They are rolling out a number of new features with the start of the subscription model.  You can see a list of them here.

MIGRATION:

Changing the software that runs your business and impacts all of your staff is a major undertaking.   Whether you have 5 staff or 500,  do NOT take it lightly.  It requires extensive planning, retraining of the staff, migration of your patient data from the old EMR to the new, a tremendous amount of patience, and often hidden costs.

When evaluating a migration, be sure to flesh out all of the costs of the new system.  Some charge for modular add-ons like scheduling, messaging, backup, etc.  Also check for the cost of migrating your clinical data.  This means, not just exporting your patient demographics, but their full chart, notes and diagnostics.  Demographics can be moved between systems with relative easy, but actual medical records are a much different story.

Beware of systems that will charge you for importing or exporting data.  Practice Fusion, according to their website, will export your full clinical data for free, one time, upon cancellation.  They say it will take 4 to 6 weeks to send you the data.

Importing the data into a new system is the real problem.  There are still not well defined standards for the process.  It has to be customized by the IT team at your new provider, based on what the old provider gave them.  The process is generally slow and glitchy.  We have seen folks exporting data from the SAME EMR (they absorbed a doctor using the same EMR product and imported his data) having tons of problems.  That’s right, the process is so convoluted that companies have trouble importing their own data.

Finally, retraining your team on all the processes you use every day, like refill requests, lab orders and results, prior auths, etc. can be a daunting task.  If evaluating other systems, be sure to look at these specific items and judge if they work better or worse than they do in Practice Fusion.  Make sure you check the ePrescribing workflow for yourself as well.  Thankfully, if you’re one of our customers, you don’t have to worry about charting, because we’ll continue to do it for you.

BOTTOM LINE:
Pay up.  Why?

• The price is right.
• Practice Fusion is right at the top of the market in quality and service, and the future looks stable now.
• There do not seem to be any viable free options left on the market.
• We wouldn’t wish migration on our worst enemies. It can be that bad.

DISCLAIMER:

We are not shilling for PF.  We have no relationship with them other than we pay for their advertising service.  We have customers across all platforms and can move with you to any platform.  We chose to advertise with PF because we thought they had the best designed, easiest to use platform, which helps our team be more productive.

As you’ve heard, Practice Fusion has moved to a paid subscription model that will start on June 1^st, 2018.  Here are the basics of how it works, plus the new features being released.

Monthly cost:

$99/Clinician (with a 1 year commitment)

 Licensing: 

• Each subscription will be issued 1 clinician license. You will manually assign this license in your dashboard to a Clinician.  It will be tied to their NPI number.
• All other users in your EHR are free.
• Licenses have no relationship to Edit Levels (i.e. staff can still be assigned NP/PA or Physician Edit Levels)
• With each license purchase, 3 “secondary” licenses are issued. Secondary licenses can be assigned to specific staff members that will have special access to sign chart notes and sign documents.  (ie. These staff won’t need to use a provider’s login for these functions)
• Only users with assigned Clinician licenses can perform certain tasks like ePrescribing, refills, be assigned to inbound diagnostic results, utilize the MIPS dashboard, etc. (ie. Staff will continue have to use the provider’s login if you allow this in your practice).

 New Features:

• EPCS – ePrescribing of Controlled Substances
• 2018 MU/MIPS and eCQM Dashboards
• Configurable Encounter Types in Chart Notes
• eCQM enhancements to metrics and results
• New Patient List report search categories

 Upcoming Features:

• MIPS QCDR Reporting
• Chart co-signing
• Delete Custom Document Types
• Pinned Notes (custom patient alerts)
• SIA data viewable in patient summary
• Enhanced workflows for Electronic Prior Authorizations

Practice Fusion states that the money from subscriptions will be used to allow them to accelerate development of new features and services.

Next:  Read our cost comparison and advice on things to consider about subscribing. 

In the article below, the Dean of Stanford University Medical School discusses the growing instance of burnout among practitioners, largely due to the amount of time and effort needed to document in the EMR.  Towards the end he mentions having to hire a full-time med tech or “scribe” to handle each doctor’s charting tasks for them.

For those of you in private practice, the “scribe” approach isn’t very appealing as it requires you to hire another full-time employee in the face of  ever-shrinking reimbursement.  It also means your patients have to deal with the humility issues of another person in the exam room with them.

Our EMR Transcription service offers the same end result for a fraction of the price.  You get a fully structured entry in your chart covering your entire visit, including the free-form typing and the data-entry tasks that consume so much of your time.  All you do is dictate (well documented as the fastest way to record a visit).

Read Dr. Minor’s article on EMR Burnout here:  Doctors are burning out because electronic medical records are broken

We wanted to share some links we thought you might find interesting:

1)  Our friends at Practice Fusion share an interesting look at EHR Adoption in the U.S. – EHR adoption rates: 19 must-see stats

2)  Nurse Practitioner led practices are booming.  We are seeing it in our customer base.  Here’s some data and projections from the Department of Health and Human Services. – Projecting the Supply and Demand for Primary Care Practitioners Through 2020

3)  Average wage data for Medical Assistants from the Bureau of Labor Statistics – Medical Assistants