EMR Tops List Of Priorities For New Mental Health Practice

By Health IT Outcomes staff

A move from paper-based filing to an EMR helps a licensed clinical social worker ensure effective billing and patient care in his solo mental health practice.

Mental health professionals typically face a unique set of challenges, not the least of which are patients with difficult diagnoses who seek treatment in a society that is surely, but slowly, opening up to public discussion of mental health issues. The challenges, however, go beyond the patient population. Like their primary care brethren, mental health practitioners face increasing overhead, lower reimbursement, shrinking employment opportunities, and increasing competition from neighboring health systems.

An EMR might not seem like the most cost-effective answer to those challenges, but when it comes to opening, operating, and maintaining a solo mental health practice, its potential for return on investment makes perfect clinical and fiscal sense. Just ask John Bracken, LCSW.

Bracken, a licensed clinical social worker for nearly 30 years, had certainly heard of EMRs but had not had the opportunity to see the benefits firsthand during his tenure at a mental health practice in Port St. Lucie, FL, that used a traditional, paper-based filing system. When Bracken learned the practice would be closing, he made the decision to open his own office to continue serving his patients.

Between March 2012, when his previous employer closed up shop, and May 2012, when his new practice officially opened, Bracken was busy putting together the nuts and bolts of his new office. One of his first major decisions was whether or not to purchase an EMR. “Between 1997 and 2002 I had operated my own office,” Bracken explains, “and of course then it was all on paper. I knew that to be able to run my practice solo and to keep my overhead down, an EMR was really the only way for me to go, economically.”

MEETING NEW PRACTICE NEEDS
Healthcare IT news of late has highlighted some of the investment backlash providers are feeling as a result of EMR implementations specific to Meaningful Use dollars. However, it’s important to remember that when it comes to solo mental health practitioners, the right EMR can serve a myriad of front and back office functions. These features can help delay the need to hire staff until a new office is firmly functioning on its feet.

Bracken knew that in order to serve his 150 patients, he’d need to find the right EMR at the right price, one that would ensure reimbursements arrived in a timely manner.

“I called a consultant first and told him what I wanted,” Bracken says, “and he gave me several different EMRs to explore.” Bracken ended up purchasing the AZZLY One Click Patient Care Management system, despite the fact that it was not specific to mental health practices.

“I was the first mental health practitioner that signed on with AZZLY,” he explains, “and so they worked with me to modify the system so that it would be suitable for mental health. We were able to customize my program with some of the paperwork I had from the old practice — biopsychosocials [an assessment of the biological, psychological, and social issues a patient is experiencing], mental health exams, and those things that were specific to my field. I started working with AZZLY in April before I opened the practice, and I went live in the middle of May. I’ve found that I haven’t missed a beat as far as what I need for my practice.”

GETTING OVER THE GO-LIVE BUMPS WITH AN EMR
Bracken notes that while the implementation was fairly seamless, he did realize soon after he went live with the system that additional features specific to mental health were needed.

“There were a lot of things that I found I needed as we went along,” he says. “For instance, I have a lot of workers’ comp patients and expanded ACCESS program patients, so I have to submit a copy of my progress notes along with my 1500 claim forms for workers’ compensation cases. Some forms I can send electronically, but some I have to print out. Based on my need, AZZLY was able to integrate a progress note that met my need that wasn’t initially included in the standard EMR package.”

REALIZING THE PERKS AND THE PAIN POINTS
Along with its clinical features, electronic billing has been the EMR’s biggest benefit, according to Bracken. “The electronic billing has really been fantastic for me because it provides shorter turnaround time than traditional, paper-based methods,” he says. “The AZZLY system has a built-in claims scrubber with coding logic that detects possible coding problems. By the time I’m finished with documentation and ready to submit, it’s already been scrubbed for errors. If a claim can be corrected prior to submission to a payer, it saves time and money and gets me paid faster.”

Bracken adds that he doesn’t see many returns for errors before the AZZLY system sends his documents to a payer’s clearinghouse, which electronically handles claims submissions and remittances. That makes a big difference to the efficiency and bottom line of his practice.

Now that Bracken’s practice has been up and running for 9+ months, he feels confident the EMR was a worthwhile purchase. “I feel that adding anything to it at this point would be superfluous,” he says. “There wouldn’t be anything necessary for me to maintain the practice billing I currently need. Down the road, there may be the possibility of adding some type of a checklist for different types of inventories like depression scales, OCD scales, or anxiety scales, but I can use those on paper right now and scan them into the patient’s file.”

One unusual challenge he experienced with the new EMR system ironically came from one of its most useful features — a call-reminder system. He found that many of his elderly patients were reluctant to answer a call that came from an area code they didn’t recognize. This group of patients is wary of identity theft and giving out over the phone some type of PIN number, such as the last four digits of a Social Security number. “I had to educate those patients ahead of time that they should answer those calls since they would likely be coming from me,” Bracken explains.

Bracken is an atypical study in the benefits the right EMR can bring to a provider that not only is bucking the employment trend by going solo, but is also not tying his practice to Meaningful Use guidelines, deadlines, and incentives. His EMR is used solely for the benefit of his patients and practice and will likely help him to provide better, more timely care to a growing patient base.