CORR Insights®: How are Electronic Health Records Associated with Provider Productivity and Billing in Orthopaedic Surgery?

In a retrospective study of various national databases, Dandu and colleagues [2] report a number of key findings and provide some interesting observations on how the Electronic Health Record (EHR) impacts various aspects of an orthopaedic practice. They document support of some widely held assumptions, including that Meaningful Use payments were a potent stimulus for adoption of EHRs. However, these bonus payments were not sufficient to assure neither universal nor uniform adoption, and there remains a large percentage (nearly 50% in US orthopaedic practices) that have yet to fully embrace their implementation. Also, despite the purported benefits of more thorough and accurate coding and enhancement of documentation, there was little effect on productivity, billing practices, and surgical volumes. This is an important first step in trying to unravel the cavalcade of potential consequences, both intended and unintended, of the near-ubiquitous use of EHRs in clinical practice. As part of the American Recovery and Reinvestment Act (ARRA), the Health Information Technology for Economic and Clinical Health generously incentivized EHR adoption, and the authors of the current study demonstrate that the “carrot” was more effective than the “stick” in increasing EHR utilization. That is, the Meaningful Use payments in the early implementation phase of the ARRA were largely successful, and the latter penalty phase has been much less impactful. In addition, the economic realities of an orthopaedic practice can make the decision to move ahead with adoption both complicated and difficult. On one hand, the gross practice income may facilitate adoption, capital investment, and systems purchasing that would otherwise be prohibitive for smaller primary care offices or less wellcompensated practitioners and groups. On the other hand, if the Meaningful Use payments are merely “a rounding error” with respect to total practice income, the investment may be seen as a waste of time, money, and resources. Clearly, this presents an interesting dilemma in highly compensated specialties like orthopaedic surgery, especially if no perceived benefit to the patient, the practice, or practitioner can be identified [7]. And, as Dandu and colleagues [2] show, only about half of the practicing orthopaedic surgeons in the United States have adopted meaningful use implementation standards.