the Centers for Medicare and Medic- aid Services’ (CMS’) requirement that all practices switch to the controver- sial ICD-10 medical billing and coding system on Oct. 1. “Obviously, it’s gotten a lot harder
to run a small personal practice, and that’s because of all the regulatory and EHR [requirements] and things like ICD-10 and new HIPAA regulations,” Dr. Ream said. “I mean, you could just go on and on about what we have to really worry about all the time.”
THE EHR MONEY PIT There’s more to AIMA’s closure. All four physicians are retiring, and about a year after closing the practice’s doors, three of them will be 70 years old, Dr. Ream says. Dr. Alsup began the practice in
“Obviously, it’s gotten a lot harder to run a small personal practice, and that’s because of all the regulatory and EHR [requirements] and things like ICD-10 and new HIPAA regulations.”
1975. Dr. Ream joined him in 1978, Dr. Robinson came on board during the 1980s, and Dr. Hoverman joined in 1992. AIMA began operating out of its current building in 1984. Kunjan Bhatt, MD, a cardiologist at
Austin Heart, P.A., who sends referrals to AIMA, says Drs. Alsup, Hoverman, Ream, and Robinson remain consci- entious of cost savings and always do right by the patient while maintaining the highest quality standard. “The fact that we have taken care
of generations of people and fami- lies — grandmother, mother, daugh- ter, grandson, aunt, uncle — and that people send their friends makes us all feel that we have done a good job and that we have responded well to our patients’ needs,” Dr. Hoverman said. However, in recent years, circum-
stances of the modern medical land- scape made AIMA’s closure inevitable. The practice holds a meeting early each year to evaluate its current situa- tion, and Dr. Hoverman says the phy- sicians began thinking about closing AIMA last year.
+ 34 TEXAS MEDICINE September 2015
“But at our meeting [this year], it re-
ally became obvious that the adminis- trative burden had really escalated even further, to the point that it had gotten just overwhelming,” she said. One big factor was the increasing
prevalence of the widely maligned electronic health records (EHRs). AIMA has never maintained an EHR system, a decision the practice made based on its available resources. In considering whether to install
an EHR system a couple of years ago, Dr. Ream says, AIMA determined do- ing so would cost hundreds of thou- sands of dollars in equipment and personnel, as well as the “cost of just having to cut back when you first ini- tiate things to the point where we’d probably be lucky to break even for several months.” He explains that many EHR sys-
tems “want you to cut back to about two-thirds of your normal practice. And at our stage of practice, it didn’t make any sense to do all that.” This year, for the first time, fore-
going an EHR also hurts a practice’s Medicare bottom line. Beginning on Jan. 1, 2015, CMS deducted 1 percent off physician payments for Medicare- eligible professionals who aren’t meaningful users of certified EHR technology. CMS will deduct 2 per- cent in 2016 and 3 percent in 2017 for those who don’t comply with mean- ingful use. Meanwhile, dealing with EHR data
from other practices has been a trial for AIMA. Dr. Hoverman says EHRs are just now beginning to become use- ful, adding that many of the practices that have maintained EHRs for a long time have refined their systems to include more helpful, less redundant information. But many of the records AIMA gets from practices that are rel- ative EHR newcomers are “just full of junk,” she says.
TMA’s ICD-10 Resource Center:
www.texmed.org/ICD10
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