Doctors can get high-tech results with low cash outlay

A geriatrician in solo practice says he is using inexpensive, off-the-shelf technology to practice better medicine, bill accurately and keep costs at a minimum.

By Tyler Chin, amednews staff. Feb. 26, 2001.

Getting timely access to patient data and staying out of the clutches of the fraud police are among the most vexing problems physicians face.

Gary McCray, MD, a solo-practice geriatrician in La Grange, Ill., thinks he has minimized those problems by using inexpensive technology and a two-page template he developed to help himself comply with Medicare rules. The combination of high- and low-tech tools has enabled him to practice better medicine, optimize billing, remain in compliance with Medicare rules and minimize his overhead expenses, he said.

The tech grab bag

Dr. McCray uses a laptop computer and off-the-shelf contact manager software that cost less than $3,000 combined. He customized the software -- a combination of database, word processing and spreadsheet applications -- so that he could create and access medical chart abstracts for all his patients.

The abstracts include each patient's current condition, care plan and insurance data, as well as information about co-providers and brief records of all contacts, including patient visits, phone calls, written communication and charges in a single file.

He can access and process all practice information at any time, anywhere -- an ability that Dr. McCray said is invaluable because he sees patients at two hospitals and 20 nursing homes.

"The abstracts make it possible for me to recall details immediately when patients call," he said. "I can say, 'You called me three weeks ago about a fall. Have you had any more falls?' You have the essentials with you all the time, and it can expedite decision-making by shortening conversations and getting right to the point. Many doctors don't want to answer phone calls because they don't have the information [they need] or the chart."

Dr. McCray, who also sees patients in their homes, uses his portable computer system to document the patient encounter. He types one line of text into the electronic chart abstract describing the essence of the visit. He also keeps on his laptop a running record of any telephone or written communication related to his patients, which provides him with documentation needed to support care plan oversight charges for hospice or home health care.

Complying with Medicare

For billing, Dr. McCray says that for several years he has been using a template that he developed from Medicare coding and documentation rules. He says the template enables him to maximize charges and still remain in compliance with the rules.

He started that project after the Health Care Financing Administration launched a widespread crackdown on fraud and abuse in the 1990s. At that time, Dr. McCray looked at the rules, which consist of three pages of fine-print instructions. But he said he found it nearly impossible to apply them to a free-text record of a patient encounter and generate a proper CPT code. "I could comply with the rules, but it was difficult without a template," Dr. McCray said.

He uses both the documentation in the template and the electronic abstracts to support evaluation and management CPT codes.

Although the template is available on a Microsoft Word document on his laptop, Dr. McCray uses a paper version. He said he is ready to use the electronic template, but the hospitals and nursing homes aren't. So he makes copies of the blank paper template, uses them to document his encounters with patients and then files the completed notes in the patients' hospital and nursing charts.

Although Dr. McCray couldn't quantify the benefits of using the electronic abstracts and paper template, he is confident that they have improved his practice. They have allowed him to listen and talk to his patients and make better decisions, he said.

"In addition to improving medical record-keeping, the template tends to facilitate attention to detail during patient visits and may improve information gathering," said Dr. McCray. "If a doctor can spend a greater fraction of the encounter listening and talking and less time reading and writing ... that will increase the patient's and physician's chances of making truly informed decisions."

Dr. McCray said he believes any physician can do what he has done by buying a laptop computer and software. But he emphasizes that it takes time to learn how to use those tools to improve medical practice. It took him about two years to learn, work and refine the system he is using now, he said.

Dr. McCray said he has been approached about marketing his services to other doctors and hospitals and he is exploring the possibility.