Mich. doctors find paper still works best

An anesthesiology group tested handheld devices to track billing but found the paperless system created more clerical work for the physicians.

By Tyler Chin, amednews staff. Dec. 10, 2001.

After two groups merged a couple of years ago to form the 53-doctor Anesthesia Medical Consultants, based in Grand Rapids, Mich., the group changed the way physicians were compensated. Instead of sharing the money equally, compensation was tied to individual productivity.

The new system based the anesthesiologists' pay on the number of units they generated or billed in increments of 15 minutes. So, if a physician spent 17 minutes on a case, he or she was credited with two units.

Billing to go

The change meant that doctors had to keep a detailed record of their productivity, said Doug Wiseman, MD, a technology-savvy anesthesiologist with the group. He wrote a handheld-based application to track his cases and proposed that the group use it.

The practice's management agreed to test the application. And after a few months, the result was goodbye software, hello again paper.

While a growing number of physicians nationwide are finding handheld devices useful practice tools, the anesthesiology group's experience shows that the devices aren't for everyone.

The Michigan group's experience also underscores that right now it's far easier to get physicians to adopt technology on an individual level rather than implement it throughout a large group. That's especially true when meeting the demands of individual doctors requires creating a complicated system that obviates the easy standardization of tasks that technology often needs.

Technology may be an easier sell to individual physicians than to groups.

Just developing the handheld-based application for the test was complicated enough. Once Dr. Wiseman got the green light from the group, he spent three months developing a paperless form using Pendragon Forms from Pendragon Software Corp., Libertyville, Ill.

After eight attempts, Dr. Wiseman came up with a version that satisfied his colleagues. The form contained 26 data fields. Physicians could enter most of the data by selecting the appropriate options from pull-down menus, but had to use graffiti writing (a special, pen-based style) on Palm computers to record the patient's name and record number. Anesthesiologists also had to write in the name of any surgeon not listed on the pull-down menu.

About 20 anesthesiologists tested the application, which also calculated the number of units they worked. They also tested a handheld database of CPT and ICD-9 codes Dr. Wiseman had developed.

At the end of each month, the anesthesiologists could either download the collected data remotely into a database at the main office or they could import the data into an Excel spreadsheet, print it, and e-mail or mail the spreadsheet to the billing department. Either way, the office staff still had to key-in certain data into the group's practice management system, which was not linked to the handheld devices.

Dr. Wiseman believes that the application helped physicians keep better track of their units and saved them up to three hours going over paperwork at the end of each month. But to his frustration and disappointment, the group decided not to use it.

High-tech or clerical work?

"I think there was resistance among older physicians, and I can't really understand why. They would claim, 'Well, I'm not computer literate' and I'd explain to them, 'If you can use a pen, you can use a Palm [device] because you don't need to know how to type,' " Dr. Wiseman said. "There's a fraction of our group who are technophobes."

Some testing physicians agree that technophobia was a factor, but they say that other considerations also influenced the group's decision.

Message to technophobes: If you can use a pen, you can use a handheld.

"The bottom line was you were taking on the responsibility of a clerk, but yet it wasn't like we were eliminating the clerical function out of the office," said Dean Downs, MD, the group's president. "You felt you were doing the clerical work that was ultimately going to be done anyway by someone you were paying to do the clerical work."

The group already keeps a duplicate copy of the paper chart anesthesiologists complete in the hospital operating room. There are three reasons:

First, the group uses the chart as part of the medical record. Second, billers pull information from the chart and the face sheet for billing. Third, "if there is a question or dispute [later] we can easily retrieve the hard copy and come to a resolution without me having to do all the data entry in the Palm," Dr. Downs said.

Too much entry time?

And while Dr. Wiseman, who continues to use the program he created, said that the data entry didn't take that much time, others disagreed.

"I saw it as a valuable program, but it had 26 different fields that had to be input. That was a bit cumbersome, especially if you were doing high turnover cases in the OR," said Daniel Visser, MD. "It took longer to input the data in the OR than it did to do the actual case as far as the anesthetic was concerned."

Dr. Visser said Dr. Wiseman didn't want to create a form with 26 data fields, but had to to win physician support. However, that support evaporated when the time came to decide whether to adopt the billing application beyond the testing phase.

"Changes, especially technological change, don't come easy ... when you get to 50 partners," Dr. Visser said.

Still, the experience led Dr. Visser to devise his own, much simpler, system to track his units. He simply uses the handheld calendar function and enters the patient's name, start and end times, and the number of units for each case and day.

At the end of the month, he compares the running count he has against a figure his secretary calculated. "If they are close, I say, 'Good.' If they are a long way off, I will go back and say, 'Here is a mistake. Here is a mistake.' "

Despite its reaction to the handheld application, Dr. Visser and Dr. Downs emphasize that the group is open to using technology if it truly saves time and money, and if it makes sense for physicians.

The group, for example, might have made a very different decision if doctors had been able to access demographic and other patient data from the information system of the hospital they are affiliated with via the handhelds, they said.

ADDITIONAL INFORMATION:

Billing to go

Here are key components and costs of a handheld billing application developed by anesthesiologist Doug Wiseman, MD. His group decided against using it, but Dr. Wiseman continues to do so, saying the application helps him capture revenue he might have lost otherwise.

Pendragon Forms from Pendragon Software Inc.: $150
Microsoft Office Suite, including Microsoft Access database: $200 to $300
TRGPro: $300
PC: $900 or more