Determining Costs for an ASC EMR

Implementing an EMR in an ASC may become increasingly important as healthcare moves toward electronic health information exchanges, but the financial commitment necessary for implementation can be overwhelming.

Patrick Doyle, vice president of sales for SourceMedical, discusses the different costs and savings present in EMR implementation in an ASC.


Software acquisition

License model vs. service model
Mr. Doyle says an ASC preparing to implement an EMR has two basic options as far as software acquisition: a license model or a service model. With a license model, the ASC owns the software and pays a high upfront fee and then annual support fees to keep the software updated. With a service model, the ASC rents or leases the software and pays a smaller upfront fee and then a recurring monthly fee.

The choice to pursue a license model or a service model will differ for different ASCs. A license model might require $75,000 for acquisition and a $15,000 annual cost, whereas a service model might require a $10,000 acquisition cost and then recurring monthly payments to make up the additional cost. An ASC that has the option of using capital outlay during the implementation year might go with a license model, whereas a struggling ASC might wish to space out payments over time with a service model.

Acquisition costs
According to Mr. Doyle, ASCs pursuing a license model should budget for the software license and customization of the software; the latter should run around 5 percent of the total cost of the software. The software will also come with a recurring annual maintenance fee that the center should plan for.

The software will also come with "soft costs," which ASCs tend to overlook in favor of focusing on "hard costs," Mr. Doyle says. Soft costs might include the cost of labor to implement the software, a process that he estimates to take around three months. The ASC will also have to budget for short-term case volume disruption, planning for a 10 percent drop in cases for three months.

Hardware acquisition

Self-hosting vs. service model

ASCs must also choose whether to self-host EMR hardware or to rely on a service model. "You really have the same dynamic [as with software]," Mr. Doyle says. "You can host the hardware yourself and purchase the server, workstations, tablets, scanners and set up a wireless network, or you can rely on a service model, where you really only need a broadband internet connection." He says the major benefit with a service model for hardware is the ASC will not need to hire maintenance to keep the server in working order.

The choice to self-host or use a service model depends on the type of ASC, Mr. Doyle says. "For a small center, it might make more sense to use a service model; you're talking about a relatively light footprint in terms of your monthly cost for the hardware," he says. "But when it starts to scale itself out for larger facilities, then you're talking about a lot of connected devices, and [using a service model] may exceed what the cost of your server and maintenance would be internally."

Acquisition costs

An ASC choosing to pursue a self-hosting model should factor in the one-time cost of a server, workstations and tablets, scanners and printers and a wireless network, as well as the recurring cost of a maintenance contract, Mr. Doyle says.

These costs can add up to over $40,000, with the biggest cost coming from workstations and tablets, which will be distributed throughout the center.

Cost Savings

Many ASCs that implement an EMR do so thinking of the eventual financial savings that come with the elimination of a paper-based system. Without focusing on clinical savings, which can vary greatly from center to center, Mr. Doyle says ASCs can start recognizing savings from an EMR after about 18 months.

The savings associated with an EMR include the money spent on chart materials, including dividers and tabs, chart folders and covers and pre-printed forms, and money spent on document security, including shredding and storage. EMR can also save ASCs money in hours per day spent preparing a paper chart by business office personnel, including chart pack assembly, collating, document and chart retrieval and copying and faxing. These hard and soft costs can add up to over $120,000 per year.

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