Considerations for Choosing an EHR : An Interview with Melinda Fierros, MD

Melinda Fierros MD

The various options of EHRs are vast. Going through the process of choosing an EHR can be time consuming and complex. Melinda Fierros, MD shares her journey in shopping for an EHR and why she ultimately chose Valant as the EHR to trust with her patient’s data and the success of her practice.

What were you looking for in an EHR?

The EHR at the practice I was working with was not conducive to what I wanted. Specifically, I wanted to be able to electronically prescribe medications, provide convenience to my patients, optimize billing, and I wanted an EHR that could help me provide the quality psychiatric care that I really believe in. To me, that meant having the ability to seamlessly perform objective measures that easily incorporated into my notes.

Why are measures important to you?

I know patients may downplay their symptoms and that discussion of their symptoms with me is not as objective (they want to please me). Being able to give them a measure to fill out without any interference is very important to me. It helps me measure how they are doing over time and get a glimpse into what is happening in the moment. For example, a patient comes in for a session and the last time I saw them they took the GAD-7 and they scored low, but this visit they scored 21/21. What happened? This triggers pertinent conversation, and also shows the patient that I am paying attention to them and the events of their life without even having discussed it! In some ways this breaks the ice if they are having a hard time bringing something up.

What is 96127 and how does it impact your practice?

I heard about this code during my time in the military; they suggested we use it because they use a lot of measurements. I clued into this as I knew one day I would be opening a practice of my own. In my mind, this was great because as a psychiatrist delivering quality care, it was important to me that I was recognized for my time and good work. Quality care takes time, and it should be rewarded and compensated.

What was your shopping process like?

I decided to make a spreadsheet with several of the things that were very important to me. I found a survey online and Valant was one of the recommended EHRs on a list of 4 others. I called and compared and the one that hit almost all of my desires, and the only EHR that could specifically meet my requirements for objective measures, and the billing of the 96127 code, was Valant.

Among the 4 EHRs you researched, why did you choose Valant?

Measures and Patient Portal, Data, Billing Features, Efficiency

Measures and Patient Portal
I knew that I didn’t want the typical features of the common EHR. Of course, I wanted to be able to order meds electronically, but I really needed a seamless note taking process and I wanted it to be easy (I wasn’t asking too much!).

Valant has a lot of measures built in that seamlessly go from the patient portal and into your note with the click of a button and you can chart it over time.

Valant’s patient portal allowed a patient to complete a clinical history that would automatically pull into my note. So now I don’t have to double up on the work. When the patient comes in, I do a very comprehensive intake and the background information I need is already in my note. All I have to do is review it with the patient. This allows me to spend more time developing rapport with my patient.

Data
If you have a system that makes it easy for you to implement outcome measures, then you have data.

You can push out a measure to a patient through the patient portal. They can input in their responses that you haven’t influenced in the subtle ways a psychiatrist can just by a change of environment and complete privacy. And so, it makes your life easier. You have objective data that helps you evaluate your treatment and make necessary changes. It also provides evidence to the various payers (Medicare, Medicaid, Aetna, etc) that you are providing quality care to your patients. It makes sense because it helps you quantify the quality care that you are giving. Other systems can’t offer you that.

Billing Features
Along with billing for 96127, I also asked about add-on codes. One of the problems I had with my other EHR was, if you put in 2 codes like 99215 in combination with a therapy code like 90838, it wouldn’t allow me to put in more add on codes This was a common combination because I love to do therapy. Additionally, I also was unable to bill for sessions with interactive complexities: for example, seeing patients who are children with Autism who have their parent’s present in session; family therapy; and couples therapy; AND measures performed for each of these sessions. There was no way to put in any additional codes in my previous EHR. That meant I was not being compensated for the work I was doing, because of a limitation of the EHR!

When I spoke to Valant, I discovered that not only could I add them without a problem, I could add as many as was necessary and accurate to each session. I can also indicate how many measures I did! I’ll note that not all insurance companies reimburse for it, but some do, and it adds up over time. It is a way of making sure I continue to provide excellent care, which I would do anyway, but getting rewarded for it also rewards my patients.

Can you tell us more about insurance companies and reimbursements around 96127?

Each time I attend the popular Behavioral Health Conferences (APA, AACAP) I always go to a coding session and they have been advocating we try to do this for a long time. I told my biller to make sure we ask about 96127 whenever we get the contracts and to make sure it is on the list of things that we’ll be billing frequently. I still see patients from insurances that don’t include reimbursement, but it adds up from those that do. I’m not doing extra work. I’m just getting rewarded for the work that I do.

On average, what does this reimbursement look like?

I get reimbursed 5-6% more a session (per encounter) by billing for 96127. That’s about 3-4 measures a session and it really adds up over time.

Efficiency
I score measures and look at their trends from previous notes. That probably takes about 5 minutes of my time. When you use Valant, it shows you their previous score and you click to add it into your note to compare to today’s session. This saves me about 75 minutes a week alone. Valant has decreased my workload in half with measures. Which gives me more time for my patients. When looking at patient portals from other EHRs, they’re mainly for communication between the clinician and patient but none of them helped with note writing.

Valant has created templates that can be sent to patients before their intake appointment and then it can be incorporated into your notes without ever having to type it in. This is a huge time saver and also a rapport builder.

I don’t have to actually be typing and looking at my computer while trying to build rapport with a brand new patient. I am still able to use my computer when needed, which is easier for me to do now. The relationship you build with your patient is stronger. It takes less time to get really good information. I can spend less time on mundane questions about their medical history and spend more time on the stressors that are really bothering them. We can get into the nitty gritty of what brings them to see me. And it’s all easy, it’s the push of a button. That is lovely. There are very few portals that are set up like that, which I was unaware of until I took the time to look into them.

Valant also saves me about 30 minutes per intake. A comprehensive child intake with measures done onsite would typically take me about 2 hours. With Valant, it takes me 1 hour and half. And when thinking about malpractice, rushing through an initial intake with measures seems irresponsible; something could be missed when rushed. For intakes alone, Valant saves me around 600 minutes a month. Time is money, and more importantly, I get to choose what I do with that extra time!

Selecting an EHR: Where to Begin

Are you in the process of evaluating EHR platforms for your practice? Selecting the right EHR is an important decision and with so many options available, it may seem overwhelming.

In our EHR Buyer’s Guide for Private Behavioral Health Practices, we help walk you through the steps involved in selecting an EHR, timing considerations, and what questions you should ask EHR vendors to ensure you make the right decision for your practice.