Brief corporate capabilities and detailed discussion of financial benefits of EHR

1. Financial Incentives for EHR
R&D MedTech

2. Who Is R&D Med Tech?
 R&D Med Tech is an Oklahoma Limited Liability
Corporation (LLC), located in Muskogee, Oklahoma
that provides electronic health records software,
services and support to physician practices.
 The company was formed by 2 principals. Rob Raasch
who has 15 years of experience as an executive in a
publicly traded information technology services and
management company. David Edwards has 40
years of experience including owning medical practices
and medical office support companies.
 In addition to the 2 principals, the company has
employees who are experienced IT hardware and
software professionals, certified trainers, help desk
staff, experienced medical billing and collections
professionals and a professional grant writer.

3. Why R&D MedTech and Why Greenway?
 R&D MedTech provides local maintenance, training, help desk and
hosting support.
 Greenway Medical’s PrimeSuite earned ―Best In KLAS‖ honors in
2006, 2007, 2008 & 2009
 So what is KLAS and why is it important for evaluating EHR software?
KLAS measures performance of software, professional services, and
medical equipment vendors. KLAS is like the Consumer Reports or
J.D. Power rankings for EHR. KLAS is the only research firm that
specializes in monitoring and reporting the performance of healthcare’s
information technology (HIT) vendors.
 Greenway’s PrimeSuite was among the first EHRs to receive the 2011
Comprehensive CCHIT Certification in Ambulatory EHR from the
Certification Commission for Healthcare Information Technology
(CCHIT).

4. Customer Base

5. PrimeSuite
Our flagship application uses a single database to integrate the clinical, financial and
administrative processes of your practice.
This allows you to increase the quality of care you provide, enhance your patients
satisfaction and maximize your practice’s profitability.
The single database integration of EHR, practice management and interoperability
functionality eliminates errors caused by duplicate data and interface-type systems.

6. Template Summary
• Greenway has
over 3000
Templates
• Over 30
Specialties and
Subspecialties
• Developed by
Board Certified
Physicians

7. Training
 When practices look to "Go electronic", they reach for their most common real-life
experiences to guide them, cognitively, about "What is this going to take?" : For most
people, that's installing some software on their computer.
 The problem is, this experience is a poor model to understand EHR implementation :
1. It implies ―This is something you can do with an instruction book and maybe a little
help‖.
2. It implies ―This is something that is experienced at the computer, and the computer
only.‖
3. It implies ―It generally takes a week or two to 'get really good' at it.‖
 What it misses is :
1. EHR implementation means a THOROUGH examination of all of your clinical
workflows and then in some cases, reorganizing them under a new electronic
paradigm.
2. ―Support‖ is NOT an instruction book, and NOT a 2-hour class, but a continuous,
ongoing monitoring of physician, nurse, and practice management behaviors - And to
achieve this requires an entire support mechanism of its own.
3. The 'learning curve' is often longer than anticipated.
 R&D MedTech believes there is a higher probability for a successful
implementation if training is delivered in person as opposed to over the web or
from a CD. Our trainers are certified by Greenway after intensive classroom
and shadowing experiences.

8. The $1.7M Opportunity of EHR
Type of Cost Savings/New Revenue Average Dollars Per Physician
over 5 years
Practice Process Improvements $216,300/$324,835
More Revenue Through Better $210,000
Coding
Malpractice Liability Insurance $25,000
Discount
E-Prescribe Stimulus (2009-2010) $6,000
PQRI Financial Incentives $50,000
Medicare/Medicaid Stimulus $44,000/$63,750
Tax Incentive $250,000
Clinical Trial Revenue $500,000
In-House Pharmacy Revenue $360,000
Total $1,769,835

9. R&D Guarantee
 Stimulus Eligibility: Our guarantee removes
the uncertainty that the Federal Stimulus
Incentive Program has created about whether the
Electronic Health Record (EHR) that your
practice is selecting will meet the ―meaningful
use‖ and ―certification‖ requirements under the
HITECH Act.
 Quality of Service: This Program guarantees Top
quality training and support by certified trainers,
and a fully functional solution with swift and
professional implementation.

10. Meaningful Use
 Use of a certified (CCHIT) EHR for patient
care documentation and for e-prescribing
 Connectivity to a health information exchange
to help coordinate care with other providers
 Submit claims electronically to payers
 Check insurance eligibility electronically
when possible
 Provide patients with timely electronic access to their health information
 Provide patients, upon request, with an electronic copy of their discharge
instructions and procedures at the time of discharge
 The ability to submit information on quality measures (A list of the current
quality measures is available upon request)

11. Who is Eligible for Federal Stimulus Incentives?
Medicare Eligible Professional Defined --
Section 1861(r):
 Doctor of Medicine
 Doctor of Osteopathy
 Doctor of Dental Surgery or Dental
Medicine
 Doctor of Podiatric Medicine
 Doctor of Optometry
 Chiropractor* (Spine Subluxation)

12. Medicare Eligible Professional Incentives for Meaningful Use of Certified EHR
Learn/
’09-10 $18k 2011 $12k 2012 $8k 2013
Install
Cumulative Calendar Year Medicare
$4k 2014 $2k 2015 Annual Penalties
Penalty 2015 1% If Physician
is e-prescriber
2% If Physician
is not
e-prescriber
Physician must 2016 2%
Up to charge > $24K 2017 and after 3%
$44k Medicare Part B in
per provider year one to hit * If <75% of physicians have
“meaningful use” by 2018, HHS has
max incentive provisions in the law to allow increases to
the penalties up to a max of 5%.

13. Who is Eligible for Federal Stimulus Incentives?
Medicaid Eligible Professional Defined --
 Physician
 Dentist
 Certified Nurse Mid-wife
 Nurse Practitioner
 Physician Assistant * (Rural Health
Clinic/ FQHC)

14. Medicaid Eligible Professional Incentives for Meaningful Use of a Certified EHR
*The Stimulus Package states
Medicaid incentives could start as
early as 2010
Medicaid Penalties
for No EHR *Medicaid Incentives up to $63,750
for Uninsured, Rural, FQHC and
Low-Income Providers/Eligible
2015 0% Professionals with a 30% Medicaid
Penalty “population” or Pediatricians with
Reductions at least a 20% Medicaid
“population” . Pediatricians below
30% may be reimbursed at 2/3’s
($42,075) of the total allowable
incentive.

15. Greenway Experience on Where Savings Are Generated
A study revealed that an average four doctor practice is likely to recognize cost savings
of $183,945 added to its annual bottom line after implementing Greenway’s
PrimeSuite EHR.
Statement Production $1,675
Billing Procedures $14,090
Management of Lab/Test Results $2,170
Documenting Patient Encounters - Dictation, transcription $32,147
Documenting Patient Encounters – Clerical $19,292
Documenting Patient Encounters – Clinical $13,279
Staffing Consideration $13,728
Financial Indicators Improvement (Collections) $84,059
Supply and Storage Expense $4,048
Chart Audit $228
Total Estimated Annual Opportunity Cost $183,945

16. Increased Revenue Through Improved Coding
 In 2004, CMS reviewed about 160,000 claims from
2003 and uncovered $1 billion in underpayment,
mostly by Part B carriers. According to the agency,
83.1 percent of all underpayment dollars were for
E&M codes, and downcoding by one level was
common. Nearly one-third of underpayment dollars
resulted from these codes: 99241, 99212, 99211, and
99201.
 A study of fourteen small practices in the
September/October 2005 edition of Health Affairs
found that each physician could raise his/her revenue
by as much $42,000 per year with increased coding
levels resulting from implementation of EHR.

17. EHR and Medical Liability Insurance Discounts
 Malpractice insurance carriers are increasingly offering 2½ – 5%
discounts to doctors for using an EHR in their practice.
 In 2007, the Certification Commission for Healthcare
Information Technology (CCHIT) published an article
advocating for lower malpractice insurance premiums for
physicians who implement certified electronic health record
(EHR) systems. CCHIT asserted that physicians using certified
EHR systems enhance the quality and safety of their care
through:
 Improved aggregation, analysis and communication of
patient information;
 Diagnostic and therapeutic decision support
 Prevention of adverse events (such as safeguards against
prescribing drugs which interact with the patient's
current medications)
 Clinical alerts and reminders; and
 Enhancing research on clinical quality improvement.

18. E-Prescribe Incentives
2009 2010 2011 2012 2013 Beyond
Incentive 2% 2% 1% 1% 0.5% None
Penalty None None None 1% 1.5% 2%
 This incentive is separate from and is in addition to the quality reporting incentive
program authorized by Division B of the Tax Relief and Health Care Act of 2006 –
Medicare Improvements and Extension Act of 2006 (MIE-TRHCA) and known as
the Physician Quality Reporting Initiative (PQRI).
 The government said Medicare is expected to save up to $156M over the five-year
course of the program in avoided adverse drug events. The HHS pointed out
estimates that as many 530,000 adverse drug events are reported every year by
Medicare beneficiaries while the Institute of Medicine said that more than 1.5M
Americans are injured each year by drug errors.

19. Physician Quality Reporting Initiative (PQRI)
 PQRI is a CMS sponsored program.
 Participating physicians in 2010 will be awarded 2% of their
total Medicare Indemnity billings for the reporting period –an
increase from 1.5% in 2008.
 2010
 179 Quality Measures
 13 Measure Groups (Diabetes, Chronic Kidney
Disease, Preventive Care, Rheumatoid Arthritis, Coronary
Artery Bypass Graft (CABG), Back Pain, Perioperative
Care, Hepatitis C, Heart Failure (HF), Coronary Artery
Disease (CAD), Ischemic Vascular Disease
(IVD), HIV/AIDS, Community-Acquired Pneumonia
(CAP))
 2% Reimbursement -- Individual physicians and other
eligible professionals who satisfactorily reported PQRI
quality measures data and thus qualified for an incentive
payment for the 2008 PQRI received incentives amounts
from more than $1,000 to $98,000 in incentives.

20. Tax Incentives
 The HIRE ACT of 2010 (Hiring Incentives to
Restore Employment) amended Section 179 of the
Tax Code to increase the small business expense for
qualified property to $250,000 through December 31,
2009. Thus, a medical practice can expense the full
cost (up to $250,000) of its equipment/medical
software purchase that purchased by 12/31/2010.
 Thus, your practice can expense the full amount
of an EHR software purchase including software
and hardware – and reduce your practice’s
taxable income.

21. Opportunities for New Revenue Streams
 In addition, to the cost savings and opportunity for government incentive
money, there are some new opportunities for a physician to generate revenue
using EHR:
 Clinical Trials
 In-House Pharmacies

22. Opportunity For New Revenue With Clinical Trials

23. In-House Pharmacies
 The average physician spends up to 60 minutes a day
dealing with pharmaceutical issues for no revenue.
 Phoning or faxing prescriptions to the pharmacist, call-
backs for non-formulary drugs, inquiries because of
illegible handwriting and mandated prior authorization
for refills are great time wasters.
 While electronic prescribing may ease legibility and calls
to the pharmacy regarding non-formulary prescriptions,
the physician does all the work and receives none of the
revenue — while often paying for the e-prescribing
system. For a practice utilizing an on-site dispensing
system and promoting it to its patients, the profit can be
substantial.
 We have a case study of a single physician in Georgia
whose net revenue from on-site pharmaceutical
dispensing ranged from $60,000 to $72,000 per year of
additional revenue.

24. Questions?
Contact:
Rob Raasch
Rob.Raasch@RDMedTech.com
918-682-2285
www.RDMedTech.com