As many independent medical practice owners weigh whether to stay independent or sell to larger enterprises, one question has loomed: does technology – like electronic health records (EHRs) – help or hurt?
Lumping technology, or even just EHRs, into one big category is probably a mistake. There are many nuances to the adoption of technology in healthcare. A better question might be, how can technology help?
And the answer might be that the right technology, on the right platform, in the right practice can help in many ways. Josh Bock, DC, Managing Partner of AFC Physical Medicine & Chiropractic Centers knows this first hand.
Back in 1991 when AFC opened, everything was paper-based. They saw the writing on the wall and tried electronic scheduling followed by electronic billing. Finally, they tested out an EHR. “That first EHR didn’t work for us,” recalls Dr. Bock. “So we went back to paper charts.”
But times change, and so do practices. Today, AFC has 24 providers spread across nine locations who are supported by 65 staff members in billing, human resources, front desk, etc. Collectively, they conduct over 70,000 visits a year.
Like the practice, technology also changes and so do the rules and regulations governing healthcare. Not surprisingly, the billing and scheduling system became outdated. “It wasn’t going to be ready for ICD-10, and it was server-based. So it didn’t support our expansion to multiple locations very well,” explains Dr. Bock. “If a patient came to a practice location and wanted to pay a bill, the staff had to call the billing office, and someone had to look up the information. It was tedious, time consuming, and not very patient friendly.”
At the same time, they knew it was time to try an EHR again. Most patients are seen by more than one provider over time, and mid-levels are supervised by physicians who need to sign off on their notes. The practice was also facing the need to prepare for ICD-10 and determine if they should attest for Meaningful Use as well. Additionally, the practice was continuing to grow, and Dr. Bock knew that to stay independent and successful the entire staff needed to be on a single integrated system to improve communication, streamline documentation, and help more effectively manage their billing.
After looking at several systems, they chose the integrated solutions from Kareo for practice management, billing, and documentation. They wanted something affordable and cloud-based that could help them meet challenges like Meaningful Use and ICD-10. It was definitely the right technology platform at the right time. “My expectations have certainly been met, and in some cases, exceeded,” says Dr. Bock.
One of the main reasons is because they are fully connected across their nine locations.
“It’s been just over two years and the value continues to be clear,” says Dr. Bock. “All of our team members – whether they are onsite or offsite – have access to the same up-to-the-minute information and can communicate easily through a secure system. It has made all of their jobs a lot easier.”
Dr. Bock adds, “Kareo has improved efficiency in documenting, scheduling, records requests, and billing.” For example, he shares that they see most of their patients 22-26 times and it very easy to get the patients entered the first time and then the subsequent visits are seamless because it is very repetitive. The copy note feature is one of the reasons for this. They can copy the last note and just make quick updates.
And the timing couldn’t have been better. They got the system in plenty of time to tackle ICD-10 readiness. According to Dr. Bock, “We got the integrated system in part because of ICD-10 and MU. We started preparing for ICD-10 and using the tools in the system as soon as they were available. Our providers were dual coding for months to get everyone used to ICD-10. We didn’t have any issues; it was just the flip of a switch. The conversion to ICD-10 was really easy, and now we’re moving onto MU.”
The improvements they hoped to see in their billing have also materialized. “It took some time to analyze our revenue cycle management,” said Dr. Bock. “The robust reporting helped us do that, and we have been able to identify and resolve issues – some of which we didn’t even know we had.”
While unsure of their exact numbers before they implemented Kareo, Dr. Bock’s best guess is that they had average days in A/R around 50-75 most of the time and high denials. Today, their average days in A/R is in the low 20s and denials are so low he says they are almost nonexistent. He believes this is largely because an integrated platform is more than just billing or documentation, it is an end-to-end solution. The benefits start when a patient calls to schedule an appointment and continue as the patient checks in, is seen, checks out, and the claim is submitted. “It doesn’t just make one aspect better, it makes them all better,” he adds.
Dr. Bock goes on to say that, “Using an integrated platform that everyone is on and everyone understands connects your staff in way that they weren’t connected before. If you had multiple solutions then the practice could have a lot more challenges, and it would be much harder to manage.”
As times continue to change and challenges mount for independent practices, technology can bring many efficiencies and benefits, but it has to be the right technology for the practice. And the more the platform can be streamlined and integrated, the more potential benefits there are.