Brandywine Urology Consultants (BUC) used to have issues running reports. In fact, attempts to generate financial reports would frequently cause its previous RCM system to crash. “In athenaNet, I’m able to run reports for a year’s worth of data, and I’ve never waited even 30 seconds for one to run,“ says Nathan Diller, COO of BUC. Such ease-of-use and enhanced capabilities weren’t always available to the practice. Before switching to athenahealth, the group wasn’t satisfied with their systems. Separate EHR and RCM solutions made any exchange of information difficult. Staff had ways of troubleshooting and working around them, but the effort was inefficient and often futile. And the problems just kept mounting. Billing staff did not have an efficient way to “tell what they were missing from a charge capture perspective,” says Diller. The RCM system didn’t add modifiers well, staff constantly chased down payments to post, and “the back-end denial management wasn’t tightly managed.”
The separate EHR and RCM systems were counterintuitive to Brandywine's goal of being "the premiere independent urology group in the State of Delaware,” says Diller. The number of urology groups within Delaware may be small, but it’s a competitive market because patients have easy access to other metro areas in the region. Across three counties, there are roughly 20 to 24 urologists in Delaware. Eight of those physicians practice medicine at BUC in New Castle County.
When the group’s prior EHR vendor announced that they were replacing its system, it decided not only that it needed a new EHR, but that it was time for a new RCM solution, too. That’s when the medical group started to consider other options, including athenaOne®, an all-in-one EHR, RCM, and patient engagement solution. “athena was compared to five other EHRs. It came down to athena and a urology-specific EHR,” says Diller. In the end, BUC partnered with athenahealth for its strong revenue cycle background and its “great general EHR.”
The ability to succeed and remain independent
On its old RCM system, the medical group had a denial as high as 25 percent. As a result of athenahealth’s proprietary billing rules engine tracks millions of denial scenarios, its denial rate decreased to between 4 percent and 5 percent on a monthly basis. “Our firstpass payment rate has gone up tremendously,” says Diller. In addition, its days in accounts receivable had consistently been between 44 and 48, and now it’s down between 25 and 27 days. That’s not the only success the urology group has seen since partnering with athenahealth. During the year the group implemented athenaOne, it allowed the physicians to lower the number of patients that they felt comfortable seeing. The group saw 9 percent fewer patients that year than it did in the prior year. But its overall collections still exceeded the prior year’s by more than 9 percent.
With less work needed to get clean claims out the door, the billing department staff could focus on other priorities. “There is now a much heavier focus on prior authorizations so that we’re not catching back-end denials with no means of resolution,” says Diller.
Automatic eligibility checking has provided another advantage to the front end of the revenue cycle. “The eligibility functionality has made the lives of the billing staff a lot easier because the charge entry workflows are all superior to what they had previously.” says Diller. But what Diller really likes is that “it allows me to be more focused on things that actually matter, like chasing down revenue in certain age buckets almost in real time.” Diller also finds running a report to be quick and painless: “within less than 15 seconds” Diller says he can have a detailed revenue report and understand patient collections versus payer collections. “Our staff like the reporting functionality. That makes their life a lot easier,” says Diller.
The insight to identify new opportunities for growth
With easier access to patient data, Brandywine UC was able to identify care gaps and expand their practice in the processing of filling them. The urology group implemented GAINSWave, a shock wave therapy treatment for erectile dysfunction (ED). To determine opportunities to offer this new treatment, the group used athenahealth’s reporting capabilities to identify all existing patients with a diagnosis of ED who were prescribed sildenafil. It sent out an automated patient outreach campaign to inform patients of the new service. The front-desk staff set up a separate phone line to proactively manage those calls. As a result of the tailored patient outreach campaign, “we’ve now treated over 100 patients. And it’s not uncommon for us to treat an additional seven to ten patients per month.” It’s a service that is primarily cash-based with collections received at the time of service. Diller can easily track the growth of this treatment as a new revenue stream through the reporting functionality so he can easily report on progress to the physician leaders monthly.
The group has begun developing an Advanced Prostate Cancer Center that offers Provenge, an immunotherapy treatment for prostate cancer. The group uses athenahealth’s reporting capabilities to identify patients who would benefit from this treatment. Then after the patients are seen, “athena helps us make sure those claims go out clean,” says Diller. Provenge-related claims are particularly important to the practice because one patient can have up to three infusions within six weeks. “The Medicare reimbursement for one Provenge infusion is in the mid-$40,000 range,” says Diller. “If a claim was denied because we didn’t have the right referral or prior authorization in place, it will have a substantially negative impact on both the practice and potentially the patient.” Instead of having to worry about getting paid for these treatments, Diller can feel excited that his group can provide patients in Delaware the best quality of care. “The whole goal of this Advanced Prostate Cancer Center is that patients won’t have to leave the state to get this care,” says Diller.
The right choice for urology practices
Independent groups like BUC are often on their own to ensure the success of their business. But, since Diller can rely on athenahealth and their customer success managers (CSM), the group stands armin-arm with a dedicated partner and healthcare expert. “Our CSM works with a lot of urology practices, so he has developed expertise in the specialty and can understand the challenges we face,” says Diller. The group’s CSM reviews monthly performance reports with Diller, which offer “an overall look at how we’re doing as a practice.” With that report Diller and the billing staff can target key areas in which they see room for improvement.
“If your urology practice is like most, then the tools in athena are going to allow you to be more effective in doing what you’re passionate about,” says Diller. BUC has seen substantial growth and remains independent in a market that sees urologists burning out; Diller sees a trend of experienced urologists either moving to an employed model or retiring. “Decreasing overall stress on independent urologists is really important to making sure that they’re still finding joy and satisfaction in what they do,” says Diller, “and not worrying about finances because you’ve got a good partner goes a long way.”
“If your urology practice is like most, then the tools in athena are going to allow you to be more effective in doing what you’re passionate about.”
— Nathan Diller, COO of Brandywine Urology Consultants