How a solo practice survived–and thrived

Richard L. Fox, D.O. P.A. | Tamarac, FL

  • small medical practice building

    Independent internal medicine practice

  • shaking hands

    1 Physician

  • Male nurse practitioner African American

    9 Staff members


  • Lost revenue due to denied claims
  • Inefficiency and disorganization due to paper-based medical practice
  • 9 FTEs: 1 dedicated to sorting faxes, 1 opening mail, 1 calling patients



  • Lowered days in accounts receivable (DAR) to 17.4
  • Close 100% of encounters on the same day as the visit
  • Reduced tedious work and eliminated 5 admin FTEs

In 2014, Dr. Richard L. Fox’s independent internal medicine practice was at risk of closing its doors permanently. Toward the end of 2014, Dr. Fox had begun “pulling money out of [his] savings to float the practice,” says his wife and practice administrator, Kim Fox. The practice’s operations were inefficient, patients were dissatisfied, and staff were frustrated. Stress at the practice was at an ultimate high and Ms. Fox knew something had to be done—and fast.

Increased Operational Efficiency

Before athenahealth, Dr. Fox’s office was buried in paper. “The phones rang off the hook, nonstop, because we couldn’t get prescriptions filled fast enough, or if they were filled, the pharmacy couldn’t read them because we were still handwriting them. There was a lot of bottlenecking and redoing work,” Ms. Fox says. Managing paper charts was chaotic, especially between offices. Ms. Fox says, “Every day the staff was managing 300 to 400 faxes—organizing them, identifying the patient, and then finding the chart, attaching the fax, and preparing it for the doctor.” These inefficiencies required Dr. Fox to hire multiple people to manage administrative tasks just to keep the office functioning. When patients had difficulty getting the responses they needed from the practice, they began lining up in front of the doors every morning, hoping to talk to someone in person. Staff were frustrated; morale was low. “At the end of the day, you felt like you’d just been to war.”

Now, “it’s 10,000 times better,” Ms. Fox says. “When patients come in, everything is clean; it’s professional; all my staff is happy. Patients are laughing when they leave.”

The fax machine has stopped whirring constantly now that athenahealth processes all clinical and financial documents and ties them to the appropriate orders and claims in athenaNet. With all incoming documents now digitized in athenaNet, the work required to manage patient records and claims has been significantly reduced, and there are no longer charts stacked at the front desk. Now, Dr. Fox doesn’t require as many full time staff members to manage this administrative work, reducing employees from nine to four, and the staff he has can focus more on patients and higher-value activities.

Maximizing Revenue with Less Work

When they joined athenahealth in 2015, Dr. Fox’s practice needed to see immediate results in order to turn the practice around. Ms. Fox says they could finally breathe again after going live with athenaOne. “It’s your business, and it’s sink or swim,” says Ms. Fox, “if it hadn’t been for athenahealth, I don’t think we would have survived 2015.”

Prior to using athenaOne, payment came in the form of paper checks and required extra work to sift through the mailbox, file payments, and handle remittances. “That workload was completely lifted, which gave us time to go through all of the old stuff.” In the process, Ms. Fox discovered nearly $20,000 that went back two years that they could reprocess and collect. Having a paper-based practice meant a lack of visibility into financial performance. “We didn’t have a good tally of what our bad debt was,” says Ms. Fox. Now, she has full visibility into claims activity, revenue, and health plan contracts and is able to negotiate better rates with health plans, and uncover revenue opportunities. Through a combination of athenahealth’s years of experience, the resulting collective knowledge on the network, and work that’s been automated, practice staff don’t have to be billing experts to collect full revenue.

One opportunity the practice can take advantage of now is attesting to government quality programs, something they didn’t have bandwidth for before. With reporting tools and quality measures built into the workflow in athenaNet and the support of athenahealth’s teams of in-house experts, the practice has been able to collect quality bonuses and even received a quality award from UnitedHealth. “You can do it, because athenahealth gives you so much information,” says Ms. Fox.

Ms. Fox is able to help the practice improve by comparing their performance to that of their peers on athenahealth’s connected network. She can see how their revenue and quality program results stack up and leverage best practices from high performers on the network to increase revenue. “To have a benchmark and be able to look at your practice according to what other practices are doing, that’s important, because otherwise, you’re just flying blind as a practice manager.”

Better Work-Life Balance

Now that the practice has regained control of their billing, reduced paper work, and improved patient satisfaction and staff engagement, Dr. Fox is able to enjoy a better work-life balance along with his staff. Because athenahealth is cloud-based, Dr. Fox can be more flexible in his schedule: “He doesn’t feel tied to his office. He knows he can go home, work out, and at home he can look for blood test results instead of waiting in the office like he used to. He feels more comfortable because he has his entire patient history and charts at his fingertips, at his will, whenever he needs them.” And concerns about cash flow have been eliminated. “He’s a lot happier and has peace of mind about his financial situation,” says Ms. Fox.

Their practice is thriving and staff feel comfortable with athenahealth, so Ms. Fox is able to enjoy better work-life balance, too, with time to do things like travel to visit colleges with her teenaged daughter, something she never would have been able to do before. “They can check in with me anytime. I can stop, pull up athenahealth, and help my staff. My staff isn’t panicked that I’m leaving for two weeks because they know that everything is under control.”

Ready to talk?

Let's find a time that's convenient for you. 

Schedule 1:1 meeting