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David J. MacGregor Dermatology

More Control and More Visibility for Better Care


After temporarily losing the ability to access patient information from his previous software system, dermatologist David MacGregor, MD, needed a cloud-based medical billing service that could move with him, provide greater control over his practice, and increase efficiencies for staff.


  • Located in San Francisco, CA
  • Solo practice board-certified dermatologist*
  • One physician assistant, one medical assistant, one back office manager, one part-time billing support contractor
  • Sees an average 900 patients per month
  • Overcome flaws of inherited practice management system
  • Achieve an integrated solution from a tablet
  • Make workflow more efficient and reduce after hours work
Solutions Results
  • Average days in accounts receivable (DAR) reduced 40%
  • Appointments per provider up 14.8%**
  • Staff able to leave an hour earlier every night with work complete††
More Control and More Visibility for Better Care

Dr. David MacGregor runs a dermatology practice in downtown San Francisco, in the bustling commercial district near Union Square, blocks away from the city’s glass and steel corporate core. He has 17,000 registered patients, many of them the kind of young, hip, tech-literate 20- and 30-somethings who can appreciate looking their best with professional skin care and understand the benefits of having their medical records in the cloud.

Being from a generation that conducts so much of its life online, Dr. MacGregor’s patients often ask about his use of a tablet during exams, running athenaCollector, athenaClinicals, and most recently athenaCommunicator.

“Out here we’re pretty tech-familiar and Internet-savvy so the concept is pretty appealing,” he says. “We talk about it all the time. They have a universally high regard for what we are doing.”

But all was not so slick at first. MacGregor joined the practice in 2003 and when he took it over in 2006, the existing arrangement for outsourced billing and scheduling collapsed, nearly crippling the business.
From Acute Pain to “Good Stuff”

Buying a practice is supposed to be easier than it was for Dr. MacGregor. The idea is to inherit the infrastructure, employees and the billing system and go from there. “You roll right into a working practice,” he says. “Everything should be there and turnkey.”

But after a year, the billing and scheduling manager—a former member of the practice staff who had gone independent—wanted to change the business parameters. He offered a new contract that was unpalatable to Dr. MacGregor.

“The terms were totally onerous. I smelled a rat. I said 'No, that's a bunch of baloney'," he recalls.

MacGregor wanted out but the scheduler had the patient information database on his server. MacGregor needed the information but had no interest in having the legacy software system at the practice. “It was a crappy old interface. It needed all these updates.”

The disagreement over the new contract escalated to the point that the billing manager shut off the scheduling program, throwing the practice into acute pain. MacGregor started considering his legal options.

“We had a huge rupture,” he says. Without access to the patient database, “We had to treat every patient that walked in the door as a new patient.”

So MacGregor called the practice management consultant who had negotiated the sale of the practice. The consultant recommended athenaCollector.

The cloud-based practice management service was implemented in May 2007 and, as MacGregor puts it, “It’s been good stuff ever since.”

Transparency and Control

Dr. MacGregor is the first to acknowledge that medical billing isn’t exactly sexy if you are practicing medicine. But he did like the interface of athenaCollector. And he was happy that his staff still liked it two or three months after implementation. For someone who had temporarily lost the ability to access patient information, the transparency and easy grasp of patient information was a welcome relief.

“I like the idea of having a little more control. It’s like a hybrid. You’re not farming it out completely,” he says.

The cloud-based nature of athenahealth services means information he needs isn’t piled into servers in closets in the office and it’s not at some remote site or nearby hospital where he can’t get at it. The scut work of billing and claims processing gets done elsewhere while he has the information he needs to provide patient care and keep the business of the practice running smoothly.

“It’s not the black box paradigm anymore with one person with a sheet of paper and you had no idea how much work they were doing or which claims they weren’t pursuing, and which they were throwing in the round file,” he says. “With athena you feel like you know what’s going on.”
Reaching ‘Total Enchantment’ and ‘Evolutionary Perfection’

Like most doctors who first attempt to use an EHR, MacGregor was worried that the new tool would slow him down. For a while it didn’t save him any time. athenaClinicals—the cloud-based Stage 1 Meaningful Use-certified EHR—took some getting used to. But then he could see he was starting to document better. Integrated with athenaCollector, it was easier to remember to bill. If he needs to hop from the EHR over into billing or demographics, it's an easy click away.

“My total enchantment with the whole thing, it didn’t reach the point of ecstasy until I was a year into athenaClinicals [in early 2010]. It just feels so powerful. You have everything together, clicking along. I feel extremely efficient now—how seamless it all is, how easy it is even as a clinician to move around.”

In addition to photographing dermatological conditions for the patient chart, MacGregor finds it extremely valuable to include patient headshots as part of the check-in process. It’s a crucial recall device when you have 17,000 registered patients and see 40 to 50 of them per day. “You feel so empowered. You remember the person and their conditions instantly.”

And as a doctor with a personal interest in improvements to technology, he enjoys what he calls the “evolutionary perfection of athenaClinicals.”

“athenaClinicals just continues to get better,” he says. “Every single day I find something I can tweak or use. You’ve got it all right there. It’s crystal clear.”
Getting Home on Time

In March 2011, MacGregor’s practice went live on athenaCommunicator, athenahealth’s on-demand, automated, and live communication services. He looks forward to it taking care of tasks like contacting a patient about normal lab results which would not have warranted a phone call in the past. More broadly, he looks to athenaCommunicator to save his staff time and hassle, fill his schedule, reduce no-shows and improve engagement with patients.

“I’ve been meaning to get into that space for a long time with the practice website,” he says. Now he has a Patient Web Portal so patients can update insurance information, demographics, as well as access outbound messaging, test results, and provider information, all in one spot.

MacGregor appreciates the improvements he’s seen when it comes to running his practice. For example, it used to be that he and his staff had two hours of work still waiting for them after 5pm when the last patients left. Now with the practice running on all three athenahealth services, not only do they wrap up the work in under an hour, but it’s complete, leaving a clean slate for the next day.

“Getting out of the office at the end of the day is my metric,” he says. “It just makes the whole practice better. It’s more efficient. It kind of cleans everything up. Everything is tightened up. And we just do a better job of delivering health care.”

* David J. MacGregor, M.D. participates in athenahealth’s National Showcase Client Program. For more information on this program, please visit

** Doctors on athenaClinicals®, our web-based EHR service, see an average 3.4% increase in patient visits. This average increase in patient visits is based on a comparison of the average change in patient visits for clients without athenaClinicals with that for clients that had their six-month anniversary on athenaClinicals during the year ended November 30, 2009.

† athenahealth clients see an average 37% decrease in days in accounts receivable (DAR). This average reduction in DAR is based on a weighted average for athenahealth clients with valid pre-athenahealth benchmark data that had their 15-month anniversary with athenahealth during 2009.

†† Due to the unique nature of each individual practice, we are unable to determine how much time the average practice using athenaCollector, athenaClinicals and athenaCommunicator is likely to save due to less work.

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