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Wilson Stream Family Practice

Staying Independent, With a Business Partner


Struggling to keep its independence, Wilson Stream Family Practice needed to improve financial efficiency and data management. With athenahealth's medical billing and EHR services, the practice was able to organize clinical data, make patient visits more efficient, and improve overall quality of care.



  • Located in Farmington, ME
  • 2 full-time physicians, 1 nurse practitioner
  • 2 part-time and 1 full-time medical assistant
  • 1 office manager
  • 2 full-time receptionists
  • 450-500 patient visits per month


  • Poor data management
  • Needed to improve financial efficiency
  • Goals for improving the quality of care
  • Struggling to stay independent



  • Able to generate quality and outcome measure reports
  • Clinical data is organized and retrievable
  • More efficient patient visits
  • Practice able to maintain independence
'We Preferred Our Independence'

Farmington is a community of about 7,000 in western Maine's Franklin County. The demographics range from rural poor to the affluent. The workforce supports the paper industry, a local ski resort, a state university campus, and the Franklin Community Health Network.

When Drs. Steve Bien and Jeff Fuson opened Wilson Stream Family Practice 29 years ago, Farmington's six primary care practices were all independent. Over the last ten years, the 70-bed Franklin Memorial Hospital health network has absorbed all but two. At the same time, the pressures on small practices grew as they were expected to follow the same increasingly complex billing and coding rules as the hospital-based practices but without the expertise or staffing. Work and expenses mounted while reimbursements dropped.

Five years ago, Franklin contacted Wilson Stream. Even though the pressure on the practice to sell was growing, Bien and Fuson had other ideas.

"We were approached by the hospital at one point but we preferred our independence," Bien says.

To Bien and Fuson, being independent medical providers in rural Maine means maintaining a personal approach to patients. They believe that kind of relationship would have been lost if they sold out.
'We Were Absolutely Drowning'

But when it also started getting harder to get paid five years ago, beautiful rural Maine began to feel like bleak, isolated Maine. Now, added rules, mandates and administrative burdens make it worse. Forces beyond Bien's control threatened to erode the personal bonds that small practices like Wilson Stream value.

"We were absolutely drowning," he says. His billing manager wrote checks with no window for any overview. There were no best practices to follow, DAR comparisons, nothing substantive. "We had no idea."

He also realized the practice needed to purchase an EHR, but they were all expensive and colleagues using them had nothing but complaints.

"None of them had anything good to say about their experience," he says. "There was nobody who was happy. I started thinking maybe the EHR rollouts were premature."

Then Bien came across an athenahealth whitepaper about the 5-stage workflow and was relieved to learn that someone understood the reality of trying to drive efficiencies and revenue for a small medical practice.
Now we're 'Connected To All These Other Practices'

After implementing on athenaCollector in August 2010, Bien immediately felt less isolated in rural Maine. He gained a business partner that was working behind the scenes to get him paid and he got connected to a network of other practices around the country. His billing manager's role immediately shifted from just trying to keep the checks flowing to being able to look at cases, solve problems and examine cash flows, which have improved because the payment cycle has shortened.

"It was tremendously attractive that you have worked into your system a collaborative model so our practice, through the rules engine, is connected to all these other practices and that our business is available to look at," he says.

athenahealth's business model aligns its interests with its clients. Serving as a partner and not a vendor, athenahealth only succeeds if practices like Wilson Stream succeed. That means that all practices, regardless of size, are highly valued.

"If anything, they have exceeded my expectations in terms of their service and interest in us," Bien says. "They are prompt and thorough in working through our questions and problems from start to finish. We are a small practice and yet they pay a lot of attention to us and that's not what you usually get in these types of relationships."
'The Value of Each Visit Has Gone Up'

With the revenue cycle under control, Bien's use of the athenaClinicals cloud-based EHR has allowed him to concentrate again on patient care. With a paper chart, Bien says he was always reacting to the patient in the exam room without being able to really make the most of the time. Now he can look at all the data in one place and really focus on what each patient needs.

"I go into every exam room knowing what I want to do. My time is much more organized, more intelligent and valuable," he says. "And the value of each visit has gone up."

Although Bien says he was a "left-wing radical" during his college years, he welcomes the role, responsibilities and challenges of being a physician. But the choice to remain independent meant the practice had to find its own solutions for billing services and EHR. Because of the cloud-based services provided by athenahealth, he has been able to preserve the bond with patients that come with running a small rural practice.

"You develop a very special relationship through implied responsibility. I like that the buck stops with me," he says. "It keeps you sharp and honest."

It also allows him to better balance work and life. If he wants to leave the office at 2pm and finish up work from home or prepare for the next day, he can do it because of the anytime, anywhere access a cloud-based EHR and medical billing service affords him.

"In a rural state, my situation as a small, free standing practice is not at all unique and often feels in jeopardy. We value our independence but how do you survive as a small business when there is so much more financial complexity and reimbursement has become such a struggle?" Bien says. "Our fit with athenahealth feels perfect. Our practice has become financially stronger through our networking with them and yet we keep our independence and are even better able to practice the medicine we want."

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