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Midlands Orthopaedics, P.A.

At a Glance


Inefficient paper records and "clunky" software used by providers at Midlands Orthopedics took time and focus away from patients. With athenahealth, the practice has improved DAR and collections, and they are able to provide innovative services as well as better quality care to their patients.


  • Located in Columbia, S.C.
  • 14 physicians
  • 9 physician assistants and nurse practitioners
  • 3 locations
  • 29,000 unique patients seen per year


  • Unusable software led to reliance on paper-based records 
  • Not enough time and resources to perfect and perform innovative outpatient procedures
  • Low visibility into practice data to convince payers to reimburse for certain procedures



  • Cloud-based services give physicians more time to pursue ongoing training
  • Robust practice data convinces payers to reimburse new procedures
  • Days in accounts receivable reduced 34.9%*
  • No-show rate decreased 23.71%**
  • Collections increased 53.66%*
Orthopedic Practice Gets Support Needed To Innovate and Excel

With athenahealth providing EHR, practice management and patient communication services at Midlands Orthopaedics, physicians have been able to focus on delivering unparalleled orthopedic care across a range of subspecialties.

“There’s a strong reputation here because these physicians are very progressive, they’re very innovative and they’re not afraid to try new things,” says AnnMargaret McCraw, Chief Executive Officer of Midlands Orthopaedics, based in Columbia, South Carolina. “Our doctors are very specialized in what they do because they have the time to pursue ongoing training to get better.”

Having more time for training is critical to staying cutting-edge in a specialty where new techniques and procedures are emerging all the time.
Covering all patient needs outside a hospital

Midlands Ortho provides comprehensive care from 14 fellowship-trained physicians at three locations, including an outpatient surgery center. The practice has approximately 29,000 unique patient visits every year from a diverse rural and urban population in the Columbia, SC area.

Now in its 30th year of operation, the practice has a patient-friendly, non-hospital environment that’s become a real differentiator in the region. “That’s one of the things that makes us unique. There’s a real sense of community. There’s something to be said for a group that can cover all your orthopedic needs. But at the same time, patients don’t get lost in the hospital system,” says McCraw.
Laying a strong financial foundation

Life before partnering with athenahealth was a lot more paper-driven because most of their DOS-based software was just clunky and unusable, says McCraw. That caused the practice to devote too much energy just to staying in business and not enough to perfecting new orthopedic surgery techniques that benefit patients.

Since adopting athenahealth’s practice management, EHR, and patient communication services, the practice’s business performance has improved considerably. Midlands’ days in accounts receivable (DAR) has been reduced 34.9%, from an average of 60 days to just 27 days, and its collections have increased 53.66% since adopting athenaCollector.

athenaCommunicator allows Midlands to continually call patients until outstanding balances are settled or a payment plan is set up. The service also sends automated schedule reminders with ease, helping the practice save time and hassle while reducing its no-show rate by 23.71% since rolling out athenaCommunicator.

“We get more done. We get paid faster and we get paid more. Our physicians have the time to pursue ongoing training to employ better techniques that allow us to move care from a hospital setting to our outpatient surgery center,” says McCraw.
Pioneering outpatient orthopedic procedures

Having more time and financial stability has allowed Midlands Ortho to add even more advanced surgeries like hip resurfacing and joint replacement to its outpatient procedures.

“To my knowledge, no one in the state of South Carolina or the Southeast is doing joint replacement as an outpatient surgery. I don’t know anywhere in the world where hip resurfacing as a subspecialty operation has been done yet as an outpatient surgery,” says Dr. Thomas Gross, Midlands’ pioneer in the hip resurfacing subspecialty. “We’re breaking new ground in doing that. But it’s not like a sudden change. We’ve been working towards this for seven or eight years.”

Dr. Gross was able to work through and correct the difficulties of performing hip resurfacings before approaching McCraw in 2012 about moving the surgery from the hospital to outpatient setting–provided they could find a payer to reimburse them. “There’s no reason patients should have to endure the hospital setting when this is clinically appropriate and available,” says McCraw.

She adds, “the bottom line with payers is if you’re going to consider something new and innovative, yes they care about quality, but they really care about cost.”

Finding a payer to reimburse for these surgeries was only possible because of Midlands’ partnership with athenahealth. “We have to take data to a payer for them to even let us in the door. We have to know what our experience with that payer has been, how many patients we’ve seen from that payer, how many patients may benefit from the surgery, and what the savings achieved for them would have been previously if we had this opportunity. In our particular situation, it was really a cost equation we were taking to the payer. All of that information lives inside athenaCollector and athenaClinicals,” she says.

athenahealth’s services make it easy to obtain the necessary data. “All systems don’t make this easy to figure out. I can’t really imagine pulling that data together from another system as easily as I was able to do it with athena,” adds McCraw.

To date, Midlands has successfully performed 170 hip resurfacing and total hip replacement surgeries, 24 partial knee replacements, and 24 total knee replacements. “We know we can do it and we’re proving it,” says Dr. Gross.
A True Partnership

Moving orthopedic surgical procedures to an outpatient setting has proved to be a more cost-effective and quality solution for patients and payers. The partnership with athenahealth has given Midlands Ortho more time to invest back into the practice.

On the clinical side, physicians like Dr. Gross have more time to perfect world-class and innovative orthopedic procedures in an outpatient setting. On the business side, McCraw has time to convince other organizations how much money they can save by moving certain procedures from a hospital setting over to Midlands Ortho with the data to back up those claims.

“I’m able to be freed up from my daily work to do that and nothing suffers because athena is handling it while I’m not there,” says McCraw.

© March 2014
* Our clients see an average 8% increase in collections and 29% decrease in days in accounts receivable. These figures are based on a weighted average for athenahealth clients with valid pre-athenahealth benchmark data that had their 15-month anniversary with athenahealth through 9/30/2012.

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