For those considering an MSO, hospital offers 7 valuable insights

By Carley Thornell | June 16, 2020


Elizabeth (Liz) Durante has worked for Mount Sinai South Nassau Hospital for almost two decades – long before the 455-bed, not-for-profit hospital added several ambulatory practices throughout Long Island that needed integrated electronic health record systems.

“In 2012, we had a vice president who came to me and said, ‘How long will it take you to get a practice on an EHR system?’,” said Durante, who is now director of physician integration. “And I said… ‘I’m not sure—we don’t have one.’” The answer was just 90 days for the first practice to implement athenaOne with the support of managed services organization Caduceus. The hospital system has since seen monumental growth thanks to its partnership with athenahealth and the MSO. Not only does MSSN have invaluable transparency into billing activity and quality data, but embedded MSO staff, training, and ongoing support from each partner also contributes to overall satisfaction and financial performance. By working with CaduceusHealth and using athenaCollector for revenue cycle management and athenaCommunicator for patient engagement across the hospital organization, the enterprise is able to improve its financial performance significantly. For instance, comparing April 2018-March 2019 to April 2019-March 2020, MSSN increased collections by more than 29 percent year-over-year, and charges increased by 4 percent.

In a conversation with athenahealth, Durante and her colleagues shared their insights on why the right technology and ongoing support from an MSO is the best way for them to achieve their administrative and financial goals, along with the ability to provide an award-winning patient experience.

How does partnering with athenahealth and Caduceushealth help solve your organization’s three biggest challenges?

Leakage – when patients leave a hospital network in favor of out-of-network providers – can be a significant financial hindrance, says Michael Friedman, Executive Director of MSSN’s managed services organization. “If you look at referral patterns, that's something we can [with the use of Caduceus data] quantify. We have data to say, ‘Maybe you’re sending us only 60 percent of your radiology (orders). Why? Is it the service, is it the location?’ You can have the data to present to start those conversations.”

Durante and Dr. Anthony Rosalia, physician liaison for the hospitals’ accountable care organization, said that for generating quality and financial reports, the quality of data and ease of accessing it makes their day-to-day smoother. “I love it because we can slice and dice and get down to a lot of detail in athena with all the different types of robust reports,” said Durante. “They’re also very easy to generate.”

And when it comes to billing and training, Durante said that due to limited resources, an MSO is essential. “Caduceus does a lot for us, they’re almost like our system administrators within athenahealth,” she said. “We utilize Caduceus staff to do all the builds in athena.” The MSO staff also trains physicians, clinical staff in practices, and front desk and registration staff on how to use the system, which has “very user-friendly” modules. And for unexpected situations when Durante can’t hire or train people fast enough — like COVID-19 — Caduceus’ staff got MSSN caught up with a large coding and billing backlog.

How else has the support of CaduceusHealth and athenahealth helped you during the pandemic?

“We were told by our CIO that we had to stand up a telemedicine solution with some sort of video conferencing system in a matter of days,” said Rosalia. “Literally, within one-and-a-half days after I reached out, Caduceus set up a mirror of all of our athena locations in a telemedicine solution.” 

Friedman said their speedy work contributed to fiscal success. “We went from zero to 100 miles an hour. The amount of telehealth visits we were able to schedule into athena and the ease of it … we really were able to keep up with the revenue,” he said — estimating that 2,500 out of 4,000 billable appointments in the first month were conducted via telehealth. 

What are some other ways partnering with athenahealth and CaduceusHealth has supported profitability?

On the front end and claims going out the door, the hospital system is “about 98 percent clean going out the door,” estimated Durante. “That’s an awesome number, really amazing.” Backend denials in the practices are also low. Due to different rules for some hospital billing, denials are higher — but Durante said reconciling data is easy. “In athena, we can clean up those edits pretty quickly. … Since all those edits are already built into athena (through a custom rules engine), you basically know what you have to work right away. 

Your telehealth integration was speedy, but what other great results have you seen from long-term projects like your recent TIN consolidation?

“It's great for the patients, it's great for the physicians,” said Friedman of the months-long endeavor to move patients to a single chart. No matter what the location within the hospital system, physicians now see a patient’s entire record, including specialties like radiology and gastroenterology that previously required more legwork to access. “For the short amount of time we did it in and the amount of resources we had, the results have been very good. And we had a lot of support from Caduceus staff and athena.” 

There was a staggered approach to move specialties onto the new tax identification number, and some “mini challenges” like interfacing labs and prescriptions between charts. “But it was really pretty fast,” explained Durante. “It’s basically like we set a date and flipped a switch.” 

The data can now be pulled into a data warehouse for Rosalia’s team to make Tableau dashboards and charts. His team previously struggled with separate TINs assigned to physicians by the location they were working. “The consolidation really eliminated siloed systems,” he said. 

Can you share more about how your partnership and technology improve the day-to-day experience of staff who work with patients?

Even something seemingly as minor as processing faxes adds up incrementally, said Rosalia. “The ability of athena to easily ingest data through faxes—that saves a lot of time. When it’s automatically put into that chart, it’s a big (difference) for front-desk staff.” 

Friedman concurred, saying that the patient experience is now more seamless thanks to the TIN consolidation. “You can move patients along in the office quicker because you don’t have to call, for instance, a specialist’s office to get a consult report that maybe wasn't faxed over to you. It’s about efficiency.” 

Practice Operations Manager Tinika Henry says that the partnership has “streamlined the whole patient process,” citing systems training from Caduceus that makes it easy for her staff to explain features like the patient portal and online payment options. Durante added that athenahealth’s Success Community and online learning have helped keep everyone engaged and informed. 

How do you think your MSO partnership will benefit future growth?

“I've been putting together a department where we're going to enhance and take on more nursing homes for our hospitalists,” said Friedman. “When we move forward, it's going to be an easy transition if we use Caduceus to do the billing, considering all the information is there. So, it's really just a statement of work needed — just to expand our book of business, it's pretty easy for us to work with athena and Caduceus to simply get it up and running.” 

What advice would you have for another enterprise considering a similar MSO structure?

Durante says there’s a reason she’s been working with Caduceus for 17 years: “They're a company with more of a ‘Yes, I can do that’ attitude as opposed to ‘No, we don't do that.’ They always try to bring forth a solution for us.”

What that often means are customization options. “There’s so many different ways that you can utilize them. So, say a practice was doing its billing in-house and it became too overwhelming for their own staff to do it and they're using athena — athena can come in and clean up all that old information for them,” Durante explained. “Caduceus can offer all sorts of support to them. They can offer credentialing support, coding support, billing support, analytical support. There’s so many great qualities.” 

Henry contributed that using Caduceus along with athena provides the optimal experience. “All in all, after working with various EMR systems, athena by far makes our lives in the office easier.” 

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