Brandywine Urology Consultants Case Study | athenahealth (2022)

Challenges

  • Found separate, siloed electronic health records and revenue cycle management systems cumbersome
  • Claims in accounts receivable for 44 to 48 days
  • 25 percentof claims denied
  • revenue cycle managementsystem would crash when running reports

Solutions

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  • athenaOne®

Results

  • An integrated, intuitive EHR and RCM system provides greater efficiencies for the practice
  • Exceeded collections YoY by 9%+ while seeing 9% fewer patients
  • Claims in accounts receivable for 25 to 27 days
  • Claim denial rate decreased to 4.5% after 12 months
  • On-demand, detailed reporting for staff to review performance

Brandywine Urology Consultants (BUC) used to have issues running reports. In fact, attempts to generate financial reports would frequently cause its previous RCM system to crash. “In athenaNet, I’m able to run reports for a year’s worth of data, and I’ve never waited even 30 seconds for one to run,“ says Nathan Diller, COO of BUC. Such ease-of-use and enhanced capabilities weren’t always available to the practice. Before switching to athenahealth, the group wasn’t satisfied with their systems. Separate EHR and RCM solutions made any exchange of information difficult. Staff had ways of troubleshooting and working around them, but the effort was inefficient and often futile. And the problems just kept mounting. Billing staff did not have an efficient way to “tell what they were missing from a charge capture perspective,” says Diller. The RCM system didn’t add modifiers well, staff constantly chased down payments to post, and “the back-end denial management wasn’t tightly managed.”

The separate EHR and RCM systems were counterintuitive to Brandywine's goal of being "the premiere independent urology group in the State of Delaware,” says Diller. The number of urology groups within Delaware may be small, but it’s a competitive market because patients have easy access to other metro areas in the region. Across three counties, there are roughly 20 to 24 urologists in Delaware. Eight of those physicians practice medicine at BUC in New Castle County.

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When the group’s prior EHR vendor announced that they were replacing its system, it decided not only that it needed a new EHR, but that it was time for a new RCM solution, too. That’s when the medical group started to consider other options, including athenaOne®, an all-in-one EHR, RCM, and patient engagement solution.“athena was compared to five other EHRs. It came down to athena and a urology-specific EHR,” says Diller. In the end, BUC partnered with athenahealth for its strong revenue cycle background and its “great general EHR.”

The ability to succeed and remain independent

On its old RCM system, the medical group had a denial as high as 25 percent. As a result of athenahealth’s proprietary billing rules engine tracks millions of denial scenarios, its denial rate decreased to between 4 percent and 5 percenton a monthly basis. “Our firstpass payment rate has gone up tremendously,” says Diller. In addition, its days in accounts receivable had consistently been between 44 and 48, and now it’s down between 25 and 27 days. That’s not the only success the urology group has seen since partnering with athenahealth. During the year the group implemented athenaOne, it allowed the physicians to lower the number of patients that they felt comfortable seeing. The group saw 9 percentfewer patients that year than it did in the prior year. But its overall collections still exceeded the prior year’s by more than 9 percent.

With less work needed to get clean claims out the door, the billing department staff could focus on other priorities. “There is now a much heavier focus on prior authorizations so that we’re not catching back-end denials with no means of resolution,” says Diller.

Automatic eligibility checking has provided another advantage to the front end of the revenue cycle. “The eligibility functionality has made the lives of the billing staff a lot easier because the charge entry workflows are all superior to what they had previously.” says Diller. But what Diller really likes is that “it allows me to be more focused on things that actually matter, like chasing down revenue in certain age buckets almost in real time.” Diller also finds running a report to be quick and painless: “within less than 15 seconds” Diller says he can have a detailed revenue report and understand patient collections versus payer collections. “Our staff like the reporting functionality. That makes their life a lot easier,” says Diller.

The insight to identify new opportunities for growth

With easier access to patient data, Brandywine UC was able to identify care gaps and expand their practice in the processing of filling them. The urology group implemented GAINSWave, a shock wave therapy treatment for erectile dysfunction (ED). To determine opportunities to offer this new treatment, the group used athenahealth’s reporting capabilities to identify all existing patients with a diagnosis of ED who were prescribed sildenafil. It sent out an automated patient outreach campaign to inform patients of the new service. The front-desk staff set up a separate phone line to proactively manage those calls. As a result of the tailored patient outreach campaign, “we’ve now treated over 100 patients. And it’s not uncommon for us to treat an additional seven to tenpatients per month.” It’s a service that is primarily cash-based with collections received at the time of service. Diller can easily track the growth of this treatment as a new revenue stream through the reporting functionality so he can easily report on progress to the physician leaders monthly.

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The group has begun developing an Advanced Prostate Cancer Center that offers Provenge, an immunotherapy treatment for prostate cancer. The group uses athenahealth’s reporting capabilities to identify patients who would benefit from this treatment. Then after the patients are seen, “athena helps us make sure those claims go out clean,” says Diller. Provenge-related claims are particularly important to the practice because one patient can have up to three infusions within sixweeks. “The Medicare reimbursement for one Provenge infusion is in the mid-$40,000 range,” says Diller. “If a claim was denied because we didn’t have the right referral or prior authorization in place, it will have a substantially negative impact on both the practice and potentially the patient.” Instead of having to worry about getting paid for these treatments, Diller can feel excited that his group can provide patients in Delaware the best quality of care. “The whole goal of this Advanced Prostate Cancer Center is that patients won’t have to leave the state to get this care,” says Diller.

The right choice for urology practices

Independent groups like BUC are often on their own to ensure the success of their business. But, since Diller can rely on athenahealth and their customer success managers (CSM), the group stands armin-arm with a dedicated partner and healthcare expert. “Our CSM works with a lot of urology practices, so he has developed expertise in the specialty and can understand the challenges we face,” says Diller. The group’s CSM reviews monthly performance reports with Diller, which offer “an overall look at how we’re doing as a practice.” With that report Diller and the billing staff can target key areas in which they see room for improvement.

“If your urology practice is like most, then the tools in athena are going to allow you to be more effective in doing what you’re passionate about,” says Diller. BUC has seen substantial growth and remains independent in a market that sees urologists burning out; Diller sees a trend of experienced urologists either moving to an employed model or retiring. “Decreasing overall stress on independent urologists is really important to making sure that they’re still finding joy and satisfaction in what they do,” says Diller, “and not worrying about finances because you’ve got a good partner goes a long way.”

“If your urology practice is like most, then the tools in athena are going to allow you to be more effective in doing what you’re passionate about.”

— Nathan Diller, COO of Brandywine Urology Consultants

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Claim scrubbingAthenahealth uses a rules engine to keep its first-pass acceptance rate above the industry standard.Denied-claim managementAthenahealth will manage some of your denied or rejected claims, but unlike other providers we reviewed, it won't manage all of your denials.EMR and PMS inclusionAthenahealth includes access to its EMR and PMS with its billing services.Integrated clearinghouseAthenahealth files claims either through its integrated clearinghouse or directly to payers.Medical billing dashboardAthenahealth's RCM dashboard shows all your financial data so you can get performance insights around the clock.Follow-up on unpaid claimsIf payers or patients aren't paying what they owe you, athenahealth will handle all follow-up.. However, a 99% FPAR isn't 100% – that just doesn't exist.. Company representatives have told us that, over time, athenahealth will begin handling all denials and rejections in-house.. In addition to these customer service resources, there is an account management team that proactively contacts you to discuss practice improvements.. [Looking for user-friendly medical billing services and software?. Athenahealth is the rare medical billing company that manages only some of your denied claims.. Athenahealth offers all of these benefits in athenaCollector, making it our pick for the best medical billing service for reporting.. AthenaCollector, athenahealth's medical billing service, costs a percentage of your monthly practice collections.

athenahealth partners with more than 140,000 ambulatory care providers, throughout all 50 states and across more than 120 specialties, to accelerate the pace of healthcare innovation and support the delivery of leading clinical and financial outcomes.. athenahealth’s solutions and services enable its customers to increase clinical efficiency, optimize financial performance, improve patient care outcomes, and support providers in accelerating their shift toward value-based care.. “Today marks a significant milestone for athenahealth and our partnership with Veritas Capital and Evergreen Coast Capital, and we are thrilled to work with Hellman & Friedman and Bain Capital to drive the next phase of our growth journey.. “Given our deep experience in software and healthcare, we are excited to work with Bob and the executive team to rapidly scale the business and continue to innovate and grow alongside our most disruptive and innovative ambulatory care clients to build the foundations of a multi-sided digital care network between patient, payer, and provider,” said Allen Thorpe, partner at Hellman & Friedman .. “Over the course of our successful partnership with Bob and the management team, athenahealth has driven tremendous growth and transformation, reinforcing its position as the premier healthcare IT company supporting the largest nationwide network of healthcare providers,” said Ramzi Musallam, CEO and managing partner of Veritas Capital .. “Elliott is proud to have worked with Veritas to help transform athenahealth, and we welcome Hellman & Friedman and Bain Capital as new stewards of this unique and important healthcare leader.”. In addition to Hellman & Friedman, Bain Capital Private Equity, and Bain Capital Tech Opportunities, the investor group includes Veritas Capital and Evergreen Coast Capital, which will each retain a minority investment in athenahealth, as well as other new coinvestors, including GIC, Singapore’s sovereign wealth fund, and a wholly owned subsidiary of the Abu Dhabi Investment Authority (ADIA).. Bain Capital has partnered closely with management teams to provide the strategic resources that build great companies and help them thrive since its founding in 1984.. Among these investments has been partnering with dynamic healthcare companies dedicated to quality, access, innovation and improved patient outcomes (to learn more please visit https://www.baincapital.com/healthcare/ ), and with scale and disruptive technology businesses where the firm’s in depth knowledge of fundamental trends, insight into evolving customer dynamics, and vertical market expertise helps accelerate growth.

Customization100Pricing90Consultation100Revenue cycle management90Patient portal70 We recommend athenahealth as the best medical software vendor for reporting because the athenaOne software can generate customizable weekly and monthly reports with seemingly limitless filters.. Patients can use the calendar to easily schedule appointments via the patient portal as well.Appointment schedulingAthenaOne's appointment view displays all patient billing info and includes A/B testing tools that determine the best way to remind patients of their appointments.Billing toolsAthenaCollector offers a wide suite of billing tools for scrubbing medical claims and managing rejections and denials (though you'll still need a medical biller on staff).Clinical notesAthenaClinicals enables easy notetaking by whatever method you prefer.Customizable reportsAthenahealth's customizable weekly and monthly reports have seemingly countless filters.Electronic ordersThrough athenaClinicals, you can order new labs and prescriptions while adding diagnoses.InteroperabilityAthenahealth's interoperability tools facilitate the seamless sending of patient data to other providers and vice versa.Medical practice networkAthenaNet comprises 150,000 providers and leverages data from all of them to offer recommendations for optimizing performance.Patient intakeThe athenaClinicals patient notes clearly display allergies, medical conditions and medication history alongside a patient's waiting room status, visit history and vitals.Patient portalAthenaCommunicator offers a patient portal that includes tools for patient appointment scheduling and HIPAA-compliant messaging.TelehealthAthenahealth's telehealth capabilities are embedded in its EHR, and patients can join appointments without any new software or special devices.. In our testing, we especially liked the calendar's tools for calculating how many scheduled patients are onsite at your practice, thus helping to monitor for inefficiencies that could be detrimental to the patient experience.. Athenahealth's scheduling feature keeps patients in touch with your practice.. In our examination of this software, we noticed that athenahealth emphasizes patient engagement and gives patients tools to get directly involved in their healthcare experiences.. Patients can log in to athenahealth's patient portal to request new appointments and prescription refills.. Patients can use the athenahealth patient portal to complete intake forms and pay bills.The patient portal includes a HIPAA-compliant messaging tool that lets patients contact your staff whenever, wherever.. For this review, we compared athenahealth to dozens of other medical software solutions – see our review of AdvancedMD and our DrChrono review for examples – and paid close attention to the reporting features available on each platform, to ensure that all of our recommendations included extensive reporting functions.. Patients can log in to the athenahealth patient portal to contact doctors, schedule appointments, request prescription refills and pay bills.

WATERTOWN, Mass., November 22, 2021 --( BUSINESS WIRE )-- athenahealth, Inc. ("athenahealth" or "the Company"), a leading provider of cloud-based enterprise software solutions for medical groups and health systems nationwide, today announced it has entered into a definitive agreement to be jointly acquired by affiliates of Bain Capital and Hellman & Friedman for $17 billion.. "Today marks a significant milestone for athenahealth and our partnership with Veritas Capital and Evergreen Coast Capital, and we are thrilled to work with Hellman & Friedman and Bain Capital to drive the next phase of our growth journey.. "athenahealth is at the frontier of digital health in the United States, enhancing the clinical quality, operational efficiency, and delivery of preventive care to nearly 20% of the population today, unlocking the front door of the consumer healthcare journey and positioning the Company to support physicians in the continuing shift towards value-based care," said Devin O’Reilly, a managing director at Bain Capital Private Equity .. "We are excited to leverage our extensive vertical software and healthcare experience to help Bob and the management team accelerate growth, develop new products, gain market share, and continue to innovate in a highly scalable and vitally important end market," added David Humphrey, a managing director at Bain Capital Private Equity .. "Over the course of our successful partnership with Bob and the management team, athenahealth has driven tremendous growth and transformation, reinforcing its position as the premier healthcare IT company supporting the largest nationwide network of healthcare providers," said Ramzi Musallam, CEO and managing partner of Veritas Capital .. "athenahealth demonstrates what can happen when a team of dedicated and talented employees and executives is given the right resources to invest in innovation and to help improve the quality of care that its providers are able to deliver," said Jesse Cohn, managing partner, and Marc Steinberg, senior portfolio manager, on behalf of Evergreen Coast Capital, an affiliate of Elliott Investment Management.. In addition to Hellman & Friedman, Bain Capital Private Equity, and Bain Capital Tech Opportunities, the investor group includes Veritas Capital and Evergreen Coast Capital, which will each retain a minority investment in athenahealth, as well as other new coinvestors, including GIC, Singapore’s sovereign wealth fund, and a wholly owned subsidiary of the Abu Dhabi Investment Authority (ADIA).. Bain Capital Private Equity ( http://www.baincapitalprivateequity.com ) has a global team of more than 275 investment professionals which creates value for its portfolio companies through its global platform and depth of expertise in key vertical industries including healthcare and technology.. Among these investments has been partnering with dynamic healthcare companies dedicated to quality, access, innovation and improved patient outcomes (to learn more please visit https://www.baincapital.com/healthcare/ ), and with scale and disruptive technology businesses where the firm’s in depth knowledge of fundamental trends, insight into evolving customer dynamics, and vertical market expertise helps accelerate growth.. In addition to private equity, Bain Capital invests across asset classes including credit, public equity, venture capital, real estate and insurance, managing approximately $150 billion in total and leveraging the firm's shared platform to capture opportunities in strategic areas of focus.

There may be better EMR softwares but nobody competes Athenahealth on PM, billing, EMR, patient portal, integrated functionality, and affordable cost.. Verdict: Consider the cost, it is on the higher side, but you do get a great product, ahead of most systems, easy to work with and integrates easily with other programs that we utilize.. Pros: This EMR software is User friendly, EMR and billing in one system, card on file, works with other outside companies, instant messaging. Pros: Flows overall efficiently, well integrated system; scheduling, clinic notes, billing, patient portal.. Pros: Reminder calls, insurance validation, eligibility and phone daily report, ticklers that remind patient to schedule an appointment if not done at check out, ease of entering/dropping claims, ability to generate useful and custom reports, day end review allows you to see if any claims need corrections immediately

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