Doing (much) more with less. Orthopedic group grows rapidly, without adding staff.

EmergeOrtho is made up of four orthopedic practices that merged in 2016 to become one of the largest physician-owned group practices in the country. Its 363 providers, including 134 physicians, practice across 49 office locations and 18 orthopedic walk-in urgent care centers blanketing North Carolina’s I-40 corridor. For administrators, providers, and staff alike, the merger was the realization of a years-long dream—one they had to overcome many daunting hurdles to achieve.

Hurdles to growth 

For years, Triangle Ortho, one of the four practices that make up EmergeOrtho today, considered expanding. As the healthcare industry evolved around it, the practice worried about being excluded from narrow networks and health plans. With a larger practice came stability, and the possibility of attracting larger employer groups. “Even though we were already one of the larger practices of our kind in the country, we never felt like we were large enough,” explains Chris Adkins, EmergeOrtho’s Chief Administrative Officer.

But to make the 2016 merger possible, Triangle and its fellow member practices (Ortho Wilmington, Blue Ridge Bone & Joint, and Carolina Orthopaedic Specialists) had to overcome several challenges.

The four practices were dispersed across the state, each one operating multiple offices, making it difficult to communicate—a problem made worse by the fact that they were not using the same EHR, revenue cycle management, or practice management systems. Existing administrative staff had little bandwidth to support new providers, let alone coordinate across new practices. There were also concerns about being able to grow without taking on additional overhead costs.

Wicking away low-value administrative work 

When it came time for the four practices to agree on a single EHR and practice management solution, one concern quickly rose to the top of the list: reducing administrative work. Triangle and Wilmington had been athenahealth clients before the 2016 merger. They shared how their clinical and financial workflows had improved, and their experiences swayed Blue Ridge and Carolina Orthopaedic to choose athenahealth’s comprehensive EHR, practice management, patient engagement, and care coordination solution, athenaOne.

After joining the athenahealth network, Blue Ridge and Carolina Orthopaedic saw improvements in both patient engagement and payment collections. Automated call, text, and email reminders enabled staff to reduce no-show rates without spending more time on the phone. Online check-in tools saved time for both patients and staff. Secure messaging with their providers helped patients take an active role in their care. And in addition to automating payment reminders, athenaOne also made it easier for patients to quickly and securely submit payments online, dramatically reducing days in accounts receivable from 61.5 days to less than 30.

“Before athena, one of our practices had an employee in charge of posting claims and following Electronic Fund Transfers as they came in,” Adkins says. “Even if an electronic payment came through, they still had to push it through their legacy practice management system. Now they have transitioned to something that actually brings in revenue.”

Growth without the extra overhead 

In addition to freeing staff up to focus on higher-value tasks, the reduction in administrative work meant that EmergeOrtho’s practices could add more providers without having to also hire additional administrative staff to support those providers. In fact, the Triangle practice more than tripled its number of providers without hiring any additional staff. That’s because athenahealth’s in-house teams took on time-consuming work like submitting claims, posting payments, and appealing denials.

“Since we formed EmergeOrtho, each practice has added additional providers and there has been minimal, if any, increase in administrative staff. If anything, we have not backfilled positions that we have lost to natural turnover. We haven’t needed to because of the efficiencies that athena provides,” explains Robyn Pecora, Electronic Health Records Manager at EmergeOrtho

Because athenaOne connects all clients on a single, cloudbased network, EmergeOrtho’s member practices were also able to shrink their information technology support staff. athenahealth builds and maintains secure interfaces to connect clients to other providers and payers, and monitors network performance around the clock. With no servers to support or back up, and no need to take the system offline to perform upgrades, EmergeOrtho has been able to grow while maintaining a small help desk staff.

“All we’ve been required to provide are computers in good working condition with the right browsers installed,” Adkins says. “The thought of having to build a system from scratch is a huge concern for practices, but athena pretty much delivers a system that’s ready to go.”

Maintaining clinical and financial performance 

Throughout a period of dramatic growth, athenaOne allowed EmergeOrtho to maintain consistently high performance by providing both insight into the combined practices’ financial outcomes and easy-to-use reporting tools, as well as a single EHR solution that cut down the challenges of coordinating care across a large dispersed group of offices.

Being part of the athenahealth network gives EmergeOrtho practices visibility into their own financial performance, and how they compare to their peers. The ability to quickly identify trends has made a big difference across the combined practices. Staff can now easily spot changes in provider productivity, collection rates, and other key indicators of financial health. Today, EmergeOrtho boasts a ratio of 0.185 billing staff to every provider—exceeding athenahealth’s recommended ratio of 0.20.

Revenue tied to quality programs like Meaningful Use is notoriously difficult to capture. But the robust reporting tools in athenaClinicals, the EHR service in athenaOne, have been a game-changer for EmergeOrtho, enabling staff to work collaboratively to support quality programs across all four practices. “The way athena lets us keep up with our reporting responsibilities—that’s one thing I love about athenaClinicals. We use the MIPS Dashboard to see how we’re performing, where we’re failing, and what we need to differently. And it takes less time,” Pecora says.

Moving to athenaOne has also made it easier for the practices to coordinate care across offices and providers. It’s not often that a patient needs to be seen by multiple EmergeOrtho providers. But when one does—as sometimes happens when a patient is injured while vacationing in a different part of the state—being on a single, integrated platform has been a major advantage.

Triangle’s providers, for example, include a hip specialist who performs unique procedures that are difficult to find offered elsewhere. When an internal referral comes in from another EmergeOrtho office, that provider no longer need to complete a data request, but can instead view the patient’s MRI results, medical history, and more directly in their medical record on athenaNet, just as the referring provider entered it.

Ask Adkins and Pecora what the future holds for EmergeOrtho, and they’ll tell you the group is poised for even more growth. “Expansion doesn’t seem difficult to us anymore. For a group of practices that have almost tripled its number of providers, we have minimally increased our billing and administrative staff. I don’t think we could have done that had we not been on athena,” Adkins says.