With less administrative work, an orthopedic practice triples its size

Checking patients’ eligibility for insurance coverage shouldn’t be a full-time job. But at Watauga Orthopaedics, that’s exactly what it was—three full-time jobs, in fact. Before partnering with athenahealth, they employed a team of full-time employees to manage eligibility checking.

“All they did all day long was call and go online and check benefits from the specific payers,” said CEO Kim Wishon. “We were spending hours on the phone to confirm eligibility with the specific payer.” And the practice had to pay their vendor each time they checked eligibility, so they tended to wait until patients came in the door to do so.

Once patients arrived for their appointments, the process became even more complicated. Take the hundreds of walk-ins who came to their clinic each month. When a walk-in patient arrived, he or she would be left waiting while the check-in staff emailed the eligibility department. Then the eligibility department could contact the payer and submit the needed information back to check-in—all before that patient could be seen.

Fewer staff delivering greater value

When Watauga went live with athenaOne, all that changed. With athenaCollector, insurance eligibility is automatically checked by athenaNet in advance of the appointment 94 percent of the time, and the practice can check at will at any time they need to.

In fact, since partnering with athenahealth, Watauga has been able to cut six full-time positions, including the eligibility checking roles and other administrative positions. Some of those staff have remained in other roles to focus on higher value work, while athenahealth handles some of the routine tasks that had previously slowed them down.

Most importantly, now Watauga staff can spend more time on patient care. “They have more face-to-face time with patients [and] with scheduling surgeries,” said Wishon, which are crucial both to delivering better care and bringing in higher revenue.

The Insight to Collect More Revenue, Faster When it comes to the administrative tasks they still perform, Watauga staff work more efficiently and effectively using the industry knowledge that athenahealth provides.

Before using athenaCollector, said Wishon, “Our charge entry person was entering the information [for claims] with 48 sticky notes around her computer,” in order to keep up with changing payer rules. “She’s human, and she would miss some of those, so [sometimes] the bill would be sent out incorrectly…and we would receive a denial.”

athenahealth’s Billing Rules Engine is constantly updated to apply the extensive knowledge of payer rules that has been accumulated over nearly 20 years checking each client’s claims for potential errors and omissions before the claim is ever submitted to the payer. Since using athenaCollector, Watauga’s denial rate decreased from 11 percent in 2011 to 4 percent in 2016—and staff no longer have to rely on one employee’s notes.

Watauga also started implementing best practices identified by studying other high-performing clients on athenahealth’s network to help them collect more revenue, faster.

“We changed our whole billing department to follow athenahealth’s best practices,” said Wishon. “That decreased our charge entry time because we were able to keep up with it much better.” In fact, Watauga’s charge entry lag decreased from 15.8 days in 2011 to 2.1 days in 2016.

Wishon said athenahealth “gives us the tools we need to collect every dollar that we are owed.” That includes collections the practice didn’t even realize they were missing. Reporting capabilities in athenaCollector have allowed Watauga to identify patterns of underpayment in a way that employees wouldn’t be able to on their own. For example, certain PPOs in Tennessee were automatically underpaying workers’ compensation claims, and by loading their fee schedule into athenaCollector and running cost comparison reports, Watauga gained insight into the discrepancy and reported that insurer to the state of Tennessee for investigation.

With less time spent on administrative tasks, Watauga is able to spend time digging into insights that can add new value to the practice. “The reports available within [athenaNet] are very powerful… And it’s very easy to data-drill into any practice performance metrics that you want to see,” said Wishon. “That allows you to identify trends or solve problems that you notice very quickly and effectively.”

A network that scales with practice growth 

Since going live with athenahealth in 2012, Watauga has grown quickly. They’ve added new providers, including one occupational therapist, one hand surgeon, and three midlevel providers over the last three years, and they’ve signed four additional surgeons to start over the next 18 months.

The practice has also tripled the size of their location in Kingsport over the last three years, and that’s allowed them to increase the number of patients they see at that facility from 200 walk-ins per month to 750. “We’ve opened our clinics from 8 a.m. to 8 p.m. for walk-in appointments, and the patients are…flooding through the doors.” For a community that has seen patients struggle to access specialists, that make a real difference in the care they can provide.

As the practice grows, athenahealth scales with them. “The great thing about the athenaNet experience is we already have the infrastructure set up,” said Wishon. There’s no need to purchase additional licenses for new physicians or employ additional billers and coders. New physicians require only a fraction of a full-time employee’s time.

“We’re adding an MRI in Kingsport next year, and you don’t really have to worry about billing and collecting for the MRI. You have to set up the department in athenaNet, and athenahealth takes care of the rest.”

athenahealth is an excellent business partner. They keep you focused on the core business of medicine. They take some of the routine tasks away from you, so you can focus on what’s more important, which is patient care.