Better care, stronger financial performance with athenaOne® Authorization Management

South Texas Spinal Clinic is a 13-office orthopedic surgery and services provider serving the region in and around San Antonio, TX. The practice employs 18 physicians—a team of orthopedic surgeons, pain management physicians, and physical therapists who deliver the finest in orthopedic care.

The clinic’s pain management practice was in high demand, but its resource-intensive process for managing insurance authorizations was causing a bottleneck, resulting in a 6-8 week wait time for most patients.

To solve this challenge, the clinic leveraged athenaOne® Authorization Management services to alleviate the administrative burden and establish a more scalable process, with the goal of reducing patient wait times and enabling growth. The result has been drastically reduced wait times for patients, improved financial performance, and new career opportunities for redeployed staff.

Removing the insurance authorization bottleneck to clear the path for growth

South Texas Spinal Clinic is a multidisciplinary orthopedic services organization, primary focused on orthopedic surgery, physical therapy, and pain management. The pain management practice in particular was a busy operation, performing a high volume of procedures like muscle, joint, and spine injections daily at its two in-house procedure suites.

“Every day of the week we do injections and procedures and our role is to maintain back-to-back appointments for our physicians in order to serve our patient population, because we see people from everywhere,” said Angela Szymblowski, director of clinical operations at South Texas Spinal Clinic.

The clinic employed 4 full-time employees who were focused on managing insurance authorizations to ensure patients were covered for the procedures the physicians recommended. However, the arduous work—involving lots of time on the phone or in payer portals—was a major bottleneck.

This bottleneck was not just an operational hassle: long delays in authorizations were impacting the experience of the clinic’s pain management patients. Because they serve the broad area around San Antonio, many patients drive 2-3 hours for their procedures. For this reason, patients—many of whom suffering from chronic pain—had to schedule appointments out by 6-8 weeks to ensure their authorizations would be settled before they made the long drive to the procedure suite.

Even worse, the difficult and unpredictable authorization process meant physicians couldn’t get all their procedures done, to the hindrance of patients’ quality of life and the clinic’s financial performance. In some extreme cases, physicians opted to simply perform a procedure without knowing if they’d be reimbursed.

“Many times our physicians had to do what was best for the patient at a financial loss because we were just so far behind,” said Szymblowski.

One potential solution the team considered was adding more staff to the 4-person team already doing authorization work. However, they determined that, to effectively manage their volumes, they would need to add 2 or 3 more full-time employees just to manage authorizations. Even more help would be needed as the practice continued to grow.

Rather than starting the search for new support staff, the pain management team decided to pilot the athenaOne® Authorization Management service, offered through the athenaOne platform.

Partnering with athenaOne to streamline insurance authorizations, improve care, and expand

South Texas Spinal Clinic started its initial pilot with the athenaOne® Authorization Management service in November 2021, when the service was newly offered. The decision was made to test the service for pain management authorizations only, due to the high volume of authorizations needed to keep up with procedures.

The pilot, which has turned into a core element in the clinic’s operational model, has been a great success, achieving the outcomes the team had hoped for.

Now, when an order for a procedure is placed through athenaOne, the platform’s Authorization Rules Engine automatically checks against payer requirements to determine if an authorization is needed. The Authorization Rules Engine is highly accurate because it is constantly updated with new knowledge about payer requirements. This knowledge is gained through the many thousands of orders that run through the system daily, which are also monitored and managed by the team behind athenaOne.

The majority of this authorization work is done automatically. In fact, more than 7.4 million orders for authorizations were processed through the engine in 2023¹, with over 98% processed without the need for further intervention.² When a denial or request for peer-to-peer review is issued, athenaOne authorization specialists work to resolve the problem.

Having now used the service for a number of years, South Texas Spinal Clinic has declared the partnership a resounding success. One symptom of this success? Those 2-month wait times have been drastically reduced.

“In terms of productivity and provider efficiency, our ability to serve our patient population went from 6-8 weeks to 2-3 weeks, and many times patients can be seen within five days,” said Szymblowski.

Not only is the clinic providing more timely procedures for patients, it has also been able to achieve its growth goals. These goals have been met, in part, due to an increase in referrals as the clinic’s reputation for fast scheduling and appointment availability has spread.

The clinic now performs between 80 and 90 procedures each day between its 6 pain management providers. The team even has plans to add 2 additional providers in the near future. And, in the time since starting its pilot with athenaOne® Authorization Management, South Texas Spinal Clinic has added a third procedure suite, which they’ve kept busy from day-1 without missing a beat.

Incredibly, South Texas Spinal Clinic is achieving these high volumes with only one staff member involved with the authorization process.

“We went down from having four people to do authorizations to one person being the gatekeeper for this platform,” said Szymblowski.

Rather than spending hours on the phone with payers, that staff member is now in charge of quickly sending all approved authorizations to be scheduled and helping push along any authorizations that require additional information. For urgent cases, this “gatekeeper” can often expedite the approval on the same day it is requested.

Besides this single gatekeeper, the people who were previously responsible for insurance authorizations are now focused on more value-adding work, like educating providers on evolving documentation requirements and staying up to date on shifting payer requirements. This work has helped evolve the clinic into a more sophisticated operation, working proactively instead of reactively.

“We’ve been able to take the opportunity to educate staff and understand things that we haven’t been able in the past because we were always behind a phone or a portal,” said Szymblowski.

South Texas Spinal Clinic’s successful experiment with athenaOne® Authorization Management has been a benefit to everyone involved, and especially in the pain management side of the clinic. Most important, it’s enabled the practice to provide the procedures their patients need, while improving their business’ bottom line.

“The most important part I would say is how valuable is it to continue to maintain and service our patients efficiently and at the same time succeed financially,” said Szymblowski.

Interested in learning more? Schedule a demo and value assessment to find out if athenaOne is the right fit for you.
 

To be as efficient as we are now with athenaOne, we would probably need six or more full-time employees focused on authorizations.

Angela Szymblowski, Director, Clinical Operations, South Texas Spinal Clinic