How a Customized EHR Implementation with RCM Boosted Practice Growth

Marrying revenue cycle management (RCM) and clinical workflows through a customized EHR implementation helped a pain management practice streamline efficiencies.  

After experiencing rapid practice growth from 2015 to 2017, Commonwealth Pain and Spine sought to standardize care delivery and optimize revenue cycle management (RCM) through a customized EHR implementation.

Jeff Ellison, chief operating officer of Commonwealth Pain and Spine, noted that the pain management practice's "relatively archaic EHR platform" presented workflow challenges for clinicians.

"One of our biggest challenges was that the system wasn't set up appropriately, so providers were creating all these workarounds in the EMR platform and really making their job a lot more difficult," Ellison told EHRIntelligence in an interview. "As we got larger, it was hard to standardize with so many different clinical sites using workarounds and working outside of the EMR."

EHR workarounds, which happen when providers circumvent or temporarily fix a real or perceived system flaw, complicate operations and have implications for clinician burnout and patient safety.

"All physicians have to use an EMR platform; it's just part of how it works," Ellison said. "If you're going to try to avoid burnout for physicians, the system needs to be set up appropriately. It needs to be very intuitive, easy to process, and provide the ability to shortcut systems."

He also explained that Commonwealth was looking for a modern EHR with analytics capabilities.

"Understanding where chronic care management is headed from the standpoint of data collection for our patients, we wanted a platform that could allow us to mine that data without having to be IT experts," Ellison said. "We didn't want to have to write code to be able to collect the data on the patients that we needed to prove that our comprehensive pain program was effective for our patients."

Additionally, Commonwealth wanted to bring its RCM processes in-house, as reliance on third-party companies for RCM presented obstacles for practice operations.

"You have to be able to combine clinical workflows with back-office workflows to maximize your efficiency and your ability to collect appropriately," Ellison said.

"We wanted to reduce our dependency on third-party billing and collecting, contracting, and credentialing companies," he noted. "There wasn't a lot of transparency with those platforms. The data came in the form of an Excel spreadsheet that was converted to a PDF, and we really couldn't use it."

"We were looking for an EMR that we could have some equity in from the standpoint of being able to fit our needs and address our rapid growth,” Ellison said. “For us, that meant being able to set up a structured front of house that allowed us to map procedure codes and create specific scheduling templates."

Commonwealth looked at platforms from various EHR vendors in 2017 and ended up settling on a partnership with athenahealth in 2018 to customize an EHR system.

"We had a pretty heavy lift," Ellison admitted. "We were looking to migrate the engine of our practice to a completely new platform and, at the same time, bring all of these services in-house so that we were in control of our own destiny."

"If we had done that outside of the EMR platform, we would've had to have hired up to 50 or 60 people to do credentialing and contracting and revenue cycle management, denial management, and appeals," he said. "With the creativity of the athenahealth team, we were able to do that with about 15 or 16 people."

Within two years of using the EHR, Commonwealth recognized the potential the system had to help other pain management practices succeed, which led to the creation of ConfirmaMD, a managed services organization.

"We saw that the system we created and the workflows on the clinic and revenue cycle management side was something that we could replicate for smaller practices that struggled to survive in today's environment," Ellison noted.

"The idea of ConfirmaMD is to leverage the technology that athenaOne brings to the table along with the athenahealth Marketplace vendors and the workflows that we've created to allow smaller independent practices to plug into our network to get the same results that we have as a practice," said Ellison, who serves as CEO of ConfirmaMD.

Through the EHR platform, customers can see exactly how long it takes ConfirmaMD to work on claims from the date of service.

"Similar to when we used third-party services, a lot of our clients had expressed a concern that they were kind of slaves to the EMR platform on the front end, but then also slaves to the third-party collectors because they had to rely on them for revenue cycle data," he noted. "With athenahealth, our clients have the ability to check on our progress and to see how we're doing."

"All that data is right there at their fingertips, and it's easy for them to assemble," he said. "It allows them to feel like they're part of the solution and not just doing what they need to do on the front end and wholly reliant on somebody to make sure that the economic side of their business is thriving."

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