Carlos Drayton believes in the cloud. But as practice administrator at Atlanta-based Princeton Lakes Pediatrics he’s also well aware that in a market flush with cloud technology options—many of mixed capabilities—making the best choice for your practice is far from simple. Case in point: In 2013, Princeton Lakes made the switch from one cloud-based EHR and revenue cycle solution to another—only to make the move back to its original system less than a year later.
Here’s how Drayton navigated three EHR and billing systems in less than ten years, why he cautions that not all “clouds” are created equal, and why he believes cloud-based technologies are the best way for small practices to stay independent and solvent.
Princeton Lakes Pediatrics first made the leap to the cloud in 2008. Describe the experience.
The majority of patients we treat in both our Atlanta and Kennesaw, Georgia offices are on Medicaid, so operational margins tend to be extremely tight. The financial struggle for our practice, as well as others like us, is very real. Coming off a disastrous client server experience, our first priority was getting control of the financials. Second was investing in flexible, cloud-based technology and services that could grow with us by helping integrate and streamline our workflows and billing processes, and equally as important, help us adapt and keep our doors open.
I was also excited that I no longer had to manage our unreliable server, which was a time drain. It’s not something I was trained to do, nor could we afford to hire an IT professional to manage it. What we were looking for was a one-stop shop that would free us up from client servers and administrative work like managing faxes and submitting referrals. We eventually decided on athenahealth. Financially, we saw improvement through small efficiencies and a RCM solution with a rules engine intuitive enough to correct my mistakes if, for instance, I forgot to add a modifier to a claim.
We are now able to stay ahead of payer changes because we are part of a network powered by more than 40 million payer rules that come from the processing of 140 million claims per year. athenahealth’s network can capture data on payer standards, denials and pay-for-performance opportunities, and learn from this data to help us submit cleaner claims the first time around, expediting any payments and putting more money in the operating budget.
Princeton Lakes left athenahealth for eClinicalWorks, and in a turn of events circled back to athenahealth just nine months later. Why the back and forth?
As a small business, every dollar counts. In 2007 my wife and I had twins and by the following year we were expecting another. Trying our best to keep a mom-and-pop practice open with three children under the age of two, my only thought was ‘How can I save money? Where can we cut?’ We decided to save money by trying out eClinicalWorks (eCW). Going with a cheaper option seemed a wise financial move at the time, but as they say, hindsight is 20/20.
We were assigned a project manager at eCW who helped with claims. However, three months in, we were transferred to a manager in another country, which presented serious time zone challenges.
Fixing and editing claims became labor intensive and reporting was a nuisance that required logging into a separate system. Nothing was intuitive. If a report wasn’t standard within the system, you’d pay extra. Meaningful Use reporting was an additional cost. There were monthly fees, “adding a provider” fee, interface fees, and more. Slowly, the cost increased as did problems, while the benefits and overall value diminished.
The greatest issue was with upgrades. The company purports to be cloud-based but every upgrade needed to be uploaded manually on each computer.
Bottom line: I did much more work with eCW as our vendor and we were constantly nickel and dimed.
Nine months in, we made the switch back to our original cloud service (athenahealth). Frankly, we missed the little (and big) ways we were supported that when combined mean a great deal to a small practice. Like being able to access our EHR outside of the office, pull up streamlined reporting tools, track our Meaningful Use performance within the EHR workflow, or take advantage of bi-directional interfaces to connect to state immunization registries (a big plus for the pediatricians). Our current system works; it pays for itself.
What do you see as the biggest opportunity in cloud-based Health IT?
Technology, if designed well, should help us as providers become better care managers and build stronger touchpoints with patients. Communication through the patient portal is one of our most powerful tools. For example, when Atlanta was hit with the tail-end of Hurricane Harvey, it left our office without power. I was able to keep in touch with patients by creating an email campaign through our portal that alerted everyone scheduled that our office would be closed. That campaign alone saved me from hours of manual outreach and improved the patient experience.
What advice do you have for those who are looking make the switch to the cloud?
Do your homework and find a system that can handle your needs as well as those of your patients. Specifically, inquire about services and features like the patient portal, e-prescribing, secure communication with patients, online bill pay, and appointment reminder calls—all of which are critical.
User-friendliness is key. The less “clicking” my providers and staff have to do, the better.
And finally, choose a solution that you can access from anywhere—not all clouds are created equal and access is king.
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