RCM: Easing a Solo Provider’s Business Worries Part 2
Published on Wednesday, July 26, 2017
Dr. Thomas Kelly and his business associate, Ahmed Elmanan, knew medicine and business, respectively, when they began Shore Community Medical in December 2011. What they didn’t fully appreciate were the specific challenges that come with running a healthcare business. eClinicalWorks has helped them every step of the way, from EHR/PM for documentation and workflows to RCM for billing, and Population Health programs and measures, including PQRS, Meaningful Use, HEDIS dashboards, and much more.
“eClinicalWorks has grown along with our practice. It has enabled me to concentrate on the clinical side of the practice, and has let me trust that the business side is being cared for well.”
– Dr. Thomas Kelly, Shore Community Medical
Topics From This Episode
Ahmed Elmanan, practice administrator at Shore Community Medical, says that going with Revenue Cycle Management from eClinicalWorks was the “best business decision I made.” Elmanan said that he realized within a year of starting the business with Dr. Thomas Kelly that billing was easily the hardest and most time-consuming aspect of his work. With RCM from eClinicalWorks, Shore Community Medical’s first-pass claims acceptance rate went from only about 50% to a remarkable 97%.
Shore Community Medical has used Messenger’s built-in appointment reminder campaigns to great effect. Dr. Thomas Kelly says that his Medicare wellness visit rate has increased dramatically, and his no-show rate is minimal. While many patients may not realize the importance of the wellness visits, physicians are realizing that preventive procedures and labs are increasingly key to meeting the requirements of value-based medicine and life as an Accountable Care Organization.
The HEDIS (Healthcare Effectiveness Data and Information Set) dashboard is at the heart of day-to-day patient population management at Shore Community Medical. At any point during the day, staff can check the HEDIS dashboard to see which patients are coming in that day and whether or not they have complied with recommended test, labs and screenings, such as colonoscopies and mammograms. With a single click, that information can be sent to Dr. Thomas Kelly, helping him identify and close any gaps in care. With 1,300 patients and dozens of measures, administrator Ahmed Elmanan says such work would be “next to impossible” without the assistance of the tools provided by eClinicalWorks.
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Adam: I’m Adam Siladi with the eClinicalWorks podcast and we’re here in Rehoboth Beach, Delaware, speaking with Shore Community Medical about how our RCM services has changed their practice. And here to give me the physician’s perspective is Dr. Thomas Kelly with Shore Community Medical. Dr. Kelly, thank you so much.
Dr. Kelly: Good morning, it’s good to be here.
Adam: So, tell us a little bit about how our RCM has impacted you as the physician.
Dr. Kelly: Well, to do that I have to talk a little bit about how we started the practice. I’m a solo practitioner. I started as a solo practitioner after working for large organizations, we wanted to go out, branch out on my own, and we were able to decide on eClinicalWorks as an EMR early on. And so from the very first day of our practice, which was December 2011, eClinicalWorks has been a partner in this practice. As a matter of fact, when we opened our doors, we were still receiving our training and our first patient walked in and we all started using eClinicalWorks. So it has been a part of the practice since Day One. We’ve been very comfortable with it. And so we feel — and when I say we I mean Ahmed and the rest of the staff — feel as though eClinicalWorks has grown along our practice. Specifically in terms of the RCM program, I have to talk about how it has enabled me to concentrate on the clinical side of the practice, and to let me trust that the business side is being cared for well by Ahmed, and also the RCM products. Specifically, I think that it has helped me to coordinate care and it has helped me to concentrate on care, in terms of several things specifically. Again, referrals, we’ve been able to really track our referrals. We have been able to track our preventive care. I have been able to increase the percentage of patients that are able to come in for their Medicare wellness visits, which is really important from and ACO perspective, but it’s also important in terms of a patient care perspective. So it has really helped me to be able to stay as the physician and not have to really split my care off into worrying about administrative requirements regarding documentation of care.
Adam: So, you mentioned you are a part of an ACO, that’s very exciting. I think you also mentioned that you’re handling that coordination of care aspect. Which whether you’re a part of an ACO or not that’s going to be receiving a lot more focus under MIPS, under medical home programs that other practitioners may be participating in and be asked to perform on.
Dr. Kelly: Well, we actually have the highest percentage of patients who have had their annual wellness in our ACO. I think it has been the eMessenger program that has really helped us to do that. And that’s really important, because it is very hard to document and to try to assure that patients get their preventive care when they are coming in for their acute visits. Which, as people know, as physicians know, that’s usually why they come to see their primary care doctor. It’s very hard to fit in all those preventive care issues in those visits and the annual wellness visit allows you to actually do that at a time when the patient is, you know, generally feeling well. And those visits are very important in terms of Meaningful Use, in terms of ACO, but they’re mostly important in terms of patient care. And so it has really helped us because it sends out reminders to the patients to do these visits. The patients many times don’t even know really what the visits are for. Also, most physicians realize there are more and more preventive procedures and labs that we are required to get, that help us in our practice. And to be able to have an actual visit to get that accomplished is really a great tool, and not using it really puts a practice at a disadvantage. I will tell you too from a revenue standpoint it allows you to code for the annual wellness visit, and, you know, it’s a good coding. It helps on the revenue side and so I think that it has really been one of the best aspects of our RCM program and programs that we get with eClinicalWorks have been very successful.
Adam: In our conversation earlier, you mentioned that you could put the Messenger functionalities into place to do your appointment reminder calls, which make an impact. Now you’re telling us that you’re using that campaign — the built-in campaigns that are ready to go — to do your Medicare wellness visits. I imagine that for other practices who aren’t doing that, it might be a challenge. Like you said, patients usually only come in when they have an acute problem, right, and it can be probably difficult to start that conversation about why the Medicare wellness visit is important, and why they should even have one in the first place.
Dr. Kelly: Yeah, it’s very important. I would say that when you’re a solo practitioner, you also realize that you can’t really rely on a large organization to help fill in the aspects of preventive care, and resource allocation, and revenue generation. That falls onto your shoulders, and I think that the annual wellness visit is actually the number one tool for the primary care physician. That’s really very much underutilized, but also one that there are not that many. And sometimes, there’s not an incentive in other organizations for them to really try to pay attention to. And the program at eClinicalWorks really helps us to educate the patient as to what the annual wellness visit is and many of them come in and are curious about it. The layout of the Progress Note is such that it carries over from one visit to another. So that when a patient does come in for an acute visit, you really already have that all documented; you just have to carry it over. It helps as a reference point, and it has actually become a tool that I would find it very hard to practice without. And for the patients that really are resistant, I really try to, you know, sort of pester them to make sure that they eventually come in for it. I think the other thing that is really unique — I wouldn’t say unique, but an aspect of the Messenger system that has really helped us — is we have very few no-shows. I think our no-show occurrences is very minimal, which again is important in terms of revenue generation, resource allocation, and also just in terms of being able to be assured that the slots that you have for the schedule for the patients are not going to be not utilized. So I think those are two aspects that are really great about it. In terms of the ACO I know that that’s something that has come in after Meaningful Use. I know that without eClinicalWorks it would have been very hard for us to meet our Meaningful Use goals, and we were able to get through that and do that. Now it’s the new world of the ACO environment. And I know that we have begun to use eClinicalWorks for the different types of requirements; again, as the physician, I’m a little bit not as informed as Ahmed on all the specifics about that. But I am also certain that we will be benefitting by the types of services that are provided for in the year and the next few years to come. I think as Shore Community Medical, we were starting from ground zero. You know, we were starting from a blank slate. The first patient that walked in was patient number one. We didn’t have any paper charts, and it was really sort of a unique situation where we were able to sort of grow with eClinicalWorks in our practice, and I think with each step of the way eClinicalWorks has been there for us in terms of providing the type of services that seem to meet the need of a growing practice. Down here in Rehoboth Beach, everybody seems to be retiring down here from places from large cities around Rehoboth Beach, in New York and in New Jersey and Virginia, and Maryland, and Washington D.C. And so we’ve had our practice grow quite a bit. Ahmed, being the practice administrator, displayed a lot of talent as it related to the first year with the billing and doing all of the Meaningful Use as best as he could. But it was clear that we were going to need the additional resources. And when you can do each step with the same EMR, it really is seamless. Because one program seems to build on top of another. And so from my standpoint it’s been very key. Almost like we would not have been able to grow to this successful practice with over 1,000 patients and still be a solo practice in this type of environment.
Adam: Well, it sounds like with those additional retirees you have a lot more Medicare wellness visits in your future. eClinicalWorks is proud to be a partner with you to help deliver that top-quality care that it sounds like you are giving to your patients. Thank you so much, Dr. Kelly, for being here and giving us your thoughts on the subject today. We hope we can be there for you in the future to help you do even more.
Dr. Kelly: Sure.
Adam: For the eClinicalWorks Podcast, I’m Adam Siladi. You can watch our other episodes on iTunes, YouTube, and myeclinicalworks.com. Thanks for watching.
Adam: Starting a business in any industry is difficult enough, but especially so in medicine. But it helps when you have a partner that you can trust to help you along with those difficult times. I’m Adam Siladi with the eClinicalWorks Podcast, and speaking with me today is Ahmed El Menon from Shore Community Medical, managing director of this practice in Rehoboth Beach, Delaware. Ahmed, thank you so much for being here with us today.
Ahmed: Thank you.
Adam: In our discussion before you mentioned that you are using the RCM services from eClinicalWorks, and we’re going to get into some of the details about that and your experience about that. But before we do that, why don’t you tell us a little bit about Shore Community Medical and how it came to be.
Ahmed: Shore Community Medical started in December 2011, and it was a partnership between myself and my partner, Dr. Thomas Kelly. He realized he wanted to have a practice and he was in business and finance real estate in Washington, D.C. and I told him that I don’t have any experience in healthcare, but I’m willing to learn. So together we Googled our way through it! We researched, we did all kinds of homework and that’s how we started.
Adam: You say you didn’t have any experience in medicine, but you did have experience in running businesses. I believe you had set up companies before this?
Ahmed: That is true, I had a financial management company in Washington, and I also have a real estate company in Washington D.C., as well.
Adam: What were you personally doing in the early days of the business when you were first getting started?
Ahmed: I was doing everything, basically. The managing part of it, the billing part of it. I dealt with Shore’s companies, I set up all sorts of policies, everything. I mean I did it all, but it wasn’t long after that that I realized the billing part of it was the hardest and most time consuming. But yes, I did almost everything.
Adam: So when you’re running a business, I think one of the keys to success — from what I’ve heard so far — is that you need to know when it’s time to bring in an expert, someone who can do who can do what you’re doing but better than you, right? When did you realize this?
Ahmed: Not long after we started it. As everybody knows, I mean billing in healthcare is one of the most complicated things that you could run into. So I had to do everything from scratch. I had to make sure the claims are clean, submit to primaries, submit to secondaries. Some of them were paper, some of them were electronic. And I realized not long after that I had to get help. And in the beginning I thought about hiring a billing company. And I don’t know, I think I just called our account manager, and he told me that eClinicalWorks are coming up with RCM. I think he said it was the first 30 days, and I was probably one of the first ones to sign up. So I signed up, and the rest is history.
Adam: So once you signed up, I’m assuming that since you’re still with RCM, that was a decision that you did not regret. But once you signed up, what were some of the benefits that you realized?
Ahmed: Actually it was the best decision, it was the best business decision I think I made during the life of this business. It was, it was just a godsend. I mean I didn’t have to do basically anything. I have an account manager. She calls me, she you know sends me encounters of anything going wrong. It was within 30 days that I started getting money, which was not the case when I was doing it myself.
Adam: Alright let’s talk about that, let’s talk about the turnover.
Adam: What was your turnover in the beginning, when you were doing this all yourself?
Ahmed: When I was doing it all myself, it was probably in the 50s-60s percent.
Adam: Collection rates?
Ahmed: Yes, and it took probably 60 to 90 days for payments. After I signed up with RCM, I think the last couple of months we were at 97% collection. And our days in ER, which are our days in accounts receivable, I think it was 24 days.
Adam: So you went from 90 days to ticket collections and a 50- 60% collection rate, to a 24-day and a 97% collections rate with our RCM.
Ahmed: Right, and some months, some months it goes to zero. Some months the rejection rate is zero. So, which is perfect for any business person running any kind of business. For me personally, I know, I know signing up for RCM and getting the results we were getting had a positive effect on lots of parts of our practice. But for me personally it freed me to do a lot stuff, and meet a lot of deadlines. I don’t have to spend hours, you know, filing claims, or scrubbing claims, or on the phone with insurance companies — which took up almost all my day. So it’s been a wonderful experience, and we are still benefiting from it and hopefully will benefit from it for a long time.
Adam: So you mentioned a 50% to 97% collections rate, and you know that’s like doubling the amount of people working in the office.
Adam: You know, that’s like having two doctors before you had one doctor without having to hire another one. So what are you doing with that, the time and the money that you’re saving with our RCM? Are you reinvesting it into the business?
Ahmed: We are. Well the timing couldn’t have been more perfect. Because as we handled our billing to RCM at eClinicalWorks, that was the time that we had to set up all of our modulars and all of our dashboards for Meaningful Use, PQRS and SEO and all of those good programs that we have to take care of. So signing up for RCM gave me a lot of time to sign up for this program, sign contracts, do follow up, and then I took it a notch higher, I said, well, let me see maybe eClinicalWorks has programs to help me with all of these payment schedules. So we signed up with eClinicalWorks for PQRS and meaningful use dashboards, and we’ve been doing it for the last four years.
Adam: Do you think you could have been able to hire out those services? Just to recap what you said, you said that you signed up with eClinicalWorks consulting for your Meaningful Use, your PQRS and those types of things. Do you think you would have been able to hire out those services if you hadn’t gone with RCM in the first place?
Ahmed: Absolutely not, I mean I would leave at least one staff.
Adam: What are some of the other tools and services that you might be using now that you have this extra time and revenue?
Ahmed: Right, well one of the reasons why we are sending what we call clean claims or our rejection rate is low is it takes a lot of planning to get to the point where a claim is submitted. So I had a conversation with the account manager with eClinicalWorks, and he and I went through all of the tools and programs that eClinicalWorks has that could help us to facilitate all things when it comes to office visits. So we are using that, we are using Messenger to remind my people about their appointments. We’re using campaigns for a lot of things — you know, annual visits, Medicare wellness visits, and vaccinations. So before the patient arrives in our office we already know what he or she is coming for, and we prepare for that. So thn it makes the office visit go smoother and shorter, and all of the items in the Progress Note are all lined up for us to submit clean claims. So we do our homework before the patient arrives, and we use the tools that eClinicalWorks gives us to get to that point.
Adam: I believe you guys are also using our HEDIS dashboards for quality measurement.
Adam: Tell us a little bit about what that is, and what you’re doing with it.
Ahmed: Well, the dashboard is very extensive. It’s all the HEDIS measures basically. And what eClinicalWorks does is they give us all the information to utilize the data that they generate from claims for our patients. So at any point in the morning, I could go in the HEDIS dashboard and I could see for example, who’s coming in today for an office visit and whether he or she is compliant or noncompliant with certain parts. For example, if a patient is due for a colonoscopy, the board will tell me the patient’s colonoscopy order, mammograms, all kinds of stuff. So it’s a tool that really makes our job easier because we know what to give the provider to discuss with the patient on the things that the patient has missed or needs to do in a short period of time. Which is something manually you would never be able to get or generate — basically it would be next to impossible to go through. We have about 1,300 patients to go through the chart and find out who is due for what at any given point. So the dashboard with one click I could just generate a report and submit it to the provider telling him that Mr. such and such is coming at 8 o’clock and he needs to be reminded, or he needs an order for these items.
Adam: So it sounds like you’re using that to do a little bit of pre-visit planning.
Adam: For patients that are coming in, to make sure you’re not missing any care gaps, which of course pre-visit planning is a big is a big focus not that we are moving into the MACRA world and for anyone doing Patient-Centered Medical Home. So let’s talk a little bit about your relationship. You mentioned the relationship that you have with your account manager.
Ahmed: For our SAM, our account manager, he and I have a conversation at least twice a month. And then with Asha, our RCM manager, we speak or try our best to speak every Friday afternoon. So the way it goes is she will send me an agenda, followed by a phone call, and her and I would talk about the items in the agenda sheet. She’ll tell me what and where we are with the collections and what we need to do. Of course the biggest complaint for crews RCM is to convince the provider to lock the Notes. So everybody knows in the medical practice that, that’s a big, big problem. But that’s basically the communication we have. We speak every Friday. We chose to speak on every Friday after 3 o’clock. So basically she gives me a week to correct what needs to be corrected. I am very grateful.
Adam: So she gives you a little action plan for a week to-do list to make yourself more successful. Is this a copy of the report you have here?
Ahmed: Yes. Of course, also at the end of the month I get the month’s end report, which as you see is very comprehensive. It is about 19 pages with all these wonderful graphs, and diagrams, and these beautiful statistics and stuff. I mean it is just really wonderful.
Adam: What are some of the key things that you look for in our report?
Ahmed: Well, in this report the most important thing that I look for is how much we billed and how much we collected. I do have that number that I have to achieve, in order for a directed practice to go up, so that’s one thing. It also gives me an idea about what are the most used codes for claims, and how many claims we build primary and secondary, and how long it took for them to get a date. The average submission day from the time I sent the claim to eClinicalWorks — in this case it was about two days. It contains all kinds of information about basically about locked encounters, the date of them, the amount, what’s in the account that’s receivable, what’s been collected, and write-offs, and everything..
Adam: Now eClinicalWorks, of course, has reports within EBO that can run a lot of this or all of this information, but I think what you are trying to say is that you’ve been able to take this process that would take a large chunk of your time and reduce it to an hour phone call every Friday.
Ahmed: Right, and I appreciate that RCM is sending me the report instead of me going to eBO and generate it. It’s nice to have it with the agenda. But, so you are absolutely right. There is a lot of financial report I use from eBO to supplement and go into more details about the data we have at the month’s end.
Adam: Do you have any upcoming projects that you are planning to focus on now that this is not on your plate anymore?
Ahmed: Yeah, well the next big thing for us is to go and catch up on MACRA and MIPS and all of this wonderful program that we have to enroll in. So that would be a lot of fun.
Adam: That’s certainly a project that a lot of our viewers are probably anticipating and of course eClinicalWorks is going to be there to help you and all of our viewers with that transition. Ahmed, thank you so much for being here with us and giving us your time and your thoughts. You can check out more of our eClinicalWorks Podcasts on iTunes, YouTube, and at myeclinicalworks.com. For the eClinicalWOrks Podcast, I’m Adam Siladi. Thank you for watching.