Independent primary care physicians are becoming an increasingly rare breed these days. But one Maine doctor says the automation tools available through his eClinicalWorks EHR are helping him thrive as an independent physician.
Joel Keenan, MD, owner of York Primary Care, says most doctors think continuing as a small practice is getting harder, but he actually thinks it’s getting easier. He recently spoke with Healthcare innovation about the changes you have made in your practice.
Healthcare Innovation: Could you first describe your practice? Then we can go into detail about the automation tools you use.
Keenan: I have a solo internal medicine practice in York, Maine. I have worked for just over 20 years in that capacity and have been with eClinicalWorks the entire time. I remember in 2004 I went to Westboro, Massachusetts and signed up after trying out their equipment, and Girish Kumar Navani, the head of the company, ran out to the parking lot as I was leaving, just to say hello and thank me. for entering. That’s how small they were then.
First, I must explain that I do everything in my practice. My wife is my office manager, but she has a very limited role in terms of what is actually done in terms of clinical work. So billing, handling incoming phone calls and faxes, emails, sending prescriptions, all of that is done by me. That’s why it’s very important for me to be able to do things efficiently, because it’s my time.
Incoming faxes have always been a headache for me. Until eClinicalWorks involved artificial intelligence, assigning faxes to patients was a laborious task. There were just a lot of mouse clicks involved. It may seem like a small thing, but when you handle 40 faxes a day, you can easily add half an hour to each day simply by handling the administrative task of assigning a fax to a certain category within a certain patient’s history. With your new software, a fax will arrive in my inbox and, in the vast majority of cases, your software will have already presumably assigned it to a patient and a category within their file: a lab result, an x-ray result X, a query, a reference. All I have to do is read it and with one click assign it to that patient’s history and that’s it. That saves me a minimum of half an hour a day, every day, and a lot of pain.
HCI: Are there other automation tools you are leveraging?
Keenan: Let me tell you two other things that have made a big difference for me. I mentioned that I do my own billing. It used to be a very simple process, until the benefit was explained. [EOB] Forms became electronic. And then it became a real challenge for doctors like me to even understand what the insurance companies paid for, because they no longer sent that material in the mail and you had to look it up on their websites.
Ironically, the Change Healthcare debacle was a blessing for me, because I was using Change and they were terrible. So I had to look for another clearinghouse and ended up with Waystar, which changed my life professionally in terms of accounts receivable, because Waystar is really seamless and efficient, and I can go to their website to find out what all the payers are doing. I can import EOBs from their website and understand what they pay me and what they don’t, and that makes it much easier for me to send accurate invoices.
Once I connected with Waystar, I reached out to eClinicalWorks and said, ‘Hey, what can you do to help me bill more efficiently?’ They offered me something called Healow Payment. They did two huge things that took the whole problem away for me right away. I used to mail statements to everyone. I mean, put them in the envelope and mail them. Now, with just one click, everything happens automatically. Healow sends the statements. And that’s cool, but almost as elegant: When patients pay online, those payments are automatically assigned to my eClinicalWorks account. I don’t have to post EOBs, and that’s huge. The vast majority of my patients’ payments are made to my bank and the payments are posted to their eClinicalWorks account without me doing anything. It saves me all kinds of time. It has made a huge difference in my accounts receivable.
They also have a feature where you can just press a button and dictate on the chart whatever you want anywhere on the chart. I write fast, so that never mattered to me. But for patients who have complicated things, I want to dictate three paragraphs very quickly. I can do that and that has saved me some time.
HCI: What about the potential of other AI tools?
Keenan: eClinicalWorks has something called Sunoh.AI, and that is the software that they offer that will allow me and a patient to have a conversation, and Sunoh will infer from that conversation first, who is speaking and second, what is the substance and the detail of the conversation. and organize it in a way that presents you with the option of incorporating a very simplified summary, or a modified, moderately complex summary, or a detailed summary of the conversation you just had with your patient, and making suggestions based on what you have said and what you have said. what the patient has said: referrals or laboratory orders.
I’ve only used it a couple of times because I don’t need it much yet. When I’m on the phone or having a telehealth visit with a very complex patient who has a lot of problems, it’s very good for me to use it because she and I can talk for 20 minutes and I have a really detailed history of the current illness if I want it in the box without me doing anything other than clicking OK. Like I say, it’s not something I use a lot, but it’s nice to know it’s there.
HCI: Do you talk to colleagues who are finding it increasingly difficult to remain independent?
Keenan: They think it’s getting harder and I think it’s getting easier. Doctors are really good as doctors, but they are terrible businessmen, and the reason is twofold. First, we didn’t learn anything about running a practice in medical school or residency; and two, all of our models involved working in clinics where there were 2.5 full-time employees per doctor. This is how it was always done, because for a long time it was feasible. But that meant that we were limited to doing only the clinical practice of medicine. Someone else was going to end up writing the note, and someone else was going to do the referrals, someone else was going to do the prior authorization, someone else was going to do the billing, someone else was going to do the scheduling. Next thing you know, you have to see someone every 10 minutes or you’re going out of business because your overhead is staggering. None of that has to happen, and the reason I say it’s getting easier, not harder, is because of what companies like eClinicalWorks can offer doctors like me when it comes to automation.
HCI: I have interviewed many primary care doctors and I would say that your situation (where you do much of the administrative work yourself) is quite unusual.
Keenan: It is, and it’s due to a fundamental misunderstanding doctors have about how to make money. They believe that the way to make more money is to see more patients. But for every patient you see, there are 13 before-or-after-the-fact encounters related to that visit: a medication refill, a phone call with a question about a medication, a prescription sent, a referral sent, a consultation, a laboratory review and X-ray results, scheduling the next appointment, whatever it may be. It really adds up. So you think that instead of seeing 10 patients a day, I’m going to see 20. But you have to prepare for the extra work you just created by doing that, and you have to pay someone to do it. , if you are using the standard model, right? So, of course, they’re not happy. They are doing everything wrong. It is not necessary to see all of these patients. What you need, ironically, is to do more work yourself. There is a market for doctors like me who are willing to work in this way. Plus, patients love it. They love being able to talk to their doctor.
