Preserving the viability of small physicians practices: Interview with athenahealth’s Scott Andrews (transcript)

This is a transcript of my recent podcast interview with Scott Andrews, Vice President of Client Services at athenahealth.David Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I'm speaking today with Scott Andrews. He's Vice President of Client Services at athenahealth, where he focuses on some of the smaller physician practices. Scott, thanks for being with me today.Scott Andrews: David, thanks for having me.Williams: We hear a lot about a shortage of primary care physicians in the U.S.,, Is that shortage a real phenomenon?Andrews: I do see a lot of clients that use our services qualifying for what we call health care provider shortage assistance.That's where they'll give federal money from CMS Medicare for servicing patients in predominantly rural areas. I don't know that that tells me that there's a shortage or if it's just a question of the peanut butter  not being spread over all the areas. It does tell me that there are problems in pockets throughout the country.Williams: Have you noticed any trends over time and what are the drivers of those trends if so?Andrews:  I believe the predominant driver that we're seeing is  the payment model,  the focus on fee-for-service and more importantly the trend that's leading us down this path of things like patient-centered medical homes and the Affordable Care Act.  So much of the emphasis is being put on technology and driving it through the primary care physician that it's creating an environment where the physician is less excited about doing what it is he or she thought they were going to be doing when they entered medical school. It's becoming a lot more administrative in nature.Williams: Can you describe some of those administrative challenges or burdens that a physician might face that are not what they went to med school for?Andrews: A perfect example is electronic medical records. Electronic medical records have been around for many years, but they haven't been highly adopted. This is because our payment methodology of fee for service is structured such that  you don't want to slow a physician down.  The physician is really resistant to change.Now you can argue that the federal government in giving the incentives to use electronic medical records will be good in the long run. Certainly in this interim period, it's very challenging for physicians because they have to change their workflows. Physicians have to document in ways that they are  unfamiliar with. Not all of the solutions out there are necessarily the easiest to work with and thus, it's creating more of an administration burden.Williams: –As I said upfront  you work with the smaller physician practices, and a lot of those folks are  giving up and joining larger systems as employees, which is again something physicians didn't anticipate coming out of med school. Is that the solution or are there alternatives so that a smaller group can stay viable in the market even with all these demands on them?Andrews: There's definitely a subset of the population that is turning to larger organizations for cover for investment in technology. Certainly here at athenahealth, we pride ourselves in the fact that we enable the clients to remain independent and to have that be an affordable solution. It’s one that doesn't require a huge investment upfront, but one that's going to get a return based on results that we get for the practice. There are not a lot of other solutions out there that look at it the way we do,  so in that regard,  we are certainly unique in the marketplace.Williams: Can a small practice successfully become a patient-centered medical home? And is there a technology component that you or others help with to make that a reality?Andrews: A small practice can absolutely become a patient-centered medical home. Having said that, a component of the solution is certainly technology driven, but a lot of that process is driven by the processes that the practice or the organization establishes and changes to their own protocol. Technology will get you three-quarters of the way there, but it can't get you over the finish line unless you're  prepared to look at the way you do business and the way your workflows are structured within the organization.Williams: Can you talk more about workflows within an organization? For example, some of the clinical workflows and who is involved these days besides the physician himself or herself?Andrews: At athena we  believe that everybody should be performing at their highest level of certification.. With that in mind, we want the physician to have what we call extenders or mid-level providers, whether it's a nurse or whether it's a medical assistant involved in the process whenever possible.  This allows the physician to effectively delegate components of the work that makes sense given  everybody's certification levels, so that the physicians are  focused on the things they need the most time for..A human being can only make so many decisions in a day and eventually, you're going to get bogged down. If you're trying to make every single decision within your practice, within a patient's particular care, I think that you're going to get bogged down and you're going to be somewhat limited in your effectiveness.  If you've got people around you that you can delegate to, it's going to make you more efficient and it's also going to make you more effective.Williams: What do you see in terms of how these smaller practices are evolving? Are they going away?  What would you expect in five or seven years?Andrews: We do see practices getting acquired by larger organizations, but then again at the same time, we see people coming to athena because they're running for cover and they want to remain independent. If I were to look forward, these acquisitions are going to continue for the next two or three years, while the overall payment mechanisms and this kind of trend works its way through .If you look longer term things will reverse  back to the fact that actually owning a physician and a physician being employed by a larger organization is not always the holy grail.  A lot of these doctors want to be independent and they don't want to be managed.Williams: Do you see generational differences with the physicians? I know there's a trend toward employment, but do you see younger physicians coming in to these smaller practices and if so how do they do it?Andrews They do, there's no doubt about that. Some of them certainly want to be able to hang their own shingle or be part of a small organization where they feel like they can be more intimately involved in the decision making process and managing their patients the way that they want to manage them.If you have the right tools, if you have the right infrastructure around you, you can still be very successful in today's environment. They do want a work/life balance, and I think that that's a little bit more of the younger generation phenomenon. That's something that they have to keep in mind and determine what's best for them. I do see it working both ways.  It all depends upon the individual's preference.Williams: Can you talk a little bit more about the offerings you provide for these smaller practices and what we might look for from athena over the next couple of years?Andrews: For small practices --one to four doctors in size, or any size for that matter-- we offer a whole host of software and services for your revenue cycle, for your clinical cycle, and for communicating with your patients. If you think about the revenue cycle, we'll do everything from submitting the claim, following up on the claim, posting the results that come back from the insurance company, and making sure that the doctor ultimately gets paid for the services that he or she rendered.On the clinical side, we have our own electronic medical record that we call, athenaClinicals. We'll provide the ability for the doctor to document all the care that's taking place. Aside from just your typical electronic medical record, we perform other services as well, such as managing all of the faxes that come in to a doctor's office. The average doctor receives over 100 faxes a month and all of that documentation has to be categorized and managed in a way that allows them to access that documentation almost at a moment's notice.Physicians want to make sure they are capturing all that information so that if there is something important, it's given to the provider at the appropriate time in a manner so  that he or she can track it down and know when to react and how to react to it.On top of that with our Clinicals solution, we help to manage all of the pay for performance programs that are out there. Meaningful Use is the big one that everybody's familiar with given what the federal government is doing to drive adoption of electronic medical records.We help the provider through that entire process by not only being CCHIT certified, but by also doing a variety of services, such as actually doing the testing for the provider, making sure they were connecting with the vaccine registrations or other public health entities as needed, and guiding them within the actual patient visit to make sure that they're capturing the right information so that they're using the software in a meaningful way.I Going back to the clinical side of athenahealth, we're enabling our clients to essentially communicate with their patients in manners that they never could before, whether that's via a web portal or whether it’s via text messaging and emails. It allows them to access their patient panel to drive their patients to their practice if need be to either increase their own volume or to let everybody know that their practice is going to be closed for the day. It can also enable the patient to see test results and lab results on the portal and other types of communications. .From a clinician's perspective we offer all of those services and the software that enables them to run their practice so that they can essentially focus on the things that are most strategic to them and most important to them. They know that the day-to-day management is going to be taken care of by our products and our services. Looking into the crystal ball, we're going to continue to expand the services that we provide our clients.Credentialing is an area where it can be difficult. It's very detailed and manually intensive work that providers have to go through each and every single year. That's going to be an area that we're going to try and focus our attention on in the near future, so that we can help them with a task that is very cumbersome and very manually intensive. This again is to free them up so that they can think about their practice more strategically.We'll continue to focus on how can we better help the client to coordinate care, whether it's getting a referral to a specialist or over to their hospital, or out to a lab even, we're going to help them to coordinate that care, exchange that information between all of those entities within the health care chain and do so in the most efficient and effective manner possible.Williams: It sounds like a compelling vision. I noticed upfront you mentioned faxes, do you think we'll still be dealing with faxes at doctor's offices five years from now?Andrews: Who would have thought we'd still be sending claims out on paper in this day and age? If we're still sending claims out on paper, we're probably still going to be receiving some faxes, albeit it will become a smaller percentage of the workflow for sure.Williams: I've been speaking today with Scott Andrews, VP of Client Services at athenahealth. Scott, thanks so much for your time today.Andrews: David, thanks a lot for having me. I really appreciate it.