Independent primary care physicians are becoming an increasingly rare breed these days. But one Maine doctor says the automation tools made available through his EhlinicalWorks EHR are helping him thrive as a solo practitioner.
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 Health innovation about the changes you have made in your practice.
Health Innovation: Could you first describe your practice? Then we can go into detail about this, the automation tools that you use.
Keenan: I have a solo internal medicine practice in York, Maine. I’ve been working for just over 20 years in that capacity, and I’ve 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 of parking as I was leaving, just to greet me and thank me for coming in. That’s how small they were then.
First, I should 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, invoicing, handling incoming phone calls and faxes, emails, sending prescriptions, whatever you do for me. So it’s really important for me to be able to do things efficiently, because it’s my time.
Incoming faxes have always been a pain in the neck 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 sound like a minor thing, but when you handle 40 faxes a day, you can easily add half an hour to every day, just handling the administrative task of assigning a fax to a certain category within a certain patient table. With your new software, a fax will enter my inbox, and in the vast majority of cases, your software will have already presumably assigned it to a patient and a category within your chart: 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 chart, and I’m done. That is saving me a minimum of half an hour a day, every day and a lot of pain.
HCI: Are there any other automation tools you are leveraging?
Keenan: Let me tell you two other things that have made a big difference to me. I mentioned that I do my own billing. Which used to be a very simple process, right down to the explanation of the benefit [EOB] Forms became electronic. And then it became a real challenge for doctors like me to even understand what the insurance companies were paying for, because they weren’t mailing that stuff anymore, and you had to go look it up on their websites.
Ironically, the switch healthcare debacle was a blessing for me, because I was using switch and they were terrible. So, I had to look for another clearing house, and I ended up with Waystar, which has changed my life professionally in terms of accounts receivable, because WayStar is really smooth and efficient, and I can go to their website to find out what everyone is doing the payers. I can import EOB from their website and understand what I am paid and what I am not, 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 guys do to help me do billing more efficiently?” They offered me something called Healow Pay. They did two huge things that took it away right away. I used to mail everyone. I mean, put them in the envelope and mail them. Now, with one click, all of that happens automatically. Herow sends the statements. And that’s great, but almost as elegant, when patients pay online, those payments are assigned to my EclinicalWorks account automatically. I don’t have to post EOBS, and that’s huge. The vast majority of my patient payments are paid to my bank, and the payments are posted to your account in EclinicalWorks 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 press a button and you can dictate on the chart whatever you want anywhere on the chart. I write fast, so I never really cared. But for patients who have complicated things going on, and I want to dictate three paragraphs real quick. I can do that, and that has saved me some time.
HCI: What about the potential for 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 detail of the conversation. conversation, and organize it so that it presents you with the option of incorporating a very simplified summary, or a modified and moderately complex summary, or a detailed summary of the conversation you just had with your patient, and making suggestions based on what I have said and what has the patient said: references or laboratory orders.
I’ve only used it a few times because I don’t need it that much yet. When I’m on the phone or having a telehealth visit with a very complex patient who has a lot of problems, then it’s really 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. that on the graph without me doing anything other than clicking okay. 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 feel it’s harder to stay independent?
Keenan: They think it’s getting harder, and I think it’s getting easier. Doctors are really good at being doctors, but they are terrible business people, and the reason is twofold. One, we didn’t learn anything about how to run a practice in medical school or residency; And two, our models have involved working in clinics where there were 2.5 full-time employees per doctor. That’s how it was always done, because for a long time it was feasible. But that meant we were restricting ourselves to the clinical practice of medicine. Someone else was going to deal with writing the note, and someone else was going to do referrals, someone else was going to do prior authorization, someone else was going to bill, someone else was going to do scheduling. Next thing you know, you have to see someone every 10 minutes or you’re going to go out of business because your overload 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’ve interviewed a lot of primary care docs, and I’d say your situation, where you’re doing a lot of administrative work yourself, is pretty unusual.
Keenan: It is, and it addresses a fundamental misunderstanding doctors have about how to make money. They think 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 medical refill, a phone call with a question about a medication, submitting a prescription, submitting a referral, a consultation, lab review, and results. x-ray, scheduling the next appointment, whatever it may be. It really adds up. So you think 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 doing that, and you have to pay someone to do that. , if you are using the standard model, right? Then, of course, they are unhappy. They are doing everything the wrong way. You don’t need to see all those patients. What you need, ironically, is to do more of the work yourself. There is a market for doctors like me who are willing to work in this way. Plus, patients really love it. They love being able to talk to their doctor.
