When Dr. Daniel Shurman, a dermatologist and Mohs surgeon, and I took the leap and started our own dermatology practice in 2012, we decided upfront that we would rely heavily on technology to build our practice.
We knew what we wanted ― and didn’t want ― because this wasn’t our first rodeo. We came from a practice where Dr. Shurman was one of the more productive practitioners and I was the COO. That practice was an early innovator in the world of electronic healthcare records (EHRs) and they had a home-grown practice management (PM) system, which created some decent efficiencies in the early days of medical practice technology. However, to succeed in our new practice, we knew we would need a more advanced, robust and integrated systems to serve both the dermatology and technology needs of our new patient base in southeastern Pennsylvania.
The decision to invest in technology was the right one for us, even though we started with only Dr. Shurman, one nurse practitioner, a small office staff and me. Technology has helped us to achieve a consistent growth trajectory of about 15 percent a year, a very nice pace as we have added locations, doctors and occasionally a mature practice. Today, Pennsylvania Dermatology Partners (PDP) has 12 offices, 11 physicians, seven nurse practitioners and physician assistants, a front desk person in each office, and six people in a call center for overflow calls. We are up to 7,800 patient visits per month, aiming for 8,500 per month by the end of the year. Here are the technology-related lessons we learned along the way.
Lesson # 1 - Basic systems have to work together
With so many technology vendors out there, it was a challenge to evaluate them all. You need to look not only at cost, but at the ability of the tools you choose to work together as well as their ease of deployment and use. As a dermatology practice, we had to have an EHR specific to our specialty, which was the starting point in our technology process.
Next, choosing a PM system was just as important. A practice management system doesn’t have to be specialty-specific, as our management issues are basically the same as those faced by a hospital, a small solo practice or a network group provider. A PM system must be broad and able to do many different things for all the different people working in the practice, not unlike a Swiss army knife. We found one that interfaces well with our dermatology-specific EHR and also accommodates our growth; AdvancedPM from AdvancedMD has industry-standard tools that are easy to leverage, scales effortlessly as we add offices, and helps us tie everything together, be it changing provider schedules or messaging a patient, creating custom claims scrubbing tools, analyzing financial trends, pushing out information to new patients and more. AdvancedMD has proven a facile tool for all of those purposes.
Lesson #2 - Dealing with MACRA and other CMS regulations
Over 40 percent of our patients are Medicare age (65 and older), and so a major part of our business depends on maintaining a great relationship and a state of high compliance with the Centers for Medicare & Medicaid Services (CMS) rules and regulations. AdvancedMD provides a great reporting platform for tracking demographics, flagging the relevant patients and staying ahead of the reporting curve for all government compliance.
The math is very simple. Each year Medicare applies larger and larger penalties to practices who do not comply with their Meaningful Use, PQRS, MACRA and now MIPS reporting requirements. That can add up to a hefty penalty for a practice of our size so we take the responsibility seriously. AdvancedMD helps us a lot in that process.
Lesson #3 – Interact with patients on multiple platforms
When we opened in 2012, none of the PM systems we evaluated included online scheduling or reputation management. But as those capabilities became available, we determined that with patients doing more and more online, it made sense for us to add an online scheduling system. We looked at an outside service, for which we would pay a monthly fee, which we used but weren’t keen on adopting long-term. We were pleased to learn that the same vendor, AdvancedMD, had integrated an online scheduling feature which we turned on as part of our patient portal. Appointments now go directly to the doctors only on our site, without sharing our patient demographics with a third party as it happens with outside scheduling services.
While the actual percentage of our patients who schedule appointments online is small, this capability has turned out to be a fantastic addition to the growth of our practice. Patients make appointments outside of office hours, at their convenience, even at 1 o’clock in the morning, and we see the number of patients doing so increase month by month. But for patients who are most comfortable calling us for an appointment during office hours that option will always be available.
In June of this year alone, 330 visits were scheduled online, freeing our office staff to focus on those patients who needed assistance with scheduling, prescriptions or questions via the telephone or in person. It’s exciting for us to see that certain segments of our patient population are attracted to the convenience of this technology. Also, being able to message securely with the practice is another feature of the online scheduling software that appeals to these patients.
Lesson # 4 - Know where you stand
As is the case with many medical practices, we acquire new patients primarily from existing patient referrals, referring physicians and insurance plans. Therefore, we decided not to invest heavily in outreach such as email newsletters; health care consumers are already bombarded with too many unsolicited emails. However, we know that an unhappy patient is most likely to share negative experience with others ― in private and online.
It makes sense to always check with patients on their experience and reach out to resolve any problems. And we wanted to be sure that our good work was being reflected in our online reviews in equal proportion to the occasional thing we didn’t get right. Reputation management software helps us do that on a large scale, both easily and elegantly.
The reputation management feature from AdvancedMD allows patients to interface with Google Reviews. We then can push positive reviews out to Facebook (and we hope to other sites like Health Grades, Vitals and Yelp! in the future), an important part of maintaining our reputation and expanding our practice. In addition, by logging into our AdvancedMD dashboard, I can easily see that we’ve had 183 reviews in the past seven days, 158 of them with five stars. I can also dig in to see what feedback was provided by the patients, and can aggregate reviews by category, such as by office or practitioner. Any negative reviews are flagged so we can reach out and try to do better.
We do qualitative analysis as well. For example, we recently sent out a survey to 30,000 patients, and are evaluating the 1,200 responses we received. We asked whether they had used our patient engagement and other technology tools, what’s most important to them during a visit, and how they like to engage with us. The early results suggest that people are generally happy with the practice, and like the availability of technology for them to use…from online scheduling to the patient portal to text, email and voice reminders. Our patients even appreciate our automated birthday messages, just another addition to a good health care relationship.
Lesson # 5 – Stay ahead of the technology curve
I am exceedingly proud that our practice is growing in a sensible way and, without venture capital funding, has become a real contender in a very competitive environment. We absolutely would not be able to understand and expand our business in this manner without the integrated technology platform around which we’ve built it. But we know we can take nothing for granted, nor can we rest on our successes. The future of medicine is being able to provide the best services to our patients, and to adapt as necessary to do even better on their behalf. Employing the newest technologies will play a major role in ensuring positive outcomes, for our patients and for PDP.