EHR for Private Practice

[Ipronate]

Do you guys have any recommendations for a good EMR for private practice? Ai capabilities would be a plus.
Currently considereing Nextgen and Drchrono. Thought?
Thanks!

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[heybrother]

You should consider joining the IPED group on Facebook and asking there. Its private practice heavy which this forum is not and they've got people who've used every EHR under the sun. The problem is getting someone to actually specifically spell out what they don't like.

I use Athena. I do not recommend them. Strong no. They contact me once a year asking me - "do you recommend us". I tell them - no, I don't. You are ripping me off and doing a bad job. They write back a sad face email - we're sorry to hear that. For me - Athena is like an insurance company that my practice never negotiated with and therefore they will sodomize me daily for the rest of my career until I leave or move on. Whatever your rate is on a bad contract - Athena, insurance, etc is the anchor that forever drags you down. Once you have a bad rate - you can't break free. They'd rather lose you than negotiate. They are the Humana/United of EHRs. From a clinical experience- I suppose Athena is relatively straight forward? I've been using it so long that I really don't know better. You write a note into it. Its multiple screens though which sucks ie. perfect world the entire note would be 1 template on 1 page. You have saved procedure templates that you add. Where Athena is just absolute dog crap is that they can't process claims to save your life. Essentially there's some minimum wage worker somewhere hand writing in EOBs and they are just botching it. I thought I hadn't been paid by the VA-Tricare in like 9 months. Nope. It turns out that Athena got the EOBs and money and just stuck them in a drawer somewhere. They told us they never received anything and when we pushed on it they said - oh yeah, we had these all along. Lately they've been double posting every secondary and payment so our management mail box is full of claims flagged as us owing the insurance money back. Athena is literally double posting the checks from the insurance company. I don't want to share all of their screw ups, but literally every day I looked at a claim and find a glaring stupid mistake where they are straight giving money away. Zeroing copays. Just non-stop stupidity.

The only positive I can say for Athena is that if you were an associate for a practice you could theoretically run a report and see your collections except that Athena has assuredly f^&*ed your collections up and they are lower than they should be.

 

[619]

I use eClinical works and I like it. I use the basic eCW without any fancy stuff. I have my templates for over 99% of things that I see in clinic so my patient notes are very quick and easy. Any kind of scribe will only slow me down because even with a scribe (either AI or human remote) the doc still has to go through it and cross check before submitting. That is a waste of time for me. I don't see why I need a scribe for heel pain, ingrown nail, onycho, achilles pain, any tendonitis, warts, sprain, fracture, bunion, hammertoes, diabetic foot care/ulcers etc. These are every day bread and butter podiatry pathologies that I enjoy.

eCW do have AI stuffs and AI scribe etc but I am not interested in signing up for that because obviously it will be extra money. I think they mentioned it's free but we all know down the road they will start charging for it. I currently pay $648 monthly for my basic one provider eCW and that includes healow for online appointment that links directly to my website. Also I got my website for free from eCW when I signed up with them in 2020. btw I manage and host my own website and I own the domain so If I decide to leave eCW they can't take my website. Overall I like eCW.

Billing is different but it is still connected to eCW. My Clearing house/Billing is TriZetto Provider Solutions and I have no issues with them. I pay between $112-$150 a month. My office manager does my billing and we follow up with all the claims and denials etc.

All the pre-cert, pre-auths, insurance verifications like deductible, co-pays co-insurance etc is all done by my office manager and not through my EHR or outside agency.

 

[DYK343]

You should consider joining the IPED group on Facebook and asking there. Its private practice heavy which this forum is not and they've got people who've used every EHR under the sun. The problem is getting someone to actually specifically spell out what they don't like.

I use Athena. I do not recommend them. Strong no. They contact me once a year asking me - "do you recommend us". I tell them - no, I don't. You are ripping me off and doing a bad job. They write back a sad face email - we're sorry to hear that. For me - Athena is like an insurance company that my practice never negotiated with and therefore they will sodomize me daily for the rest of my career until I leave or move on. Whatever your rate is on a bad contract - Athena, insurance, etc is the anchor that forever drags you down. Once you have a bad rate - you can't break free. They'd rather lose you than negotiate. They are the Humana/United of EHRs. From a clinical experience- I suppose Athena is relatively straight forward? I've been using it so long that I really don't know better. You write a note into it. Its multiple screens though which sucks ie. perfect world the entire note would be 1 template on 1 page. You have saved procedure templates that you add. Where Athena is just absolute dog crap is that they can't process claims to save your life. Essentially there's some minimum wage worker somewhere hand writing in EOBs and they are just botching it. I thought I hadn't been paid by the VA-Tricare in like 9 months. Nope. It turns out that Athena got the EOBs and money and just stuck them in a drawer somewhere. They told us they never received anything and when we pushed on it they said - oh yeah, we had these all along. Lately they've been double posting every secondary and payment so our management mail box is full of claims flagged as us owing the insurance money back. Athena is literally double posting the checks from the insurance company. I don't want to share all of their screw ups, but literally every day I looked at a claim and find a glaring stupid mistake where they are straight giving money away. Zeroing copays. Just non-stop stupidity.

The only positive I can say for Athena is that if you were an associate for a practice you could theoretically run a report and see your collections except that Athena has assuredly f^&*ed your collections up and they are lower than they should be.

The MSG I worked for used NextGen. It was alright. No bells or whistles but functioned well. Biggest complaint was there was a "character box" if you didnt want to just click boxes for a physical exam. If you wanted to free type anything in it only had X amount of characters and I commonly had to reword things to get my character count down. Aside from that NextGen was fine.

We switched to Athena and we lost something like 20% of collections. Athena is the worst.

 

[heybrother]

I use eClinical works and I like it. I use the basic eCW without any fancy stuff. I have my templates for over 99% of things that I see in clinic so my patient notes are very quick and easy. Any kind of scribe will only slow me down because even with a scribe (either AI or human remote) the doc still has to go through it and cross check before submitting. That is a waste of time for me. I don't see why I need a scribe for heel pain, ingrown nail, onycho, achilles pain, any tendonitis, warts, sprain, fracture, bunion, hammertoes, diabetic foot care/ulcers etc. These are every day bread and butter podiatry pathologies that I enjoy.

eCW do have AI stuffs and AI scribe etc but I am not interested in signing up for that because obviously it will be extra money. I think they mentioned it's free but we all know down the road they will start charging for it. I currently pay $648 monthly for my basic one provider eCW and that includes healow for online appointment that links directly to my website. Also I got my website for free from eCW when I signed up with them in 2020. btw I manage and host my own website and I own the domain so If I decide to leave eCW they can't take my website. Overall I like eCW.

Billing is different but it is still connected to eCW. My Clearing house/Billing is TriZetto Provider Solutions and I have no issues with them. I pay between $112-$150 a month. My office manager does my billing and we follow up with all the claims and denials etc.

All the pre-cert, pre-auths, insurance verifications like deductible, co-pays co-insurance etc is all done by my office manager and not through my EHR or outside agency.

Is there any component of your billing where someone is receiving a set percentage of your overall collections?

 

[Weirdy]

Second Eclinical works.
Current MSG uses it.
Easier to pick up than say, Cernor.
Less cluttery than full blown Epic.

 

[Adam Smasher]

third on eCW. My secretaries who have worked in other offices tell me it is primitive. Price is favorable. We pay a small annual fee for smart search so that way it finds "pain in right foot" when I search for "right foot pain." I'm going to experiement with Sunoh AI to see if it lessens the amount of clicks to order labs and imaging,

 

[619]

Is there any component of your billing where someone is receiving a set percentage of your overall collections?

No. My office manager does my billing and follow up on all rejections, appeals etc. Everything is in house. She is on Salary. Benefits include health insurance (a very good one), 401K with 3% match, PTO etc.

 

[Feli]

I use Tebra (was Kareo).
It was much stronger when it was Kareo, but it's still pretty good... it's made for PP.
It has full Rx, billing integration for claims submit, send statements, etc. $600/mo plus statements mailed.. two or three months free to set up.
It's much better than most EMRs... most notes are 1pg, maybe 20% of mine are 2pgs (aka one page front/back).

It has infrequent down/slow time like any, but it's fairly fast. (I complain to them if there is any downtime, and they usually credit me back for part of the month).
It uses text shortcuts (templates feature is not too strong). Also haven't figured out how to share Rx favorites and txt shortcuts between users (have to copy paste).
The biggest downside is definitely that Tebra bought Kareo and PatientPop, so they send roughly weekly nonsense to try to get you to sign up for their marketing, SEO, etc services.

eCW has horrible lag when I used it... almost unusable, but that was maybe 2015-18, so I'm sure it's improved.

There is no perfect EMR. That's for sure.

 

[Homo sapien]

No. My office manager does my billing and follow up on all rejections, appeals etc. Everything is in house. She is on Salary. Benefits include health insurance (a very good one), 401K with 3% match, PTO etc.

How Many overall staff do you have

 

[619]

How Many overall staff do you have

1 office manager and 3 front office so 4 staff in total. I started with one staff back in 2020.

I don't have a dedicated MA because I don't see a need for one. I don't see the point for an MA to follow me into the room or follow me around like my shadow.

One of my staff up front was meant to be my MA but I will rather have her taking phone calls and scheduling new patients. She also enjoys hanging out the other ladies at the front desk. All my front desk staff can take x-rays. All of them up front know how to room patients, clean the rooms, clean instruments, autoclave etc. so they take turns and divide the tasks as they see please. The benefit of all 3 being equally trained in front and back is if anyone is sick for the day or out for the week for whatever reason, it does not disturb the flow. Everybody knows what everyone else knows. I have a small efficient office so no need to divide task and they al work closely together. Only my office manager has her specific task that no one else can do especially billing and basically all the insurance stuff. She is my achilles heel.

I draw up own injections. I do my own DME fittings (night splint, CAM, brace) etc. They know how to fit DME but 99% of the time, I fit the DME myself so I get to spend more time with my patients. Some times if we are not so busy, I take the x ray myself. For me, It's all about spending time with the patients face-face. None of my NEW patient will ever complain that they saw me for 60 seconds or I was in and out of the room. I want to answer all their questions so the never feel rushed.

 

[deleted1162946]

I draw up own injections. I do my own DME fittings (night splint, CAM, brace) etc. They know how to fit DME but 99% of the time, I fit the DME myself so I get to spend more time with my patients. Some times if we are not so busy, I take the x ray myself. For me, It's all about spending time with the patients face-face. None of my NEW patient will ever complain that they saw me for 60 seconds or I was in and out of the room. I want to answer all their questions so the never feel rushed.

20 patients a day I assume? I can see up to 40 and there’s just no way without staff I’d be able to take x rays or fit dme

 

[Homo sapien]

1 office manager and 3 front office so 4 staff in total. I started with one staff back in 2020.

I don't have a dedicated MA because I don't see a need for one. I don't see the point for an MA to follow me into the room or follow me around like my shadow.

One of my staff up front was meant to be my MA but I will rather have her taking phone calls and scheduling new patients. She also enjoys hanging out the other ladies at the front desk. All my front desk staff can take x-rays. All of them up front know how to room patients, clean the rooms, clean instruments, autoclave etc. so they take turns and divide the tasks as they see please. The benefit of all 3 being equally trained in front and back is if anyone is sick for the day or out for the week for whatever reason, it does not disturb the flow. Everybody knows what everyone else knows. I have a small efficient office so no need to divide task and they al work closely together. Only my office manager has her specific task that no one else can do especially billing and basically all the insurance stuff. She is my achilles heel.

I draw up own injections. I do my own DME fittings (night splint, CAM, brace) etc. They know how to fit DME but 99% of the time, I fit the DME myself so I get to spend more time with my patients. Some times if we are not so busy, I take the x ray myself. For me, It's all about spending time with the patients face-face. None of my NEW patient will ever complain that they saw me for 60 seconds or I was in and out of the room. I want to answer all their questions so the never feel rushed.

Did you originally start that one staff on salary? Did you build their cost into your initial monetary requirements

 

[mandrew]

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[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji6]][emoji[emoji6]]] patients a day I assume? I can see up to [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]][emoji[emoji[emoji6]][emoji[emoji6]]] and there’s just no way without staff I’d be able to take x rays or fit dme

If seeing [emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji6]][emoji[emoji6]]] or less patients/day there is no need for more than [emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]] staff. You could even manage with only one.

 

[Hybrocure]

1 office manager and 3 front office so 4 staff in total. I started with one staff back in 2020.

I don't have a dedicated MA because I don't see a need for one. I don't see the point for an MA to follow me into the room or follow me around like my shadow.

One of my staff up front was meant to be my MA but I will rather have her taking phone calls and scheduling new patients. She also enjoys hanging out the other ladies at the front desk. All my front desk staff can take x-rays. All of them up front know how to room patients, clean the rooms, clean instruments, autoclave etc. so they take turns and divide the tasks as they see please. The benefit of all 3 being equally trained in front and back is if anyone is sick for the day or out for the week for whatever reason, it does not disturb the flow. Everybody knows what everyone else knows. I have a small efficient office so no need to divide task and they al work closely together. Only my office manager has her specific task that no one else can do especially billing and basically all the insurance stuff. She is my achilles heel.

I draw up own injections. I do my own DME fittings (night splint, CAM, brace) etc. They know how to fit DME but 99% of the time, I fit the DME myself so I get to spend more time with my patients. Some times if we are not so busy, I take the x ray myself. For me, It's all about spending time with the patients face-face. None of my NEW patient will ever complain that they saw me for 60 seconds or I was in and out of the room. I want to answer all their questions so the never feel rushed.

I’m not sure if you realize this, but your front office are your MAs and the back office lol.

 

[Feli]

I’m not sure if you realize this, but your front office are your MAs

...Yeah, same for me, tho: they're all doing both.
They have their strengths and prefs, but in any small office, they do a bit of everything (orders, stock, phones, room pts, clean, chart, make/change appts, marketing, whatever). 🙂

... 3 front office ...
...my front desk staff can take x-rays. ... room patients, clean the rooms, clean instruments, autoclave ... know how to fit DME ...

Not sure if your MAs front desk staff would want to, but I have mine draw up lido, steroid injects a dozen or two at a time during our admin time (I think there's less sterility issues and less chance of needle stick that way - versus doing them one by one and in a hurry as pt waits).

 

[Hybrocure]

...Yeah, same for me, tho: they're all doing both.
They have their strengths and prefs, but in any small office, they do a bit of everything (orders, phones, room pts, clean, stock). 🙂

Not sure if your MAs front desk staff would want to, but I have mine draw up lido, steroid injects a dozen or two at a time (I think there's less sterility issues and less chance of needle stick that way)

Yeah mine are all predrawn in the rooms. As far as X-rays go - I don’t think I could ever go back to bending over to move plates day to day

 

[Feli]

Yeah mine are all predrawn in the rooms. As far as X-rays go - I don’t think I could ever go back to bending over to move plates day to day

Same. There is nothing wrong with that (doing MA stuff yourself, esp to train them), but after awhile, it gives more impression of the doc time being valuable if you have assists for most stuff (like how it makes someone look important when they have bodyguard, assistant, etc with them). Attorneys and accountants have assist for same reasons.

Besides, the assists like doing stuff and learning in my exp. The pts are their pts too. They almost always do want to be involved, they want to take good HPI, they want new skills if you train them. They can show ppl dme, comp stockings, do Jones wraps, show insoles and other OTC stuff (I tell them not allowed for anything invasive like injects or wound debride or suture remove etc "due to liability" and infection concerns... but they can assist me 100%). It adds cred to the doc to have the assist in the room (and it's a barrier against any weirdness from pt!!!). I hang in there with them sometimes for same reasoning. Lastly, it's GROSS to be reaching into cabinets/drawers/instrument tray with gloves on that have touched the pt already imo. MA in the room solves all of that.

I am definitely not above answering my office phone sometimes, doing the occasional dme/wrap myself, etc... but I find it makes ppl less likely to consume a lot of your time or bother you with nonsense if you appear fairly busy. In that vein, I have my staff trained to take a msg if ppl call for me with anything routine - even if I'm doing nothing. Similarly, if people drop of paperwork like Fmla papers, handicap permits and the like, they have nonsense questions via email... then we have standard script that "we aim to turn those around withing a week, and we'll call you when it's complete." Routine MRIs and labs done can wait a couple hours to get a call back. You have to be careful creating expectations that you're highly accessible. Most important, the staff NEVER tell pts that I'm on vaca... it's "he goes to medical conferences." It sucks, but ppl aren't happy you're taking vaca time... they'll complain and guilt you they couldn't get an appointment. It's lame. I will tell some pts, but with most, it just causes issues.

Almost everyone wants to think their doc is Batman or busy doing important stuff... so play to that fantasy, jmo.

 

[619]

20 patients a day I assume? I can see up to 40 and there’s just no way without staff I’d be able to take x rays or fit dme

Correct. I average about 18 patients a day. 20 is the sweet spot. 25 becomes hectic and anything over 30 is hell which happens after a vacation week before things go back to normal.

Every day is different. There could be an hour when 5 patients show up and the next hour is only 1 patient. Or AM could have like 12 patients then PM only has 5 patients. It varies hour by hour, AM vs PM, day by day and week to week. I just go with the flow. I let the patients pick the times that works best for them. I try not to limit or block the schedule. I don't mind seeing 5 new patients back to back. On a typical day, about half my patients are new patients.

 

[619]

Did you originally start that one staff on salary? Did you build their cost into your initial monetary requirements

Yes started with one staff doing everything upfront. Switched her to salary about a year later when she was promoted to office manager.

 

[MMourousias]

Do you guys have any recommendations for a good EMR for private practice? Ai capabilities would be a plus.
Currently considereing Nextgen and Drchrono. Thought?
Thanks!

Most of my small, independent practices use Practice Fusion. It is a quick set up, easy to use and cost effective system where you are not paying for a practice management system that you do not need. Find yourself a good billing company that provides you with the practice management system included in their fee.