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How SaaS Has Helped A Rheumatology Practice Survive

January 22, 2014
by Rajiv Leventhal
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Miami Beach rheumatologist says, “No one should have to commit $40,000 for an EHR”
Charles Sesin, M.D.

As many physician practices are planning their electronic health record (EHR) conversion strategy, they are quickly realizing that many choices are overwhelming and costs seem discouraging.

Enter cloud-based EHRs, which require no hardware installation or software licenses, with implementation often a fraction of the cost. Practices pay a monthly fee, like a utility bill, as part of an arrangement called software as a service (SaaS).

Across the country, an increasing number of practices are warming up to the idea of not having to buy or maintain a server. According to a recent survey by Black Box, 42 percent of physician practices plan to upgrade their billing software within six to 12 months, and most of those prefer an integrated EHR/practice management solution that includes outsourcing options. In effect, that means using cloud-based vendors that can take over some or all of the billing and collection work, said Doug Brown, managing partner of Black Book, adding that cloud EHRs with revenue cycle management (RCM) innovations have given independent practices new hope.

Vanguard Rheumatology Partners, located inside the Miami Beach, Fla.-based Mount Sinai Medical Center, is one practice that has reaped the benefits of switching to a service with a more flexible pay-as-you-go model. Vanguard is a single-specialty practice with three rheumatologists—dedicated to arthritis, soft tissue rheumatic disorders, systemic autoimmune diseases, and osteoporosis—that  became electronic in 2004 with the implementation of a rudimentary EHR system from the Fayetteville, Ark.-based vendor SOAPware, says Carlos Sesin, M.D., owner of Vanguard and chief of the rheumatology division at the Mount Sinai Medical Center.

As industry standards began to change, the practice realized that the legacy system would not be able to support upcoming industry changes and newer regulations, so it made the switch to the Chicago-based Allscripts in 2009. What Vanguard hoped would be a capable and low-maintenance solution proved to be the opposite, leaving the practice with more than $300,000 in outstanding claims and its financial health at risk, Sesin says.

“We would be submitting claims and the dashboard on the practice management side would tell us that claims went through. Weeks later, we realized that wasn’t happening,” says Sesin. “Things were still in the system and not being moved over to our clearinghouse. It was very frustrating, and we started getting behind on our finances,” he says.

In his attempts to talk to the value-added reseller, Healthcare Data Solutions (HDS), a sales and service partner of Allscripts, Sesin says that despite additional training and money spent, Vanguard was getting nowhere with the system, as well as getting empty responses from the vendor. “I paid $100 an hour for additional training, and even those trainers were scratching their heads,” Sesin claims. “Remember, I’m not just a doctor; I’m the owner, and I’ve seen the numbers. I needed out,” he says.

Consequently, the organization is paying $625 a month for at least the next two years to leave Allscripts because it was tied in to a contract without a termination clause, Sesin says. In an e-mailed statement, Allscripts said the organization does not comment on contract terms and conditions it has with former or existing clients.


During the first quarter of 2012, Vanguard implemented the Miami, Fla.-based CareCloud’s practice management solution. As CareCloud’s practice management system is cloud-based, it can be accessed by any computer with a browser, enabling use across Vanguard’s two offices (Vanguard has recently opened a satellite office inside Mount Sinai Medical Center in Hialeah, Fla.). Its main office in Miami Beach has 27 computers, and Sesin says now, there is no need to outsource anyone for IT.

Sesin says the pay-as-you-go model has been a far better fit for his practice. “You shouldn’t have to pay $40,000 or commit to pay [that much] for an EHR, not in this day and age,” he says. “The onus is on them to keep me happy, and if not, I should be able to migrate my information elsewhere. This web-bases system lends itself perfectly to our patient portal, which we don’t have to pay for separately. I didn’t want to do have anything in my office physically, and I didn’t want to be responsible for security and backups,” Sesin says.

Since the switch to the cloud-based integrated system, the results have been more than noteworthy for Vanguard, according to Sesin. For one, Sesin previously had to bring in a near full-time equivalent (FTE) to help with the billing, so the elimination of that need has led to significant savings. E-prescribing has also been incredibly easy, he says. “I can prescribe 10 medicines in the time it would take me to write one or two prescriptions with another system,” Sesin boasts.

Additional results since the switch, according to Sesin, include: accounts receivable (AR) reducing substantially from the detrimental $300,000 to a manageable $10,000; and being able to attest to meaningful use (MU) Stage 1, and shortly thereafter receiving its first incentive check, which had a huge impact on the practice’s bottom line (Vanguard is now also on target to meet MU Stage 2 requirements).

“Before [CareCloud}, I thought I was on target for Stage 1, but in turns out we were sorely behind because the numbers we were running were flat-out wrong,” Sesin says. “So of course I was concerned with attesting to MU, wondering if I had enough time. But it ended up working out perfectly,” he claims. “We started using the system by July, 2012, and by mid-October we were running numbers and hitting our targets. It was so easy to do,” he says.

Best of all, Sesin says he has now learned his lesson: a lump-sum payment of a fully purchased version of an EHR program can cost a practice a lot of money if it acquires additional maintenance costs or needs to switch to a different vendor. “I don’t think anybody should be paying for stand-alone software anymore,” Sesin says. “Subscription is the way to go.”

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