A Mission to Become Paperless: How a Single Doc Dermatology Office is Making it Happen

Sept. 17, 2015
Most small practices don’t have the mindset to become paperless from the get-go. In Austin, Tx. however, a jack-of-all-trades practice manager has made that ambition become a reality for a dermatology office.

When Daniel Soteldo’s wife graduated from medical school and wanted to start her own dermatology private practice, he knew he was going to help her run the business, but in what specific capacity that would happen he was unsure about. Soteldo, after all, has a background filled with technological and business proficiency, but not one in medicine or even practice management; his last job involved managing a team of sales engineers for enterprise software. While Soteldo has experience working with Fortune 500 companies who had medical institutions has customers, running his wife’s practice was a whole different story. Soteldo says that one of the first things he realized was that a lot of smaller practices don’t use much technology, and that’s something he wanted to change right off the bat. “From the get-go, I wanted this to be a paperless office,” he says.

Blakely Richardson, D.O., is the solo practitioner at the Austin, Tx.-based Westgate Skin & Cancer, a facility where her husband, Soteldo, practice manager, bears all of the financial and administrative responsibilities. “I really do everything here but clinical,” he says. “I’m not grabbing an iPad and running into the room with a patient, but I am responsible for understanding the notice that was created with the encounter, and what it means for billing and payers. I manage all HR and financials, and all the technology. So I really have a view into everything.”

As such, in the time that Westgate has been open, one of Soteldo’s main priorities has been making the practice as tech-heavy as possible, something that is often a difficult endeavor for small medical offices. “It’s tough, but I liken it to making an investment. There are initial costs you wouldn’t have if you were on paper. But time, automation, ease of use, and patient experience are what it comes down to,” he says. The practice has tapped software-as-a-service technology company Kareo (Irvine, Ca.) as the core system that everything else integrates with. “It’s the glue that holds our practice together,” Soteldo says. When Kareo recently acquired DoctorBase, a practice marketing and patient communications solution, Soteldo immediately jumped on board.

Westgate uses DoctorBase for automated emails and texts to patients, eliminating the need for an employee to do those tasks. With the new software, between emails and re-directing people to the online patient portal, the patient appointment no-show rate has gone down about 80 percent, says Soteldo. “The no-show rate was pretty high before, at about 20 percent, and now it’s something like one out of 20, so it is way lower. We also have an idea of who will no-show us because they didn’t confirm with an email or don’t pick up the phone if we have time to call and follow up. So we can be proactive by double booking those spots we predict will be no-shows. [Relieving] my staff by dropping no-show rates has been the biggest improvement thus far,” he says. Since dermatology is a high-volume specialty where Dr. Richardson hopes to see 35-40 patients a day eventually, there is a huge benefit to having these types of things being automated and done online, Soteldo notes. “If your practice is rural, people don’t want you texting them. But in Austin there is a higher expectation of service. It’s an energetic town, so when you text and email them, it’s a breath of fresh air. They love it—they hit ‘confirm’ and DoctorBase marks it as confirmed. It’s such a great thing for our staff, as they know what’s going on right away,” Soteldo says.

Soteldo adds that DoctorBase has made Westgate ROI-positive in its first month, and even more than that, its success has been evident based on patient reviews. “We immediately see family and friends of patients coming in, and when we ask them how they heard of us, it’s often due to reviews and word of mouth. We are growing rapidly because of that,” he says.  He adds, “We are really investing in our future. What we are building is hard, but it will pay off because we are busy building the foundation for a modern practice. Now is the only time to do it too, because once you start seeing more patients and get completely booked up, it becomes twice as hard to [implement the technology]. At that point, the car is moving at 60 MPH already, rather than 5 or 10 like it is now,” he says. .

A Gutsy Call

The mindset of integrating expensive technology now, rather than down the road, certainly is a courageous one that many small practices might not be willing to risk. Soteldo says that it’s the same mindset of a startup mentality, of which he has worked at plenty of in the past.  “In the beginning you work like crazy to build it, you have your projections and you do your homework, but you still won’t get it all right,” he says.  “The first year here was very difficult due to having no experience in this industry. I taught most of it to myself, reading online and looking at on healthcare technology. I’m always looking at press announcements from different technology companies. Certainly, my background has helped me, and now it’s starting to pay off as we’re getting busy,” he says.

Daniel Soteldo

Soteldo admits that federal mandates such as meaningful use have presented their own challenges. “We have been waiting for the Centers for Medicare & Medicaid Services (CMS) to release its rules on the program, and waiting for that has been frustrating. In many ways, for us, meaningful use has just been a distraction,” he says. “Some practices might need it, but we have a high level of focus on using the right tools, automation and accuracy, so meaningful use is a distraction since we’re already doing a lot of these things. If I could get every patient to fill out a portal before they come in, I already would, so I don’t need this program to tell me to do that. Many other small practices don’t run this way, though,” he admits.

Specifically for meaningful use, Soteldo says he ran and wrote the security report with just a consultant’s help. He also clearly defined the practice’s workflows and processes with little things such as taping instructions to the back of the iPad case that reminds staff to ask Medicare patients certain questions. He additionally made it part of the front desk process to automatically activate everyone’s portal and incentivize patients by telling them they will save time in the office if they fill out these forms in advance. And it works, Soteldo says, because no one wants to be in the office for 15-20 extra minutes. He notes that Westgate has attested to Stage 1 of meaningful use after filing a hardship exemption due to timing. “We were one of the last people to get that incentive check,” he says.

Soteldo says another benefit of the technology is helping with care coordination and data exchange. “We are a solo practice and we put a high level of effort in making sure we get notes and results back to the primary care provider who referred that patient. It’s part of our intake process,” he says. “Thankfully with our systems, the workflow is easy,” Soteldo says, referring to another piece of Kareo technology, Modernizing Medicine's Electronic Medical Assistant. “For example, if that referring physician is in the system, it prompts the doctor when the summary of care is ready and automatically sends it back to them. Coordination of care is huge,” he continues. “EMR companies are all competing so maybe they’re not as incentivized to share data. We work around it the best we can though.  We have found that because we’re new, we get patients in fast for next-day appointments, we close the loop, get notes back, and let physicians know if their patients have been appropriately cared for. It makes for a better doctor and patient experience.”

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