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The Unification Process:
Key Steps to Driving Practices in the Right Direction

By Howard Drenth
Administrative Director of Physician Practices
Advanced Medical Group - Greene Health Partners


Hospital groups around the country are looking for better ways to meet the needs of specialty practices and still profitably provide the best community healthcare possible. However, as these organizations acquire medical practices and form integrated delivery systems, they must also assume much of the responsibility for managing the practices. This is not always a simple task.


Like many hospitals, Greene Memorial Hospital of Xenia, Ohio, found itself in the middle of a myriad of modern healthcare IT and financial challenges. This was due in part to having two distinct, independent medical groups using four different software systems and compounded by having multiple services for billing and collections for the various physicians. The fact that each software package also had its own unique way of reporting financials added to the challenges associated with this unsustainable situation. At the end of each month, Greene Memorial would begin the labor intensive process of trying to balance the accounts for each of the various practices. Again, not a simple task.

Facing a series of credentialing errors and omissions that had also been made, the administration realized they had inherited an infrastructure of fragmented, inefficient systems and decided to make some major changes. At first, the easiest solution would have been to unify all of the billing under one of the existing vendors. However, upon further evaluation, it was discovered that none of the solutions were able to meet the specific needs of this multi-specialty group.


The Greene Memorial team knew it had to streamline the revenue cycle, but also recognized it needed a system that would provide the flexibility, control, and consistency required to effectively work with all of the physician practices in a number of separate locations.

Realizing that it was almost impossible to standardize management and reporting across all of the practices, Advanced Medical Group (AMG), the physician practice subsidiary of Greene Memorial Hospital, formed a task force made up of physicians and administration. Their charter was to find a single solution that all the practices would use for their practice management, billing, and collection service needs, a critical part of the process. The task force ultimately had to determine what the physicians wanted in a unified solution that would also meet the needs for each practice.

Early in the evaluation and selection process, the task force decided to survey the physicians to fully understand their wants and needs. Each strongly expressed opposition to having the hospital manage billings internally. They were concerned they would be managed like a hospital A/R; meaning Greene Memorial wouldn’t pay attention to smaller dollar claims – a prime source of revenue in primary care.

In January 2007, AMG issued an RFP for an integrated system that could be installed to replace the existing fragmented and inefficient setup. The RFP produced an initial list of more than 20 possible vendors which were then scrutinized by the task force. From this initial list, only a few of the vendors submitting proposals were found to be capable of potentially meeting the organization’s needs and the rest were eliminated from consideration because of price or product limitations.

After further evaluation it became apparent that there were two distinct roads to choose from - select a billing service and have them implement their software program, or select practice management software that was best for the practices and then engage a billing service that used that software under a completely separate agreement. AMG chose to do the later and felt they would have greater flexibility in holding each respective party accountable for what they were hired to do and best meet the needs of the practices. Case in point – before, if AMG wanted to change a particular billing service the software was also eliminated. It was an “all or nothing” deal and everything would have to change. By electing to separate the responsibilities, AMG hoped to get the best of both worlds: a robust software solution and first rate service. Fortunately, the process resulted in a really great outcome.


In May 2007, AMG selected AdvancedMD (www.advancedmd.com) as its practice management system. Through this internal research, AMG learned that AdvancedMD is one of the leading providers of Web-based medical billing software and comprehensive practice management solutions. Their expertise also focused on customer service, retention, and practice solutions that give the flexibility and efficiency both physicians and staff could agree on. Having made the selection, AMG began the process of converting its practices over to this new solution, a process that standardized the revenue cycle in all practices.

Knowing that converting practices to a new, unfamiliar, system could prove to be difficult, AMG first set up a formal training program to help build internal expertise. This was very important to the success of the whole effort. Because of the multiple system scenario of the past, proficiency wasn’t available across the practices. To further ensure the success of the implementation, AdvancedMD also dedicated a project manager to the conversion process helping to train and roll out the new web-based practice management, billing, and collections software services.

No matter the system selected, differences in learning styles, computer literacy, and even individual age affect system implementation and acceptance. However, the approach used for transition and implementation successfully bridged these challenges by providing customized support designed to adapt to each individual’s needs.


After just a few short months of implementation, AMG is already seeing a return on their investment. These system changes have allowed AMG to reduce annual billing costs by close to $200,000, a substantial amount that will drop straight to the bottom line.

AMG is also seeing savings on a real time basis. In addition to changing software, AMG implemented ‘charge entry’ into each practice and every physician and related staff was trained on proper coding methods. This was done because originally, using the old process, it took an average of 12-14 days from date of service, to get charges into the system. Claims are now dropping in as little as 1-4 days from the date of service and the process has allowed each practice a significant improvement in the timeliness of claims dropping, which ultimately has improved cash flow.


The key to successfully implementing an enterprise class revenue cycle management solution into a multi-specialty, multi-location operation is to keep open lines of communication with the staff and physicians. What an administrator likes in a system will be different than those physicians or their office staff because they each have very different sets of needs and each is important! It is critical to spend the appropriate time early in the process outlining the needs and expectations of all those that will be impacted by the scope of the project. Getting input upfront, providing regular communication, and planning ahead for the needs of the users are all required to meet the ultimate goal: a system that will help make an office run better, a practice that is more profitable, and a physician’s primary focus returned to patient care.

Howard Drenth serves as Director, Advanced Medical Group in Xenia, Ohio. AMG currently employs more than 40 physicians in a multi-specialty group environment. Mr. Drenth has over 15 years of experience in physician practice management in a variety of private and hospital based settings. He has successfully implemented new practice management systems in a multi-site, multi-provider setting. Mr. Drenth has a Masters of Arts degree in Business and is a member of the Medical Group Management Association.