I’m a solo practice orthopaedic surgeon in the Bay Area.  Sounds crazy right?  As we all know, the economic forces and the consolidation that is occurring in the healthcare field today makes my professional existence quite challenging.  When I describe my practice circumstances to folks at social events, they either reflexively nod their head with that expression one gets when they learn someone has terminal cancer or they applaud me for being the lone soldier fighting the impossible fight.

Nine years now into practice, I don’t necessarily feel like I’m a dinosaur or Rambo.  I actually feel lucky that I can practice the way I imagined I would when I set off for medical school – that is to be in an autonomous situation where I am accountable to my patients.  I feel fortunate that I am able to provide personal, individual care to my patients focusing on both education as well as prevention and treatment.

However, with each year it is ever more challenging to do so and part of the survival equation is to lower your practice overhead.  In this article, I would like to share with you some of the significant cost saving techniques I have been using and encourage you all to share your solutions in the comments section.


When I started my practice 9 years ago, I wanted to create a “paperless office” and was led by a consultant to purchase a $25,000 EHR that proved to be so cumbersome and inefficient that I was never able to use it for a single patient.

Therefore, 3 years ago when I was faced with adopting an EHR for Meaningful Use purposes, I was wiser and more cost-conscious.  I was pleased to discover Practice Fusion, a cloud-based EHR (www.practicefusion.com).  Practice Fusion had several advantages that I appreciated.  It was FREE.  It was cloud-based, so I did not have to purchase additional hardware to host the EHR.  It was cloud-based, so I could access the EHR from anywhere that had an internet connection.  It was highly customizable without having to create a work-order with IT help support.  It was simple.  Practice Fusion also provided incredible support with real people.  Today, Practice Fusion is a much larger company.  The EHR has lost some of its simplicity (still tolerable) and the support has suffered as the company has grown larger.  But as far as a free solution that can help achieve Meaningful Use requirements (less critical now), it is still my EHR answer.

Practice Management – FREE

I started my practice using a software package recommended by my biller at the time.  The software proved to be reliable and affordable at the time in 2005.  However, the company required a software upgrade nearly every 3 years to the tune of $2,000 to $3,000.  They were not cloud-based.  As I explored for a more modern, cost-effective solution, I came across Office Ally, which interestingly serves as the clearinghouse for that software.

Office Ally not only serves as a clearinghouse for large practice management vendors but also provides those services to small offices like mine.  They provide a FREE online practice management client called Practice Mate (https://pm.officeally.com/).  With Practice Mate, my staff and I can manage the clinic schedule, patient roster, insurance information, and submit billing claims.  Practice Mate, of course, seamlessly and effortlessly routes the claims through Office Ally.  There is a comprehensive list of financial reports that Practice Mate can generate.  All of this is web-based and can be accessed anywhere there is an internet connection, even on my mobile phone.  This makes checking on my schedule a breeze.

Patient Engagement (Online Intake Forms and HIPAA-compliant Email) – FREE

Patients everywhere, including the Bay Area, expect modern conveniences when it comes to any service.  The medical world has tried to keep pace with this demand but is often time hampered by rules and regulations that govern the industry.  Nevertheless, patients expect to be able to engage with medical offices and their doctors through modern conveniences like the laptop, tablet, or mobile phone and this expectation should be met.

TouchHealth (www.touchhealth.com) provides simple patient engagement solutions to small practices for FREE.  They provide a customizable online intake form module to allow remote check-ins from home or in the waiting room on the patient’s own device.  These forms are easily generated and can accommodate numerous question styles and includes signature pages if necessary.  My patients can automatically access this intake form from my practice webpage or can be prompted via an email invitation from my staff.

In addition, TouchHealth offers a patient education module called Patient EDU.  This feature allows me to send patients informational and educational materials, such as a pamphlet or pdf on a particular musculoskeletal condition or post-operative instructions.  Patient EDU also allows me to “bundle” associated articles or video into a portfolio so that I can readily provide these to my patients.  For example, I can assemble pdfs on ACL surgery and ACL anatomy along with a video describing the actual procedure itself into an “ACL Reconstructive Surgery” bundle that I can pass on to all my patients who are considering that surgery.  This allows for a more informed patient and, therefore, better care.

Lastly, TouchHealth provides my office the capability to send and receive emails in a HIPAA-compliant manner.  While Patient EDU can be considered “one-way” communication from my practice or me to the patient, TouchHealth secure email (sMail) can be considered “two-way” communication allowing for a conversation.  My office uses sMail to communicate with patients, other medical offices, physical therapy offices, you name it.  They save tremendous time and expense by avoiding having to deal with paper mail or faxes.  I use sMail to communicate with my staff, remote billing company, fellow physicians, and patients – either on my laptop or from my mobile phone.  This ability for me to leverage modern email to stay connected in the work place is essential for me as a solo practitioner who relies on cultivating and maintaining relationships.  The beauty of TouchHealth sMail is that anyone involved in healthcare, including the patient, can participate on this encrypted, secure email platform – and it is FREE.  To me, free is advantageous from a cost standpoint but more importantly, I believe a communications medium needs to be free if it is to be widely adopted.  There are too many other solutions out there that compromise the usefulness of their communications platform because they limit who can participate on the platform.

(Disclaimer: I am a co-founder of TouchHealth, Inc.)

Telephone System – ~67% SAVINGS

I started my practice with AT&T and for 3 phone lines my monthly cost was averaging approximately $350 per month.  Naturally, with the rise of the internet and VOIP companies, cheaper alternatives began to present themselves.  I ultimately adopted RingCentral (www.ringcentral.com) as my VOIP provider and was able to maintain 4 lines for approximately $130 per month.  Not only is the cost about one-third to one-fourth that of AT&T, but RingCentral also offers numerous features that just are not offered by AT&T.  I can manage the hours of operation, forwarding and answering features, etc. all via their website.  My phones also are now portable and the same number can service different physical sites.  There is also a mobile app that allows my mobile phone to act like my office phone.  All in all, I benefit from more features, more control, and mobile access to my telephone communications with RingCentral.

I hope this article has been helpful to those of you who are in a similar practice situation as I am in.  I remain committed to my patients and will continue to provide care the way I want to via my mom-and-pop practice.  I do believe my patients appreciate my style of practice as an option.

Please do share your comments, feedback, and experience with cost-saving measures in your practice.