Seamless Integration and Impressive Results for Orthopaedics Practice Using CGM APRIMA EHR

Like many small, independent physician practices, Orthopaedics & Rheumatology  of the North Shore (ORNS) has experienced a financial impact from the industry’s shift to high-deductible insurance plans. Under these plans, patients pay lower premiums but higher out-of-pocket costs for their medical care. Traditionally, many patients defer payment on their healthcare bills until they’ve first met other financial obligations – which can lead to cash flow issues for providers, especially those not employed by large health systems with deep financial  pockets.

By 2016, ORNS providers and staff worried that the shift to high-deductible plans was fueling a growth in patient accounts receivable. Office Manager Amy Rogers realized that in order to preserve the practice’s financial health, the group needed to implement a credit card on file program.


Credit card on file programs are common for a wide variety of consumer services, but healthcare organizations have been slow to implement similar initiatives for patient collections. However, in order to avoid the potentially crippling impact    of high-deductible plans, Rogers worked with CGM APRIMA and their partner Easy Pay Solutions to address the patient collection  challenge.

“Historically, patients would wait for their bills and then pay us in small installments,” explains Rogers. “We decided we would much rather have patients make payments to their own credit card than to  us.”

ORNS’s credit card on file policy requires all patients to provide the practice with  a credit card number that is kept on file. Rather than accepting a default non- payment policy, payment is now captured automatically at the point of care.


Rogers emphasizes a successful credit card on file program requires full physician support. “You  can’t  do this if you have pushback from your physicians. Overall,   our physicians have been consistent in conveying our message – that we need to get paid promptly so we can continue to deliver high-quality healthcare and meet our own financial obligations. I can count on one hand the number of patients that the doctors have come to me about and asked for an  exception.”

Patient education is also critical. When new patients call ORNS to schedule an appointment, staff advises them of the credit card on file policy. The practice also displays signage that explains the policy and the staff is well-trained in addressing any patient concerns.

“We explain to patients that healthcare has changed and that we are not owned by   the hospital and must do this in order to maintain our independence. Most of the patients accept that and we’ve only had a few leave – ones who were likely not to pay anyway,”  states Rogers.


Rogers reports that the integration between CGM APRIMA and Easy Pay is “seamless,” and staff productivity has been positively impacted. The process is integrated into staff workflows for patient pre-registration and intake. They swipe the card and through the Easy Pay/CGM APRIMA integration, payments are automatically posted to CGM APRIMA.  “Not only am I able to post credit card payments in a batch, but also the system actually applies payments to individual accounts for us,” explains Rogers.

ORNS has established limits on the amounts charged to credit cards, such as $500 per swipe for patients with private insurance and $200 per swipe for Medicare patients.

When necessary, ORNS will establish payment plans that satisfy a patient’s financial needs while also adhering to the practice’s revenue cycle requirements. If a patient  has a large balance, Easy Pay can be set up to automatically charge a patient’s card monthly for a predetermined number of months. Easy Pay calculates the monthly charge amount and automatically processes the  payments.


ORNS has seen a dramatic impact on accounts receivable since implementing the credit card on file program. For example:

  • Patient accounts receivable fell 28% within the first six months of implementing the program.
  • In the first three months of 2017 – when patients are traditionally paying out of pocket to meet deductibles – ORNS experienced a 53% decline in accounts receivable compared to one year earlier.
  • Also during the first quarter of 2017, receivables in the 91- to 120-day category declined 73% year-over-year.

In addition, because the system automatically processes patient payments on a monthly basis, ORNS has been able to reduce the number of statements sent each month, saving the practice both time and  money.

Rogers believes that all healthcare providers could benefit from a credit card on file program. “As an industry, we need to create the expectation that patients need to  pay their bills because we can no longer afford not to be paid or manage patients’ no-interest loans,” says Rogers. “We are doing this successfully and are proof that this does work!”

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