1 00:00:02,240 --> 00:00:02,899 At athenahealth, 2 00:00:03,279 --> 00:00:06,019 we know your ambulatory practice wants healthier, 3 00:00:06,399 --> 00:00:09,279 a healthier business, healthier care teams, and healthier 4 00:00:09,279 --> 00:00:09,779 patients. 5 00:00:10,160 --> 00:00:12,480 But the complexities of modern health care tech 6 00:00:12,480 --> 00:00:14,240 make it hard for you and your care 7 00:00:14,240 --> 00:00:15,824 teams to focus on what matters 8 00:00:16,304 --> 00:00:19,344 most? That's where athenahealth can help. Our AI 9 00:00:19,344 --> 00:00:22,564 native all in one solutions reduce administrative burdens, 10 00:00:22,945 --> 00:00:25,904 streamline billing and payments, and deliver critical insights 11 00:00:25,904 --> 00:00:27,524 when clinicians need it most. 12 00:00:27,839 --> 00:00:30,500 That means fewer clicks, more time for patients, 13 00:00:30,559 --> 00:00:32,100 and stronger bottom lines. 14 00:00:32,719 --> 00:00:36,000 Practicing medicine is complex, but running a practice 15 00:00:36,000 --> 00:00:37,780 can be that much simpler with athenahealth. 16 00:00:38,559 --> 00:00:42,260 See how simpler is healthier@athenahealth.com. 17 00:00:43,545 --> 00:00:45,884 This is Laura Dierda with the Becker's Ambulatory 18 00:00:45,945 --> 00:00:47,324 Surgery Center's podcast. 19 00:00:47,625 --> 00:00:49,304 I'm thrilled today to be joined by Laurie 20 00:00:49,304 --> 00:00:52,045 Noble, administrator at the Endo Center at Voorhees. 21 00:00:52,265 --> 00:00:53,545 Laurie, it's a pleasure to have you on 22 00:00:53,545 --> 00:00:55,704 the podcast today. Oh, it's so nice to 23 00:00:55,704 --> 00:00:56,924 be here. Thank you. 24 00:00:57,359 --> 00:00:59,920 Absolutely. Now I'm excited for our conversation because 25 00:00:59,920 --> 00:01:01,359 I know we're gonna talk about a variety 26 00:01:01,359 --> 00:01:03,679 of things and really spotlight some of the 27 00:01:03,679 --> 00:01:05,439 interesting things you're doing at the EndoCenter of 28 00:01:05,439 --> 00:01:07,599 Voorhees. But before we dive in, can you 29 00:01:07,599 --> 00:01:08,959 tell us a little bit more about yourself 30 00:01:08,959 --> 00:01:09,780 and your background? 31 00:01:10,224 --> 00:01:11,284 Sure. So 32 00:01:11,664 --> 00:01:14,784 I've been in health care business operations and 33 00:01:14,784 --> 00:01:17,685 accounting for, you know, about thirty years. 34 00:01:18,144 --> 00:01:18,965 I've been 35 00:01:19,424 --> 00:01:22,244 in the ASC industry for, 36 00:01:22,739 --> 00:01:24,840 I would say just over thirteen years. 37 00:01:25,700 --> 00:01:28,599 I started at a multi specialty, 38 00:01:29,859 --> 00:01:30,840 surgery center, 39 00:01:31,780 --> 00:01:33,239 running the business office. 40 00:01:34,019 --> 00:01:35,079 We did ophthalmology 41 00:01:35,620 --> 00:01:36,120 and, 42 00:01:36,579 --> 00:01:37,079 orthopedics 43 00:01:37,924 --> 00:01:39,064 and, pediatrics. 44 00:01:40,165 --> 00:01:42,005 And I've been at the endo center at 45 00:01:42,005 --> 00:01:43,784 Voorhees for eleven years. 46 00:01:44,645 --> 00:01:45,944 We are a gastroenterology 47 00:01:46,725 --> 00:01:47,225 center, 48 00:01:47,924 --> 00:01:50,484 and I just I've you know, I enjoy 49 00:01:50,484 --> 00:01:51,784 working with my 50 00:01:52,229 --> 00:01:53,849 team, the staff, the physicians. 51 00:01:54,310 --> 00:01:56,489 They're very dedicated, very compassionate 52 00:01:56,790 --> 00:01:58,090 for our patients here, 53 00:01:59,349 --> 00:02:01,269 and I'm just really proud of the quality 54 00:02:01,269 --> 00:02:03,049 of care that we provide our patients. 55 00:02:03,349 --> 00:02:05,049 I think that's really most important, 56 00:02:05,795 --> 00:02:09,094 in an ASC, you know, safe, good quality 57 00:02:09,155 --> 00:02:09,655 care. 58 00:02:10,435 --> 00:02:12,854 So we are a pretty busy center, 59 00:02:13,235 --> 00:02:15,155 but I we I really enjoy it. I 60 00:02:15,155 --> 00:02:17,955 love it. Oh, absolutely. And that's amazing. I 61 00:02:17,955 --> 00:02:20,669 mean, being at the same surgery center for 62 00:02:20,669 --> 00:02:22,990 eleven years is a a huge accomplishment and 63 00:02:22,990 --> 00:02:23,490 definitely, 64 00:02:23,870 --> 00:02:25,310 I can imagine you've seen a lot over 65 00:02:25,310 --> 00:02:27,010 that time. Oh, absolutely. 66 00:02:27,550 --> 00:02:28,530 You see everything. 67 00:02:30,830 --> 00:02:33,895 For sure. For sure. Well, you know, given, 68 00:02:34,375 --> 00:02:36,615 your history of the center plus, I I 69 00:02:36,615 --> 00:02:37,974 just know a lot of things are going 70 00:02:37,974 --> 00:02:39,415 on in the health care space today. What 71 00:02:39,415 --> 00:02:40,855 are some of the top three trends that 72 00:02:40,855 --> 00:02:43,594 you're following right now in health care, surgery 73 00:02:43,655 --> 00:02:45,895 centers? Just in general, you know, what are 74 00:02:45,895 --> 00:02:48,235 the things that you're paying most attention to? 75 00:02:48,830 --> 00:02:51,569 So for us, you know, for me, financial 76 00:02:51,949 --> 00:02:53,569 and operational efficiency 77 00:02:53,870 --> 00:02:55,250 is always something, 78 00:02:55,629 --> 00:02:58,849 I keep my eye on and growing patient 79 00:02:58,989 --> 00:03:01,789 and payer preference for lower cost options are 80 00:03:01,789 --> 00:03:02,289 accelerating, 81 00:03:03,194 --> 00:03:05,775 the growth and expansion of the ASC market. 82 00:03:06,555 --> 00:03:08,474 So that's, you know, something I like to 83 00:03:08,474 --> 00:03:10,094 keep my my eye on. 84 00:03:10,474 --> 00:03:12,175 Focusing on upfront collections, 85 00:03:13,275 --> 00:03:15,194 especially here in New Jersey, we had a 86 00:03:15,194 --> 00:03:16,014 bill passed 87 00:03:16,469 --> 00:03:18,250 about reporting medical debt. 88 00:03:18,550 --> 00:03:20,310 So that's something else that, 89 00:03:21,189 --> 00:03:23,610 you know, I keep a close eye on. 90 00:03:23,989 --> 00:03:25,349 Another thing is the, 91 00:03:26,069 --> 00:03:28,489 transforming health care with responsible 92 00:03:29,030 --> 00:03:30,409 AI technology now. 93 00:03:30,915 --> 00:03:33,415 They're they're advancing every day with 94 00:03:34,034 --> 00:03:36,215 AI, which, you know, AI puts 95 00:03:36,514 --> 00:03:38,615 a focus on measurable impact, 96 00:03:39,715 --> 00:03:40,694 proper use, 97 00:03:41,314 --> 00:03:43,094 and using it, I think, 98 00:03:44,169 --> 00:03:46,349 we're having better patient outcomes. 99 00:03:46,969 --> 00:03:49,370 So I think that's really important for us 100 00:03:49,370 --> 00:03:49,949 to follow. 101 00:03:51,370 --> 00:03:53,289 Another one is, you know, kind of going 102 00:03:53,289 --> 00:03:55,469 along with the AI, but technical 103 00:03:56,090 --> 00:03:56,590 technological 104 00:03:56,889 --> 00:03:58,030 and clinical advancements, 105 00:03:58,985 --> 00:04:00,604 is something we follow closely. 106 00:04:01,305 --> 00:04:03,405 Innovations and advancements in 107 00:04:03,864 --> 00:04:05,805 surgical technology and procedures, 108 00:04:07,064 --> 00:04:08,125 clinical practices. 109 00:04:09,305 --> 00:04:12,185 All these advancements are allowing more procedures to 110 00:04:12,185 --> 00:04:12,844 be safely 111 00:04:13,219 --> 00:04:15,560 and effectively performed in the ASC, 112 00:04:16,579 --> 00:04:17,079 setting. 113 00:04:18,019 --> 00:04:20,019 So that's, you know, always a good thing 114 00:04:20,019 --> 00:04:20,680 for us. 115 00:04:21,379 --> 00:04:23,699 So those are three big things that I 116 00:04:23,699 --> 00:04:25,540 like to keep my finger on the pulse 117 00:04:25,540 --> 00:04:26,040 with. 118 00:04:27,254 --> 00:04:29,975 Absolutely. And, you know, all very important things 119 00:04:29,975 --> 00:04:32,694 and fascinating to see how the industry's been 120 00:04:32,694 --> 00:04:34,694 evolving. I think in particular, when you look 121 00:04:34,694 --> 00:04:37,194 at some of the financial and operational efficiencies, 122 00:04:37,894 --> 00:04:40,535 and then to, you know, the what you're 123 00:04:40,535 --> 00:04:41,435 hearing from, 124 00:04:42,300 --> 00:04:44,220 payers and their preferences for some of these 125 00:04:44,220 --> 00:04:46,379 low cost options, etcetera, coming into the surgery 126 00:04:46,379 --> 00:04:48,399 center. How have you seen that, 127 00:04:49,180 --> 00:04:51,199 I guess, the tone or or tenor from 128 00:04:51,339 --> 00:04:54,194 payers changing over time? Is there anything that 129 00:04:54,194 --> 00:04:56,834 you've noticed, from that perspective as you're, 130 00:04:57,314 --> 00:05:00,035 navigating your relationship with the the payers in 131 00:05:00,035 --> 00:05:00,694 your community? 132 00:05:01,154 --> 00:05:02,754 Well, you know, for us being, 133 00:05:03,154 --> 00:05:03,654 gastroenterology, 134 00:05:05,154 --> 00:05:06,915 you know, we've noticed over the years, you 135 00:05:06,915 --> 00:05:08,694 know, better screening, 136 00:05:09,339 --> 00:05:11,360 preventative screening benefits 137 00:05:11,819 --> 00:05:13,120 with, insurances. 138 00:05:14,300 --> 00:05:16,939 You know, they switched from 50 to 45 139 00:05:16,939 --> 00:05:17,600 for screening, 140 00:05:18,139 --> 00:05:19,360 so that's always 141 00:05:19,660 --> 00:05:22,720 a good thing. The more preventative benefits, 142 00:05:23,604 --> 00:05:24,345 the consumer 143 00:05:25,125 --> 00:05:27,444 receives, you know, the better it is for 144 00:05:27,444 --> 00:05:28,584 us. So 145 00:05:29,125 --> 00:05:30,985 it's there's definitely impact there. 146 00:05:31,365 --> 00:05:32,724 Got it. That makes sense. And I know 147 00:05:32,724 --> 00:05:34,264 you mentioned growth and expansion, 148 00:05:34,805 --> 00:05:36,745 within the ASC market too. 149 00:05:37,339 --> 00:05:38,620 What are some of the impacts of that? 150 00:05:38,620 --> 00:05:40,459 What are the factors that are have been 151 00:05:40,459 --> 00:05:43,420 driving more of the ASC growth whether, you 152 00:05:43,420 --> 00:05:45,259 know, in in your center, which I know 153 00:05:45,259 --> 00:05:47,680 is extremely busy, and then others, 154 00:05:48,060 --> 00:05:49,120 you know, nationally? 155 00:05:50,144 --> 00:05:52,324 Well, for for me right now, 156 00:05:52,625 --> 00:05:54,564 AI is at the top of my list. 157 00:05:55,185 --> 00:05:58,324 We've been using an AI assisted polyp detection 158 00:05:58,464 --> 00:05:59,845 system at our center 159 00:06:00,464 --> 00:06:00,964 probably 160 00:06:01,664 --> 00:06:04,550 well over three years now. The AI module 161 00:06:04,689 --> 00:06:08,709 assists physicians by detecting colorectal polyps during colonoscopies, 162 00:06:10,050 --> 00:06:13,409 highlighting suspicious areas in real time to improve 163 00:06:13,409 --> 00:06:14,389 cancer prevention. 164 00:06:15,490 --> 00:06:18,345 So the AI system uses machine learning to 165 00:06:18,345 --> 00:06:19,404 enhance visualization 166 00:06:20,504 --> 00:06:22,125 and detect subtle lesions, 167 00:06:22,985 --> 00:06:26,205 leading to increased polyp detection rates and potentially 168 00:06:26,425 --> 00:06:27,964 improving patient outcomes 169 00:06:28,500 --> 00:06:30,040 by identifying precancerous 170 00:06:30,420 --> 00:06:33,860 polyps earlier. I mean, this is amazing how 171 00:06:33,860 --> 00:06:34,920 far we've come. 172 00:06:35,300 --> 00:06:36,759 We actually have patients 173 00:06:37,220 --> 00:06:38,360 calling the center 174 00:06:38,980 --> 00:06:41,235 to see if we use it. I mean, 175 00:06:41,235 --> 00:06:43,254 this is where we're at in the industry. 176 00:06:44,035 --> 00:06:46,675 I think patients are now expecting these types 177 00:06:46,675 --> 00:06:47,415 of advancements. 178 00:06:48,115 --> 00:06:50,694 It's no longer the exception. It's the rule. 179 00:06:51,155 --> 00:06:53,500 And I I think it's great. I mean, 180 00:06:53,500 --> 00:06:55,259 what more can you ask for? You know? 181 00:06:55,259 --> 00:06:56,560 Anything to improve, 182 00:06:57,019 --> 00:06:59,039 you know, a better patient outcome, 183 00:06:59,500 --> 00:07:00,800 should be highly utilized. 184 00:07:02,060 --> 00:07:04,379 Absolutely agreed. And, you know, it's amazing to 185 00:07:04,379 --> 00:07:07,365 think about how the technology can really have 186 00:07:07,365 --> 00:07:09,384 that type of impact on the patients, 187 00:07:09,925 --> 00:07:13,045 and improve the clinical care in in, a 188 00:07:13,045 --> 00:07:15,144 significant way. And then too, you know, 189 00:07:15,524 --> 00:07:18,165 for the clinicians, were they pretty, accepting and 190 00:07:18,165 --> 00:07:19,925 exciting of the technology, or what was it 191 00:07:19,925 --> 00:07:23,064 like to incorporate that into the endoscopy center? 192 00:07:23,580 --> 00:07:25,439 We went through a trial period, 193 00:07:26,139 --> 00:07:27,920 where we trialed the system. 194 00:07:28,779 --> 00:07:31,439 And, you know, just like anything else new, 195 00:07:31,740 --> 00:07:32,639 it it took 196 00:07:33,020 --> 00:07:35,100 a a few months for for them all 197 00:07:35,100 --> 00:07:36,879 to kind of get used to it. 198 00:07:37,580 --> 00:07:39,714 They were all willing, you know, to give 199 00:07:39,714 --> 00:07:40,535 it a try. 200 00:07:41,154 --> 00:07:42,694 It just you know, 201 00:07:42,995 --> 00:07:46,675 it took some tweaking and but yeah. I 202 00:07:46,675 --> 00:07:49,414 mean, once they got used to it and, 203 00:07:49,474 --> 00:07:52,055 you know, we saw the numbers come in, 204 00:07:52,435 --> 00:07:53,814 everybody was on board. 205 00:07:54,839 --> 00:07:56,459 So it's it's definitely 206 00:07:57,560 --> 00:08:00,120 something everybody should look into if, you know, 207 00:08:00,120 --> 00:08:02,360 there's a system out there that pertains to 208 00:08:02,360 --> 00:08:03,899 what they're doing in their center. 209 00:08:04,920 --> 00:08:07,020 Absolutely. You know, that's great to hear. 210 00:08:07,644 --> 00:08:09,404 And before we wrap up, I wanted to 211 00:08:09,404 --> 00:08:11,245 look into the future as well. How are 212 00:08:11,245 --> 00:08:13,164 you thinking about growth over the next twelve 213 00:08:13,164 --> 00:08:14,064 months or so? 214 00:08:14,925 --> 00:08:17,644 So there's always an opportunity of growth. We 215 00:08:17,644 --> 00:08:18,704 just need to collaboratively 216 00:08:19,164 --> 00:08:21,404 keep our pulse on what's happening in the 217 00:08:21,404 --> 00:08:22,464 ASC market. 218 00:08:23,579 --> 00:08:25,680 Our patient base is always growing. 219 00:08:26,060 --> 00:08:26,800 Our physicians 220 00:08:27,500 --> 00:08:29,579 have added the fast track model to their 221 00:08:29,579 --> 00:08:30,079 practices, 222 00:08:31,180 --> 00:08:33,440 which has helped to increase volume significantly. 223 00:08:34,804 --> 00:08:37,144 You know, if you meet a certain criteria, 224 00:08:37,845 --> 00:08:39,944 you can kind of jump over the physician 225 00:08:40,964 --> 00:08:43,625 appointment and come directly to the center. 226 00:08:44,084 --> 00:08:46,964 Younger patients are also a significant contributor to 227 00:08:46,964 --> 00:08:48,904 the growth in our colonoscopy 228 00:08:49,284 --> 00:08:49,784 volume. 229 00:08:50,269 --> 00:08:51,490 Back in 2020, 230 00:08:51,870 --> 00:08:54,750 the 18 to 45 year old compromised, you 231 00:08:54,750 --> 00:08:56,370 know, age group compromised 232 00:08:56,750 --> 00:08:58,769 twelve percent of our center's cases. 233 00:08:59,389 --> 00:09:01,549 Now that age group is well over twenty 234 00:09:01,549 --> 00:09:02,049 percent. 235 00:09:02,909 --> 00:09:03,409 And, 236 00:09:04,235 --> 00:09:06,875 you know, lastly, it's important for physicians and 237 00:09:06,875 --> 00:09:08,975 the ASCs to educate consumers 238 00:09:09,595 --> 00:09:11,054 to know that going to an ASC, 239 00:09:11,595 --> 00:09:13,134 it's it's much more affordable, 240 00:09:13,995 --> 00:09:16,254 for them. It's a affordable alternative 241 00:09:16,714 --> 00:09:19,034 than having certain procedures done in the hospital 242 00:09:19,034 --> 00:09:19,529 setting, 243 00:09:19,930 --> 00:09:21,690 which in turn is going to increase your 244 00:09:21,690 --> 00:09:22,670 ASC volume. 245 00:09:23,690 --> 00:09:25,550 So that's, you know, I think 246 00:09:25,930 --> 00:09:27,930 those are really good things to to keep 247 00:09:27,930 --> 00:09:31,070 your eye on and, you know, keep growing. 248 00:09:32,345 --> 00:09:35,464 Absolutely. Well, it's fascinating especially to think about, 249 00:09:35,784 --> 00:09:38,504 your the growth in the number of patients 250 00:09:38,504 --> 00:09:40,504 that you have in the eighteen to forty 251 00:09:40,504 --> 00:09:41,004 five, 252 00:09:41,384 --> 00:09:43,325 year old range, which is 253 00:09:43,799 --> 00:09:46,519 fascinating. Is there anything that you're doing differently 254 00:09:46,519 --> 00:09:47,159 and knowing, 255 00:09:47,559 --> 00:09:48,779 you know, with this population 256 00:09:50,039 --> 00:09:51,559 being on on the growth or on the 257 00:09:51,559 --> 00:09:53,259 rise? Anything you have to do differently? 258 00:09:53,799 --> 00:09:56,519 You know, we just we you have to 259 00:09:56,519 --> 00:09:57,019 market 260 00:09:57,745 --> 00:10:00,865 yourself differently, and you have to kind of 261 00:10:00,865 --> 00:10:02,164 zone in on 262 00:10:02,704 --> 00:10:04,544 on that age group. 263 00:10:05,105 --> 00:10:05,904 You know, it's 264 00:10:06,865 --> 00:10:09,904 listen. Nobody wants you know, in our our 265 00:10:09,904 --> 00:10:12,459 setting, nobody wants to go come and get 266 00:10:12,459 --> 00:10:13,120 a colonoscopy. 267 00:10:14,779 --> 00:10:16,940 You know, and it's always been where, you 268 00:10:16,940 --> 00:10:19,500 know, 50 or older, that's something you have 269 00:10:19,500 --> 00:10:20,879 to do. When you're younger, 270 00:10:21,340 --> 00:10:23,660 you, you know, you you kind of think, 271 00:10:23,660 --> 00:10:25,884 oh, you know, maybe, you know, I don't 272 00:10:25,884 --> 00:10:27,965 really need to do that. So I think 273 00:10:27,965 --> 00:10:29,585 we have to, you know, 274 00:10:30,045 --> 00:10:32,524 kind of zone in on that age group 275 00:10:32,524 --> 00:10:33,024 and 276 00:10:33,565 --> 00:10:35,345 educate them on the importance 277 00:10:35,965 --> 00:10:38,445 of of getting screened or if you have 278 00:10:38,445 --> 00:10:39,504 any kind of symptoms. 279 00:10:40,009 --> 00:10:40,830 You know, unfortunately, 280 00:10:42,490 --> 00:10:44,909 you know, being in the GI setting, colorectal 281 00:10:45,129 --> 00:10:48,350 cancer is just hitting people younger and younger. 282 00:10:48,809 --> 00:10:51,070 So I think, you know, through marketing, 283 00:10:52,024 --> 00:10:52,524 and 284 00:10:52,904 --> 00:10:53,804 social media, 285 00:10:54,504 --> 00:10:57,804 we try and put education out there for, 286 00:10:57,865 --> 00:11:00,264 you know, for that age group to to 287 00:11:00,264 --> 00:11:02,904 show them the importance of of getting your 288 00:11:02,904 --> 00:11:03,404 screenings 289 00:11:04,200 --> 00:11:06,279 or getting checked if you feel like something's 290 00:11:06,279 --> 00:11:07,179 not quite right. 291 00:11:08,040 --> 00:11:11,500 Absolutely. That is amazing reminder and and certainly, 292 00:11:12,120 --> 00:11:14,139 so important for everybody, 293 00:11:14,679 --> 00:11:15,179 nowadays 294 00:11:15,480 --> 00:11:16,220 for sure. 295 00:11:16,524 --> 00:11:17,884 Laurie, thank you so much for joining us 296 00:11:17,884 --> 00:11:19,325 on the podcast. This has been such a 297 00:11:19,325 --> 00:11:21,184 fascinating conversation, especially 298 00:11:21,644 --> 00:11:23,964 looking into how the industry is changing and 299 00:11:23,964 --> 00:11:25,884 and some of the cool things that are, 300 00:11:26,205 --> 00:11:28,365 coming down the pipe for endoscopy centers. I 301 00:11:28,365 --> 00:11:30,044 appreciate your time today and look forward to 302 00:11:30,044 --> 00:11:32,159 connecting with you again soon. Oh, it's my 303 00:11:32,159 --> 00:11:33,620 pleasure, Laura. Thank you. 304 00:11:34,960 --> 00:11:35,700 At athenahealth, 305 00:11:36,080 --> 00:11:38,820 we know your ambulatory practice wants healthier, 306 00:11:39,200 --> 00:11:42,080 a healthier business, healthier care teams, and healthier 307 00:11:42,080 --> 00:11:42,580 patients. 308 00:11:42,960 --> 00:11:45,195 But the complexities of modern health care tech 309 00:11:45,274 --> 00:11:47,115 make it hard for you and your care 310 00:11:47,115 --> 00:11:49,054 teams to focus on what matters most. 311 00:11:49,434 --> 00:11:52,634 That's where athenahealth can help. Our AI native 312 00:11:52,634 --> 00:11:56,174 all in one solutions reduce administrative burdens, streamline 313 00:11:56,235 --> 00:11:58,955 billing and payments, and deliver critical insights when 314 00:11:58,955 --> 00:12:00,179 clinicians need it most. 315 00:12:00,659 --> 00:12:03,240 That means fewer clicks, more time for patients, 316 00:12:03,379 --> 00:12:04,919 and stronger bottom lines. 317 00:12:05,539 --> 00:12:08,740 Practicing medicine is complex but running a practice 318 00:12:08,740 --> 00:12:10,600 can be that much simpler with athenahealth. 319 00:12:11,299 --> 00:12:15,000 See how simpler is healthier at athenahealth.com.