Data mining represents wealth, a wealth of opportunity, action, and success. Directly put, data mining (the process of centralized data management and retrieval) helps LTC providers find hidden treasures of knowledge, not just data. Just as rare gems or precious minerals are only valuable when processed from the ore that is unearthed, so too is knowledge when refined from countless bytes of data. Refined data transformed into information becomes knowledge and knowledge – the power to act. Data mining, therefore, helps executives discover what is happening now, track trends, anticipate with some accuracy what may happen in the future, and explore the strengths of possible actions.

In real terms, providers today have the ability to mine their own data and, yes, to share the data and knowledge with others at practically a simple click of a button. They can view and act on Key Performance Indicators (KPIs) in real-time* and, based on the information collected, take action or create their own predictive models or what-if scenarios. Some vital KPIs, among others, include:

• Census Information, such as actual-to-budget census by payer type
• Admissions and Discharges trending, including admissions sources and discharge destinations, lengths of stay, and readmissions to hospitals
• Labor information, including actual-to-budget as well as actual-to-flex budget (by which providers can determine staffing needs based on the actual census)
• A review of overtime hours so that providers can schedule staff and minimize overtime pay
• Cash and accounts receivable comparing actual payments to targeted collection dates by payer, also cash trending by payer, reconciliation of collections to bank statements, DSO, periodic aging reports
• Regulatory reporting, such as the 671 report, detailed discharge reports, reports for uploading to other systems, such as AHCA’s Trend Tracker
• Clinical  SNF and assisted living KPIs, including relevant trending

The strength of data mining for operators of multiple facilities lies in its ability to drill down from a consolidated dashboard view configured by the provider to the region, facility, department, individual employee, or resident. Administration of such a system is provider driven to determine who shall have access to what within the system.

A viable data mining system is responsive to the ever-changing long term care environment, such as data and information-hungry ACOs, remaining top of mind for hospital discharge planners by maintaining hospital readmissions at an acceptable level, involvement in policy-determining studies, or meeting HIT requirements (Stage 2 meaningful use) to be eligible for the federal electronic health-record financial incentive program.

Data mining is more than a curiosity; it is the Mother Lode of vital information in today’s health care environment. Talk to us during the AHCA/NCAL 63rd Annual Convention and Expo, booth #1317, or during the 2012 LeadingAge Annual Meeting and Exposition, booth #530,to discover for yourself how providers like you have benefited in real dollars from data mining using our primeVIEW business intelligence tool.

*Let’s talk about “real-time” for a moment. The term, real-time, can mean “without perceivable delay.” So, in this case, the data is processed as soon as it is received. How often is the data pulled? That is directly driven by the provider’s need to know. You could say that “real-time” reporting is driven by the need for “real-time” decision making. For example, labor hours require perhaps a greater frequency of reporting during a given day than collections or census. Our primeVIEW customers determine data pull frequency.

Leaders who are really successful are those who are accountable and hold others accountable. Over the years I have served in several leadership positions in this amazing industry/profession, we call Long Term Care, and have observed many who live the principle of accountability. The more precise the terms of the accountability, the more effective the leader and the team he or she leads. You may think it odd that in a technology blog, you would read about leadership, but be patient. There is an IT-related point to this.

Accountability starts from within; it is a state of mind – a conduct-determining constant. It is the leader’s willingness to be responsible for his or her own actions and the actions of those who report to him or her. Merriam-Webster defines accountability as “an obligation or willingness to accept responsibility or to account for one's actions.” How does one measure “one’s actions?” How accurate are those measurements? How often should one be held accountable?

Rendering an accounting has been a periodic, often formal event. But the nature of that “rendering” has changed. In the past, when all things were paper based, either the leader prepared or relied on someone else to prepare documentation/reports targeting specific responsibilities – a time-consuming and laborious process. What’s more, it was very much after the fact. As I sat in on monthly P&L reviews or periodic performance reviews, the matters discussed were usually a “day late and a dollar short.” I like the adage that I heard Dr. Wayne Dyer once cite, “I can’t should’ve anything.”

Well, fortunately for those who possess an “accountable” paradigm (and, yes, I am finally making my point), IT has streamlined accountability and the its rendering process; at the click of a button it is current, up to date. With Business Intelligence (BI) and data mining, leaders have real-time access to their Key Performance Indicators (KPIs) for which they are accountable. No longer do they need to prepare reports. No longer are there managers working blind and needing to set, and harangue their subordinates about, deadlines for reports submissions. In real time, leaders and their managers can view what is going on. If the data exists, digital dashboards can display. Senior management can view these KPIs at a high level or drill down to the operational unit level. Local leaders can also use the dashboards to refocus on that which matters most. Leaders do not have to wait for reports or try to guess how they are doing. BI is actionable, because it’s current and displayed in terms that are useful, which is what accountable leaders hunger for. “Feedback is (indeed) the breakfast of champions.”

From a more global standpoint, embedded in the heart of the whole Accountable Care Organization momentum is accountability. More immediately, as LTC leaders have recently pointed out, only providers who can render an accounting and demonstrate that they can help hospitals meet their regulated readmission constraints will get the referral business.

I don’t know about you, but I’m on board with the idea that real-time business intelligence is a key to effective accountability. In today’s world, accountability – it’s more than just a mindset; it’s a must; it’s reality.                

You’re about to make a major decision regarding clinical and financial software, recognizing the need to move into the next generation of applications. With competitive pressures, new reimbursement opportunities and restrictions, electronic medical records, health data and information interoperability, and quality care accountability, your team recognized that the status quo will not suffice. However, with a new clinical software application decision also comes the need to reexamine your IT infrastructure. To ignore that consideration, you run the risk of putting “new wine into (an) old (bottle)” and “the new wine doth burst the (bottle).” Cloud computing is the "new bottle of IT and continues to grow as a viable option that is cost effective and offers agility of service. It is scalable and helps you to focus on what you do best - operate your business. (Read our previous blog, How the Cloud can help you meet today’s opportunities more rapidly, for more details.) With virtualization leading the way, cloud computing affords businesses an entirely new IT paradigm. Assuming, cloud computing is your infrastructure of choice, how do busy executives, like you, best leverage cloud computing providers?

Cloud computing is a new world for many and changes the way businesses look at IT and how to use it. By entrusting the IT infrastructure to cloud computing providers or Cloud Services Providers (CSPs), like PCT, executives need to apply their well-developed management skills.

Because cloud computing offers on-demand and scalable solutions, executives are able to effectively apply such well-honed management skills as delegation, accountability, and oversight to this model. Start with the Master Services Agreement (MSA). The MSA not only addresses such issues and service features as security, infrastructure, data center, cloud computing service features, email hosting, and user support, among others, but it is a living, breathing document.

Here are three ways that you can effectively leverage you cloud computing provider of choice.
1.    Delegation – Effective delegation implies not only the handing off of certain tasks, but most importantly, the vision and supporting goals justifying those tasks. If you are too focused on the individual tasks identified and miss the synergy of how the whole is greater than the sum of the parts, opportunities will pass unseized. Share with your provider your company’s goals and objectives. Lay out a five year plan with your provider clearly outlining how you expect the CSP to help you meet your goals. Harness the CSP’s project management skills and expertise to fully capture the power of delegation.
2.    Accountability – Conduct regular accountability meetings using the MSA as a benchmark combined with your vision and the role the CSP is to play. Evaluate the services and projects, identifying road blocks and how to mutually bypass or remove them. This is a time for purposeful dialogue, discussion, decision, and redirection, if required. It reinforces that you are still in charge.
3.    Oversight – Now, the tack I am taking with this may be a little different than what you would otherwise expect. I strongly believe that IT’s purpose is to help you more effectively manage your operations in much better way than without IT. One of the best tools to give you the oversight you need is real-time data mining or dashboard reporting. Your CSP should have the skill set to build and deploy for you a digital dashboard that displays in real time such Key Performance Indicators (KPIs) as labor, census, collections, RUGs (where appropriate), and others that are important to your company and its vision.

Cloud computing takes IT and businesses to the next level of performance. In truth, your cloud computing provider should be a member of your management team not just a vendor. Better phrased, you can more effectively leverage the power of cloud computing by employing the management skills set you already possess – delegation, accountability, and oversight.

What qualities are you looking for in a cloud computing provider?

Learn how providers use Business Intelligence to stay on top of their business. Download this free white paper.

According to experts, disaster recovery (DR) is how a business restarts itself following a disruptive incident that is natural, man-made, or a systems failure. On the other hand, business continuity implies a more comprehensive consideration of how your business continues to operate not only following a disaster, but also the departure of a key member of your management team or department head or any other incident or event which could interfere with daily operations.

Recently, we have witnessed the severe impact that weather has had on entire communities, their people, property, and infrastructure. While these tragic events certainly get our attention and cause us to reevaluate, reinforce, and rehearse our existing disaster plans, do we really give due diligence to planning for business continuity (BC)? To most people, BC and DR go together. That being the case, you will be well served to consider particularly the role IT can play to insure that any interference to your business's work flow is as small as possible.

Stepping back and examining the possible consequences of each type of adverse incident is an important step in performing a business impact analysis (BIA). By doing so, you can anticipate and plan specifically for each such event. Handling the consequences of a fire is much different than handling the sudden departure of the corporate IT manager or payroll manager.

First, you need to consider your most valuable asset – people. After a disruptive event, how will your employees communicate, where will they work, and how will they continue to perform their jobs? Who needs to take the leadership role and under what circumstances? What aspects of the workflow are essential and how will they continue?

Second, determine which systems, processes, and business units are essential. Particularly when it comes to IT assets and resources, you should consider not only your internal and contracted resources and assets, but also the businesses which develop and support the critical software applications you use. For example, while IT Asset Management is useful, it may fail to track which software versions your business is using.

Recent developments in technology, such as virtualization, cloud computing or other data center technology-enabled business solutions, social media, or mobile devices, can facilitate business continuity.

This blog cannot begin to cover all aspects of BC/DR, but anticipating, planning for, and rehearsing how you will handle a disruption to your business is well worth the effort, time, and money. Just ask someone who didn’t. Keep in mind that IT plays a major role and should be an essential part of your planning.

What are your doing to insure BC in your business? To learn more about how PCT can help, contact us.

Ignorance is no excuse. Over the last few months, like me, I’m sure you’ve seen headlines and read articles about the federal crackdown on Medicare and Medicaid fraud. Millions of dollars have been identified as fraudulently paid for services either not rendered or with limited justification. I acknowledge that there are unscrupulous practitioners and providers out there who should be identified, indicted, convicted, and sentenced to the fullest extent the law allows. However, while I don’t have the numbers, I wonder to what extend “fraud” was committed by those who unwittingly engage in poor billing practices, such as miscoding and/or absence of support documentation for procedures provided. The old adage, that if you didn’t document it, it didn’t happen, may put providers and practitioners at risk of investigation and indictment with all the attendant negative results, such as loss of reputation, decline in confidence, and possibly business failure.

If this falls within the reasonable realm of plausible possibility, I have to scratch my head and wonder why. Why place your business and your future at risk, when you don’t have to? Once again, and you have to admit that this blog is consistent when it comes to waving the IT banner, IT can come to the rescue. Imagine the peace of mind you could have while reducing your DSO, assuming you are at risk not for lack of integrity, but credibility, if your organization had a billing and claims management system that would file clean claims each and every time.

Such an automated revenue cycle management system exists, specifically designed for long term care providers. Imagine a system comprised of a comprehensive and configurable user-friendly web portal to manage claims throughout the submission process, with functions for loading, reviewing, editing, and tracking claims online. With this portal, providers can fully leverage enterprise-level security and permissions with user-definable roles to satisfy their specific claims processing practices. As part of a complete health care transaction solution, providers can submit, monitor, edit claims, and review their claims on-line.

Key benefits of the ProClaim Partner’s application:

• Increased revenue stream and reduced DSO through quick claims turn-around and real-time claims management reporting viewable through a user-defined digital dashboard
• Smoother claims flow through direct connections with providers, trading partners, and value-added networks
• Eliminating avoidable payment delays by increasing successful first-pass rates, tracking claims, and automatically checking claim status
• Reduced transaction fees and paper handling costs by enabling direct connection with providers and payers
• Decreased operations costs through automated handling of routine questions and documentation requests associated with eligibility, claims status, and referrals
• Preserving investments in existing systems by offering an off-the-shelf claims management application that easily interfaces with existing adjudication, financial, and membership systems
• Reduced risk through its robust user audit functionality

Providers would be well rewarded for looking into it. At times like these and under this “gotcha” environment of fraud crackdown, doing billing right certainly has its virtues. But a system is only as good as the workflow that leads to the filing of claims – preadmissions screening and documentation; admissions documentation; clinical documentation; therapy services documentation; proper coding; charges compiled; and claims created, scrubbed, triple checked, filed, and monitored. All are critical components of the workflow and are at risk of vital data and information leakage.

In the next blog, we’ll discuss some of these workflow components which are considered industry best practices.

Question: What solid claims management practices have you observed or implemented?