If you missed the opportunity to listen in on last week’s CMS Open Door Forum, Understanding the IMPACT Act, you may be at risk of missing some key deadlines in 2016. A little background may be needed. The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 requires that CMS “make interoperable (Italics added) standardized patient assessment and quality measures data, and data on resource use and other measures to allow for the exchange of data among PAC (post-acute care) and other providers to facilitate coordinated care and improved outcomes.” Loosely translated, that means that the standardized assessment data generated by Long-Term Care Hospitals (LCDS), Skilled Nursing Facilities (MDS), Home Health Agencies (OASIS), and Inpatient Rehabilitation Facilities (IRF-PAI – my favorite acronym du jour) must be interoperable, that is, they must be able to talk to each other.

What's the scoop?

The presenters highlighted the need for immediate action, because of:

• The lack of comparable information across PAC settings undermines the ability to evaluate and differentiate between appropriate care settings for and by individuals and their caregivers
• Standardized PAC assessment data will allow for continued beneficiary access to the most appropriate setting of care
• Standardized PAC assessment data allows CMS to compare quality across PAC settings
• Standardized and interoperable PAC assessment data allows improvements in hospital and PAC discharge planning and the transfer of health information across the care continuum
• Standardized PAC assessment data will allow for PAC payment reform (site neutral or bundled payments)
• Standardized and interoperable PAC assessment data supports service delivery reform

The objective ultimately is to make care safer, reinforce person and family-centered care, promote effective communications and care coordination, promote effective prevention and treatment, promote best practices for healthy living, and make care affordable. Noble aspirations, these.

Fundamentally, the underlying principles include enabling innovation, fostering learning organizations, eliminating disparities, and strengthening infrastructure and data systems. While a couple of these principles as stated are a little vague, the last point about infrastructure and data systems is much clearer. Why? (And this is where I hear the screech of a needle slid across an LP vinyl record.) Because, you have an important reporting deadline to meet come October 1, 2016.

Here's the rub for SNFs

The IMPACT Act requires (italics added) SNFs to report standardized assessment data for the following Quality Measure Domains starting October 1, 2016:

• Functional status/cognitive function
• Skin integrity
• Incidences of major falls

CMS cautions that these domains are not exhaustive. In other words, there is more to come. For example, medication reconciliation and communicating the existence of and providing for the transfer of health information and care preferences have a common 10/1/18 deadline.

What is CMS supposed to do with this data? Why make them interoperable, of course, by standardizing/aligning/harmonizing the data elements, linking them to health IT standards, and making them available “to the public reports mapping assessment data elements to health IT standards.” (Say again?)

What's the hurry?

What are the drivers behind this? To replace fee-for-service with value-based payments with a focus on outcomes in contrast to service volume with emphasis on complex individuals who may receive care from providers across the entire care continuum.

Accomplishing this requires a change in the way providers communicate by relying on the electronic exchange of standardized and interoperable information to:

• Foster effective communication between sites
• Create safer transitions of care for those with the most complex issues
• Improve coordination of care across all sites with a shared care plan

There is so much more the Open Door Forum presented. But critically, providers need to focus on what they must do to report standardized functional status/cognitive function, skin integrity, and incidences of major falls assessment data to CMS starting October 1, 2016. This is just the beginning. Be alert to opportunities to learn more from CMS, your national trade association, and expert bloggers.

Will you be ready? We recommend that you include this among your important 2016 initiatives.

LTPAC CFOs in the 21^st century have to be concerned about many things. But in reality, much of what CFOs do revolves around getting paid on time in the amounts anticipated. Perhaps paying attention to the not-so-obvious factors influencing payment may be worth investigating.

Does this CFO job description for a Life Plan Community (LPC) sound familiar?

• Ensures corporate financial processes and systems, including overall financial controls
• Oversees accounting and financial reporting, financial planning & analysis, and budgeting
• Establishes financial systems and investment accounting and reporting
• Assures all financial operations function efficiently and effectively in compliance with all applicable policies and procedures and statutory/regulatory guidelines (Italics added)
• Strong participation in strategic planning and initiatives, project management

To accomplish this, the essential duties involved include:

• Providing proactive and sound guidance regarding management of assets, investments, and financial trends
• Overseeing a system of responsible accounting including budget and internal controls
• Developing and leading the finance team to maximum productivity and responsiveness (Italics added)
• Ensuring that monthly financial statements are provided on a timely basis
• Acting as a trusted counselor regarding development of new sources of revenue

Although each of these are specific to this LPC, they are for the most part what CFOs are responsible for no matter how many locations the company operates. They have one thing in common – responsible oversight of all income, expenses, and investments. For the purposes of this blog, let’s focus on three ways to shorten the revenue cycle by “developing and leading the finance team to maximum productivity and responsiveness” – specifically by addressing A/R team job satisfaction, claims processing costs, and secondary claims payments.

1. A/R Team Job Satisfaction

In previous blogs, we have addressed such job-satisfaction drivers as empowering the AR team through participation in the admissions process, direct involvement in helping residents apply for Medicaid, sharpening the blade of job skills through recurring education and best-practice updates, employing successful billing habits, making sure the census is correct, checking eligibility regularly, participation in regularly-held billing triple checks, familiarity with key aspects of payer contracts, and getting back to the billing basics. Competence, education, and good, old-fashioned appreciation and positive feedback contribute significantly to reduced turnover and job satisfaction. A happy team is a productive team and a productive team collects money owed.

2. Claims Processing Costs

Does it matter how much it costs to process claims? Yes. Let’s just take a simple example. An operator of 40 facilities in the western US used to process claims at the facility level. But with the advent of all-in-one claims clearinghouses, centralizing the billing function in the corporate office became doable and resulted in cost-saving efficiencies. Much of the claims preparation, submission, corrections as needed, follow-up, and payment receipts could be performed on line and for the most part automatically. Fewer billers were needed, resulting in a reduction in labor costs. Just as importantly, they collected money more quickly.

3. Medicare Secondary Payer (MSP) Claims

In the case cited in the previous paragraph, the provider in question was able to automate the processing of MSP claims resulting in an accelerated payment cycle with a reduction of 30 days between secondary claims filing and payment receipts. 

Is your company getting paid on time in the amount anticipated at lower costs? We suggest that with your AR manager(s) you take a hard look at these three productivity contributors and determine what initiatives need your support. Because, really, it all makes good cents.

You can’t go wrong with Business Intelligence (BI). But if you are new to the game, knowing which Key Performance Indicators (KPIs) are more useful to seasoned LTPAC BI Pros, those who were early adopters, may be useful. From start-ups to well-established providers, executives and managers have selected what they consider to be the most important KPIs for their operations. Let’s look.

Frontline Management’s Dean Kiklis, CFO, knows the importance of BI to multi-facility operations. In the beginning, the management team skipped the step of manually creating reports and moved right to BI to meet its aggressive information and scalability requirements for this rapidly growing company. Kiklis says, “By doing it right the first time, we won’t have to face a disruptive economic and operational challenge later on.” Focusing on census, labor and Days Sales Outstanding every Monday with daily updates throughout the week, Frontline Management is able to observe quickly the daily status of these key areas of its operation. For example, since employing primeVIEW, Days Sales Outstanding have dropped by 10 days.

Southeast-based American Healthcare, LLC operates multiple SNFS in Virginia. To remain competitive in a rapidly-evolving, quality-driven reimbursement environment, Robbie Dalton, CFO, reports that controlling costs are critical. Because labor consumes over 65%-75% of total spend, having a firm hand on labor is mission critical. In primeVIEW, the current daily census and labor are automatically tied, affording management a precise view each day of staffing to budget and actual census. This insight gives AHC’s management team opportunities to train Administrators and DONS to more effectively oversee staffing during each shift. Routinely, management uses PCT’s primeVIEW BI dashboard during its weekly census calls and goal setting.

Revenue is also important to AHC and BI has helped its facilities to increase the average daily census of skilled patients by 7% and private pay by 9% over a 12-month period, resulting in revenue increases of $2.6 million and $980,000 respectively.

Jackson, Mississippi-based Health Care Management, Inc. (HCM), reports Greg Seeger, COO, is able to track what is going on at each of its facilities. “We train our team to use primeVIEW as their go-to KPI information source to track census, labor, 5-star, length of stay, clinical quality, receivables, cash flow, and more. It’s a tremendous resource.” Utilizing the dashboard enables the team to identify discharge types and forecast trends. In addition, decision makers from the facility to the corporate office can access the current census levels by total as well as by payer type which enables the facility to forecast their labor and cash projections with ease.

Health Services Management’s Ray Tyler, COO, reports, “One of the biggest advantages to primeVIEW is our ability to view labor from a consolidated corporate, as well as a facility and even department and employee level…not only today, but we can trend and report on past performance as well.” Take overtime for example. PrimeVIEW’s facility, regional, and corporate reporting enables administrators and their department heads to view not only their performance, but they can also observe how they are doing compared to the other facilities within the company. Information in the dashboard helped HSM facilities reduce OT by an average of three percentage points in the nursing department alone.

Because BI generates current and relevant views of critical LTPAC-related and configurable KPIs, executives and managers are able to monitor and effectively manage those KPIs which are critical to achieving strategic goals. Take it from the pros, they literally know what they are doing and the impact their decisions can have on facility performance.

“To know is to grow.” Yes, as I pondered this week’s blog topic, this quote came to mind – probably not original, but it is apropos and kind of catchy. As the manager of an accounts receivable team at the corporate, region, or facility level, your job is to help your team members grow in knowledge, skill sets, and ultimately productivity. For over ten years, Prime Care Technologies has asserted that knowledge is the power to succeed and to grow. The seed of knowledge is data converted to useful information and transformed into knowledge. Let’s explore five ways you can help your team’s productivity and success through knowledge.

1. Become a part of the admissions team – Know who is to be admitted when, who is to pay, and be able to collect permissable deposits. Office managers have the obligation to remind admissions decision makers that the temptation to admit “warm bodies” just to fill empty beds will certainly drive up direct care costs, but may not contribute to a healthy bottom line. Further, company policy can insist that the administrator/executive director sign off on all write-offs. Bad debt sitting passively on the books is one thing, but a write-off is concrete confirmation that the facility is not going to collect and can serve as a real deterrent to the practice of “heads in beds,” as a veteran AR consultant once stated to me.

On an even more proactive note – become part of the admissions team. We have observed that the more responsible facilities, which happen to have a better bottom line track record, require that each member of the admissions team (comprised at least of the administrator, director of nursing, rehab services, and the business office) must sign off on each pending admission. By doing so, the team members insure that the essential bases are covered.

2. Help the family with the Medicaid application – Figuratively speaking, hold their hands. Once you know that the resident may qualify for Medicaid, at the least, either prior to or on admission have a copy of the Medicaid application ready for the responsible party. Highlight the applicable sections to be filled out. Even include a cover list with simple instructions about how to fill out the form. In some facilities, the business office actually sits down with the responsible party to walk through the form and to complete the form right there and then. The facility makes a copy of the completed application for the responsible party and then mails the original.

3. Collect resident liability up front – For Medicaid-covered residents, some states allow you to collect the resident liability on admission. Check with your state’s Medicaid program to confirm and to determine what the collectible pro-rated amount should be.

4. Ask if the responsible party would like the facility to manage the resident income – The resident trust fund can be a real benefit to responsible parties and families members. Because it is federally insured direct-deposit account that collects interest, the facility business office can pay resident-specific bills. The family does not need to worry about bringing in deposits or paying bills. It can contribute to peace of mind and can strengthen the responsible party/facility relationship.

5. Thank your staff. Regularly let them know how much you appreciate your team. They work hard and in a frequently frantic environment. A “thank you” goes a long way by letting them know you appreciate them and are aware of their successes.

Knowledge about admissions, that the Medicaid application has been filed, that deposits are collected, the resident bills are going to be paid, and that good work is recognized goes a long way to foster success. What other things do you do to fuel your AR team’s pursuit of excellence? Please share it with us. It makes cents.

Nationwide, Business Intelligence is increasingly integrated in the day-to-day management of long term post-acute care (LTPAC) facilities. As we have posted in previous blogs, decision makers at the corporate, region, facility, and department levels have adapted to the features and seized the resultant benefits that BI has to offer. Examining the observable trends in LTPAC and some of our own research may be compelling. Here are three of the more obvious trends:

1. Self-service analytics – What drives self-service is the unsatisfactory reliance on the IT-generated “report factory” which can be slow, often dispensing outdated information. This model of information gathering and distribution places an unnecessary burden on the IT department. However, BI, designed with input from users, is responsive and current. BI gives the users the flexibility and the knowledge to effectively make decisions with up-to-date information right at their fingertips. With data transparency, they have the capacity to drill down to greater details enabling them to ask and answer their own questions.

2. The gap between governance and self-service analytics is narrowing - In our experience and research, decision makers can get access to the data they need without having to go through someone else, such as the IT department, to deliver the information. This results in a reduction in the gap between technology and management. Let IT do what it does best, gather and store data securely. And let management retrieve the information through BI which automates data retrieval across disparate applications to generate user-friendly views with drill-down capabilities and custom-designed reports

3. BI for everyone - BI has become the decision-enabling and planning tool for any manager, department head, or leader. If users have decision-making authority, they can access relevant, timely, and actionable information. We have observed over the eight-plus years we have offered a BI solution, that BI satisfies the growing hunger for a broader menu of digestible information to fuel savings, compliance, and growth at the department, facility, region, and corporate levels.

One of BI’s benefits is that it helps decision makers discover new questions – a world of analytics of which they may not have been aware. Sometimes it takes more questions and answers to generate more questions and answers to discover, decide, and succeed. And that’s good. For the more precise the probing, potential problems emerge before they get out of hand and new opportunities are discovered before they get away. One COO mentioned recently that primeVIEW (PCT’s BI dashboard solution) has alerted his team to problems they had not before discovered when their only source of information was the “reporting factory”.

Because primeVIEW is customer driven, we have watched this desire for more in-depth information with keen interest and responded quickly with new views and reports. Often customers will request a new and expanded, or more in-depth, view of a particular KPI or set of KPIs, such as census, admissions, discharges, and readmissions to hospitals, among others. This access to more information has a direct impact on efficiencies, cash flow, and the bottom line.

These are the top three trends we have observed and responded to, developing the primeVIEW platform further as the self-analytics source, to narrow the gap between governance and what IT departments deliver – a tool for all decision makers. As LTPAC moves into the new world of care and reimbursement models, they can be confident they will be able to get the right answers to the right questions through BI.