A revisit to the world of data mining

Simply stated, to data mine is to analyze data from a variety of perspectives and to convert the findings into valuable (or actionable) information in the form of graphs, charts, and/or tables. This information identifies previously hidden or difficult to spot performance patterns to help providers improve clinical outcomes, increase revenues, convert those revenues to cash, and cut costs. But let’s pause for a brief moment and go just one step deeper

What is data and data warehousing?

We throw the term, “data”, around a lot, but what is it? Data embraces any and all facts, numbers, and texts which computers can process. If your organization uses computers, you have data – lots of it. But more than likely, your data resides in disparate data locations existing in the clinical, financial, time and attendance, procurement, etc. applications your organization uses. More than likely, these applications don’t speak to each other, impeding performance pattern discovery. Data warehousing gives data meaning.

OK. So what is a data warehouse? Data warehousing centralizes data management and retrieval of all of your organization’s data. Just as the name implies, it is a virtual (in the cloud) or physical (a data server) location where you can store and manage data in a multidimensional database system. Ideally, the warehouse can automatically extract or pump data from diverse data repositories. A physical warehouse has an inventory which is only useful if you can find and combine what you are looking for to achieve your intended ends. For data warehousing to be useful, you need software to help you effectively mine all of your data to help you achieve your organizational goals

Data mining and long term care – bringing it home

The “spectrum of care” is a term used for many years to describe various health care delivery models and their relationship one with another. Just look at Long Term and Post-Acute Care – Skilled Nursing Facilities, Home Care and Hospice, Long Term Acute Care Hospitals, Inpatient Rehabilitation Facilities, Assisted Living Facilities, PACE (Program of All-inclusive Care for the Elderly), and Independent Care. Yet, we are witnesses to possibly a major shift from provider silos to a person-centric delivery model. It embodies only one healthcare segment, the individual. For that to happen, data warehousing is a must

But for now, whether the person-centric model happens sooner or later, your organization needs to know if you are the right setting for the right services at the right time at the right acuity and at the right cost. In other words, data mining can have meaning for your organization right now. It goes both ways - what the payer wants to pay and what outcomes you can afford to deliver with that paymen

Dashboards – the one-stop shop for all data-driven decisions

There is a third term to understand – business intelligence. In short, BI delivers meaningful and actionable information for business analysis purposes. And it’s available today delivering patterns of information through Key Performance Indicators (KPIs) meaningful to your organization and viewable in a dashboard with drilldown capabilities. These KPIs include census, labor, financial, cash, clinical, among others relevant to your organization’s mission

Results-focused

Users of our primeVIEW executive management dashboard have seen real, measurable results because they have been able to view performance patterns practically in real time. For example:

• An operator of 17 SNFs was able to manage 71% of its buildings to achieve overtime goals within 3 months resulting in significant savings.

• Real-time census monitoring helped the same provider keep his team focused to realize a 7% and 9% increase in ADC in Skilled and Private Pay respectively from 2014 to 2015.

• Another similarly-sized operator of SNFs reports an 18.5% improvement in Days Sales Outstanding while achieving 100% collection efforts using the financial information screens.

• A 41-facility SNF operator was able to gain back up to three FTE’s in labor hours in targeted facilities by using the labor and overtime management features.

• The same operator reports that primeVIEW has helped them track dozens of critical measures, such as 5-Star staffing, hospital readmission, and length of stay.

• Another multi-facility operator was able to reduce nursing staff overtime by 3% with organization-wide access to overtime screens.

All of this adds up to real take-it-to-the-bank meaning regardless of what the future holds for healthcare delivery.

Shrinking margins

Over the years I have observed that LTPAC providers have faced and still run the risk of facing possible shrinking profit margins or, in the parlance of not-for-profit providers, surplus revenue. For the purposes of this blog posting, I’ll keep things simple by referring to the bottom line as “margins”

In a report issued in 2013¹, from 2010 to 2012, SNF median net income declined from 1.8 percent in 2010 to 1 percent in 2012. Not only does this impact funds needed to competitively and cost-effectively operate, but also affects access to capital. Although SNFs have access to capital, they do encounter challenges other health care providers don’t; specifically, the high cost of debt financing with dependence on high yield bonds and bank loans. In one instance, a large SNF provider with similar credit ratings to two acute care providers had bonds trading at 2.3 percent to 3.5 percent higher than its acute care counterparts. Experts tie this to sector-specific reimbursement models.

SNFs are heavily dependent on Medicare and Medicaid while hospitals have a more advantageous mix of commercial payers compared to Medicare and Medicaid. The biggest problem is the risk created by Medicare and Medicaid uncertainty. With greater risk comes the need for higher returns and investor caution. While investor confidence has somewhat improved, large and, especially, small providers still face a challenge. So what can providers do in today’s world of potentially shrinking margins to keep their doors open and to grow their business? Collect revenue owed as soon as possible

Revenue cycle management is critical

Ok, The truism, “Cash is King,” is a bit passé. But it is still true today. And the biggest challenge is converting outstanding revenue to cash quickly. Some of the essential elements to sound revenue cycle management include auditing, implementing best practices, policies, technologies, and training

Providers need to acquire the experience, expertise, and technologies either internally or by contracting with experts to focus on:

• Billing and A/R management best practices
• Systems auditing and problem solving
• Business process analysis, development, and standardization as well as policy design
• Project management
• Team building
• Getting results

For those providers who are struggling with implementing effective revenue cycle management, we recommend contracting with billing and A/R consultants who have the expertise and breadth of experience to implement practices and policies resulting in:

• Reduced A/R,
• Decreased DSO,
• Lower costs, and
• Helping the internal A/R team to institute effective and time-saving policies and procedures.

Consultants can either directly provide or assist in the development and implementation of time-proven systems audits and A/R reductions best practices. The benefits of these efforts are rewarding in terms of:

• Discerning problems and/or needs
• Identifying root causes
• Proposing end-to-end solutions, and
• Moving plans forward into action and successful completion.

In today’s cloud computing world, technology knowledge and skills improve chances for effective revenue cycle management. Experts can recommend functional system modifications and user supporting/training in sophisticated accounting, billing, and collections applications and practices.

Undertrained staff can lead to wasted hours and needless costs. Discovering a skills set baseline through an accurate assessment of billing staff is critical and can help providers fine-tune training needs. This understanding leads to compliance thorough process training in conjunction with best practice A/R policies and procedures from admissions through to month-end closing.

Providers can reduce the risks of shrinking margins by implementing solid revenue cycle management best practices. It only makes cents

We can help you

Prime Care Technologies combines the skills and knowledge of our in-house revenue cycle management experts with our LTPAC-targeted primeCLAIMS clearinghouse to help you stand on solid fiscal ground even in times of potentially shrinking margins.

¹Ref: Skilled nursing facing pinched margins http://www.healthcarefinancenews.com/news/skilled-nursing-facing-pinched-margins 

ICD-10 Implementation is a journey not necessarily a destination – at least for the foreseeable future.

Remember Y2K? The proverbial sky was predicted to fall. It didn’t. Will the long-anticipated ICD-10 implementation be similarly anticlimactic? Probably not. ICD-10 has been dubbed the “complexification of healthcare” in the Washington Post, which also predicted that “the resulting confusion and inconsistency in claims processing would create unnecessary administrative costs and take resources away from patient care.” Texas Medical Association President, Dr. Tom Garcia, has been quoted as saying, “It’s the countdown to a perfect storm.” Whether the financial firmament will come crashing down on providers’ heads due to ICD-10 will depend not only on their preparations, but what they do after implementation.

It may well prove helpful to consolidate insights, tips and best practices submitted by experts around the country.

Let’s first address the Challenges. Despite all the training and preparation, providers still may encounter the following:

1. Productivity decrease. As coders attempt to employ ICD-10, decreasing productivity and inaccuracy-induced delays will have an impact on cost and the bottom line.
2. Financial impact. Cash flow disruption from increased denials and underpayment may also occur.
3. Resources. You’ve allocated required resources to prepare for implementation. Now it’s time to determine the resources needed to keep the implementation on track.
4. Technology-related challenges. These may include data transmission issues and unscheduled vendor updates. You may need to retest critical application or system functionality.

What should you be doing?

1. Create, implement, assess, and continuously correct a post ICD-10 implementation strategy. Take into account that this has not only impacted procedures, policies, and skill sets, but also people—including employee morale. Any change is threatening until employees can acknowledge what practices they need to let go of, deal with the sense of loss of the familiar, can understand and envision what ICD-10 competency can do for the organization and for them personally, and fully embrace the new best practices and skill sets. Tip: Involve your staff in troubleshooting through problem and resolution identification.
2. Assess demands on resources. Address effective allocation of the most impacted resources.
3. Set goals from the top down and the bottom up. Setting goals goes hand-in-hand with tracking key metrics. Involving ICD-10 stakeholders at all levels within your organization is critical.
4. Monitor net revenue and cash trends. Identify, understand, and mitigate the root cause(s) of any cash flow disruptions or revenue declines.
5. Assess documentation quality. Experts emphasize the need for specificity in clinical documentation.
6. Prepare to defend code assignments. Make sure that the documentation is consistent with the ICD-10 coding demands and supports the classification information details. Notwithstanding their inherent differences, learning a coding/classification system and understanding the clinical factors of a diagnosis are related…and important. Tip: Audit coding productivity and accuracy.
7. Training, training, and more training. Training will never stop. Tip: Develop a formalized on-going training program for clinicians and coders.
8. Hire coding help in the short run. Experts can help you assess where you are by conducting audits and working closely with coders and clinicians alike.
9. Review the Q&A document before submitting claims and MDS assessments that include October 2015 dates of service (include SNF clinicians, MDS coordinators, and billers in the review process)
10. Track key preparation and processing metrics. Rome wasn’t built in a day...nor will your process be built over night. If you have not already done so, identify key preparation and processing metrics and track them. Set benchmarks for the near and long term.
11. Acknowledge that it's an on-going process and accept it.

Conclusion

Taking steps throughout the ICD-10 implementation process will prevent the cash flow and bottom line storms from raining on your financial parade. Several resources are available to help you make the transition to ICD-10 successful. For example:

• CMS offers extensive education and clarifying questions and answers
• The American Health Care Association also offers ICD-10-related information.
• Contact primeCLAIMS clearinghouse for additional support

Additional thoughts from CMS

The Centers for Medicare and Medicaid Services have recently offered the following:

• The ICD-10 Ombudsman will be available to help answer nursing facility questions and can be reached at ICD10_Ombudsman@cms.hhs.gov.
• Minimum Data Set (MDS) assessments with Assessment Reference Dates (ARDs) on or before September 30, 2015 must contain a valid ICD-9 code in Section I if a diagnosis code is necessary.  SNF MDS assessments with ARDs on or after October 1, 2015 must contain a valid ICD-10 code.  CMS will reject MDS assessments if a Section I diagnosis code version does not apply for the ARD entered.

Are the rates investors are quoting competitive?
Ever wonder if you’re getting the best rate you can on capital?  It’s a challenging question with a data-driven answer.  In a perfect world, skilled operators would be able to benchmark their performance against others, enabling those with the best performance to prove they are worthy of the best rates on capital.  In a perfect world, investors would have access to current performance data on every skilled nursing building in the country, and be able to set attractive rates for those with a positive and predictable track record of success.   That perfect world is in the process of being created.

NIC to flex muscle…again
NIC is ideally positioned to take on this challenge. Years ago visionaries at NIC set about to change the world of investing in senior housing by creating access for investors to a huge library of regional demographic data.  With confidence, today investors can easily size up markets in which to invest.  Over the years, this transparency has catalyzed development of many senior living products across the nation.

In a recent bold move, NIC announced a new initiative to create transparency with a new data set for investors and operators, dubbed the “NIC Skilled Nursing Data Initiative.”  This visionary program will help answer two strategic questions asked by:

• Operators:  are you getting the right rates?
• Investors:  are you setting the rates?

Today capital is flowing into senior housing, but the challenge is much of it goes to organizations focused on private-pay.  For those serving other segments, it’s an uphill battle to find capital at competitive rates. 

Timing could not be better
Nationwide, skilled nursing properties are aging.  The industry urgently needs capital to modernize physical plants, update mechanicals, and upgrade technologies that are the hallmarks of well-run operations in demand.  According to NIC, “The average age of skilled nursing properties in the top 99 markets is 36 years, making many buildings functionally obsolete.” 

Old data is useless
As new payment models across the skilled sector unfold, operators are flexing business models fast. What used to take years is getting done in weeks.  To lend capital, investors rely on historical government data that is 12-18 months old. As a result, the capital rate an operator is quoted may not reflect today’s operating reality. Current data is needed by investors to set the right rate. They need census, revenue by payer source, and much more.

NIC’s Grand Plan
NIC created a clearinghouse for current skilled data and is making it available to operators and investors.  For investors, this innovation will boost confidence in setting rates for capital that are more closely aligned with performance.  For operators, this innovation will boost confidence that the rates they get are competitive.

The data set
NIC is encouraging operators to submit monthly data in the following categories:

• Occupancy
• ADR by Payor Class
• Overall Revenue Trends
• Total Operating Expenses
• Skilled Mix
• Quality Mix
• Patient Day Mix
• Profit Margin/EBITDAR/EBITDARM (profit margin data is sensitive so it is not a requirement)

In return, subscribers get a monthly summary that de-identifies and aggregates data from all contributors.  Subscribers will be able to compare their performance with national benchmarks. As the database grows, subscribers will over time be able to see regional benchmarks.  Operators will not be able to see the specific data of peer operators for confidentiality. 

How Prime Care Technologies helps
NIC turned to Prime Care Technologies (PCT) to help operators submit data. NIC clients do not have to be current clients of Prime Care Technologies in order to participate.  For these operators, PCT will set up and automate data delivery directly to NIC.  For PCT clients using the primeVIEW business intelligence solution, the data feeds are already in place and the automation required for sending data to NIC is simple and straightforward. 

Ready to opt in?
Take the first step toward fair, competitive rates on capital for your skilled nursing portfolio of properties. Visit the NIC Skilled Nursing Data Initiative and complete the form at the bottom of the page. 

ICD-10: Are you ready?

I have been around the proverbial block of Long Term Care many times over the last 30-plus years. Occasionally. I have seen signs of pending change—sometimes immediate and sometimes off in the distant, protracted future. Rarely in the last 10 years has any change been more dramatic and more protracted than the transition from ICD-9 to ICD-10. And now it’s here, ready or not. 

The New York Times (9/14, A1, Pear, Subscription Publication, 11.82M) reports that the change “is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly.” While many providers, I anticipate, have prepared themselves for the change, some may be less certain. This may result in delayed or denied claims with disruptions in cash flow.

Is your team ready for ICD-10? There are so many bases to cover, so many details to acknowledge, so many tasks to take on, and so many transitions to tackle. You’ve planned. You’ve trained. You’ve directed. You’ve encouraged. You’ve engaged. But sometimes, it’s the small and basic tasks that can trip you up or elude you, as you make your way around your own potential LTC ICD-10-studded block.

Get a solid footing – check out the basics – one more time

For example, MLN Matters® Number: SE1408 points out that “ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time.” Here are a few tips from our “ICD-10 Readiness Briefing” to help you round the next billing block on solid ground:
To assure a smooth transition, have a clear picture of your entire claims submission process. Be sure each stakeholder in the process is ready for the transition.

1. Three mission critical steps to confirm ICD-10 readiness. Confirm that:

• Clinicians and biller(s) are trained.
• Your EMR partner has a crosswalk from ICD-9 to ICD-10 codes and has tested its systems.
• Your clearinghouse and key payers have all the new codes in place and have completed their testing successfully.

• Identify problems that lead to claims being rejected
• Provide basic guidance about how to fix a rejected claim
• Edit the claims to ensure appropriate code sources are used, based on date of service and/or discharge date.

3. Your EMR vendor should supply crosswalks to assist in selecting appropriate groups of ICD-10 codes to use.

Are you ready? What steps has your organization taken to ensure that the ICD-9 to ICD-10 transition is as smooth as possible?

Our free two-page “ICD-10 Readiness Briefing” contains more useful information to make sure you are ready.