In the Spring of this year, I used baseball as a metaphor for the “game of Long Term Care.” At that time I said that providers were “going to have to step up to the plate and respond swiftly and powerfully to the curve balls of regulatory changes, the sliders of reimbursement, the change-ups of market pressures, and the fast balls of competition.” Little did I know at the time that the term, “sliders of reimbursement,” was going to be uncomfortably prophetic. Because of the drastic “adjustments” to Medicare reimbursement and declining Medicaid rates, the slider is real – a potential slide downhill, that is; they’re game changers. I would like to take the baseball metaphor one swing further.

A successful swing at the plate requires not only skills, talent, great vision, quick reflexes, good upper body strength, and sound judgment, but a solid bat as well, one that each batter can handle comfortably and confidently. It’s the tool that hitters rely on. In the case of LTC, the “bat” I am referring to is IT (information technology). And it’s time for IT to prove its worth as a tool to identify savings without cutting quality and to prevent unnecessary revenue leakage through automated tools and processes.

Savings – the IT Infrastructure

Let’s start with IT itself. Article upon article and one study after another have clearly identified that the “cloud” offers the scalability, flexibility, reliability, and savings that other methods of IT deployment may not offer. Cloud-based computing means lower initial costs and TCO, because all IT-related procurement, maintenance, management, and upgrades are handled remotely. Further, the cloud’s monthly subscription-based model enables providers to use their capital for other critical areas of their business. Earlier this year, the CIO Consortium identified that, “Reasonable, five-year costs to deploy currently available EMR technology and eliminate paper records range from $254,000 per facility for third party hosted solution (italics and color added for emphasis), $259,000 for vendor hosted Software as a Service (SaaS), and $356,000 for an in-house hosted solution.” Clearly, now is the time to carefully consider the cloud as a solid source for immediate and long-term savings.

Real Savings through IT Tools

What specifically does IT offer that will help providers identify savings, stop revenue leakage, and ensure that they are in compliance with regulations? The answer is automation - automated claims management to stop revenue leakage; automated MDS and RUGs reporting; automated procurement to make sure that purchases are per contract pricing, timing, and quality; automated labor management; and automated real-time Key Performance Indicator (KPI) reporting.

Automated claims management helps providers not only to generate, review, edit, and transmit claims, but to identify and act immediately on issues when and where they occur. This includes incorrect claims codes, codes changes and regulations, missing codes, poor communication between clinical and billing staff, poor pricing practices, and inefficient and ineffectual internal review processes.

Automated MDS and RUGs reporting lets providers identify facilities most "at risk" with poor survey performance; discover how each of their facilities ranks among its peers; pinpoint facilities which are operating below or above critical primary care staffing levels; detect residents/patients who are clinically at risk; observe the financial impact of MDS submissions by facility, region, and corporation; scrutinize QM/QI’s at a facility, region, or corporate level, and analyze reimbursement rates (RUGs).

Automated procurement involves complete commerce automation (purchase orders, invoices, and product and contract maintenance) and reporting with intelligent direction and feedback for procurement decisions.  It connects multiple facilities, satellite locations, and branch offices to the vendors, products, pricing, delivery terms, and service providers carefully negotiated and selected by their parent company. Automation allows flexibility and customization for each corporate entity to support their partner selection, the business rules negotiated with each partner, their internal G/L structure, and their purchasing chain of command.

Automated labor management gives providers the tools necessary to manage and control that which amounts to almost 60-70% of a provider’s spend – labor. Automation offers applicant tracking, time and attendance, payroll, and human resources management. Not only can providers reduce costs wisely, but also increase productivity.

Automated real-time Key Performance Indicator (KPI) reporting, or a digital dashboard, translates into business intelligence, which to LTC providers means they can quickly analyze and act on census levels, admissions, and discharges; labor hours and costs; and receivables and collections. Armed with this incredibly valuable information, providers are able to monitor how well they are saving money and increasing revenue in real time and take action, when necessary, with surgical precision.

Summary

IT through the cloud will not only help providers survive, but ultimately win, by confidently hitting whatever is thrown at them out of the park.

Personal productivity devices, such as desktops, laptops, smartphones, and tablet PCs, and the data they generate and retrieve have contributed to a wealth of information and…risks for Long Term Care. If Information Technology (IT) managers are unable to monitor, manage, and protect productivity devices, software distribution, and how information is exchanged and filed, providers run a considerable risk of data loss, non-compliance, and potentially fatally damaging their operations. Implementing sound hardware and data management practices is the responsibility of all providers. IT Asset Management (ITAM) embraces the technology and best practices that can help IT Managers with this critical task.

What is asset management?

ITAM encompasses mostly the hardware components of the IT infrastructure and its interconnected computers - in other words, everything that supports the flow and processing of information. Consider, for example, data and computers. What IT assets do you have? Where are they? Who has access to them and who is using them? What is the lifecycle of each? What are the procedures for safeguarding each? What is the most cost-efficient method for tracking and maintaining them? One way to look at this challenge is to consider that IT is a business within a business. ITAM is the specific method and tools you employ to manage that business. It is 80% systems and 20% tools.

Why ITAM?

A few years ago, Patricia Adams, Research Director, Gartner Research, identified five drivers toward IT asset management:

• Software license compliance. Most vendor contracts authorize compliance audits. The Business Software Alliance (BSA) is now offering rewards of up to $200,000 for qualified piracy leads.
• ITIL (IT Infrastructure Libraries). ITIL outlines an extensive set of management procedures that are intended to support businesses in achieving both quality and value, in a financial sense, in IT operations.
• Cost control. This includes the cost of IT labor, purchasing, and managing device complexity.
• Asset security. This involves monitoring and managing asset displacement and network assets.
• Operational efficiency. With ITAM, most facets of your business run more smoothly.
  Neglecting ITAM can be risky?

In the absence of ITAM, LTC providers are at risk. They may suffer unauthorized access to or the loss or corruption of critical business information and EPHI (electronic protected health information). The impact of such could include liability risks, poor public relations, including diminished shareholder value and goodwill, exposure to and during law suits, and a significant disruption in the conduct of business.

A disruption in business, for instance, will likely involve non-productive time, even downtime resulting from non- or mal-functioning equipment, critical documentation missed or erroneously recorded, missing files, emails not received, and an inability to send MDS or other claims. Providers may also experience loss of continuity in the form of missed deadlines or poor communications. By not managing computing devices, users may download unauthorized applications or updates which can introduce software incompatibilities, even viruses or other malware.

The risks can be costly

Providers also risk increased or unnecessary costs. Malfunctioning IT assets mean upset users; upset users mean increased support calls, which can be costly in terms of needed help desk resources to handle such calls. In the absence of ITAM, providers may have to unnecessarily search out and recover lost data/files. In recovering lost files, providers experience down time and fees associated with archived data retrieval, assuming the data/files can be found. Additionally, lost/misplaced inventory, unnecessary repairs, or necessary repairs not addressed, can also disrupt the day-to-day flow of business.
Other risks include exposure to software licensure and regulatory non-compliance which may result in significant fines/penalties.

Conclusion

An organized and well executed ITAM program is a sound business investment – a practice that should not be ignored.

Question

• In the absence of ITAM, what other risks do businesses/providers run?
• What have you implemented to manage your IT assets?

Next Time

In future blogs we’ll discuss ITAM best practices and tools available today through the cloud. Until then, write, if you get a round to IT.