Data is everywhere; it’s pervasive. The challenge as well as the opportunity lie in retrieving the raw data and converting it into useful and actionable information. In the past, we have posted a number of blogs on a wide range of Business Intelligence (BI)/data mining-related topics - from Payroll-based Journal (PBJ) reporting to data-driven decision making, from BI’s role in helping providers stand out in the ACO crowd to how BI helps providers demonstrate value, and so on. But let’s step back and reexamine what has driven BI to become what it is today.

The challenge

Long Term Care (LTC) providers are sitting on a vast reservoir of data. However, many do not have the resources to tap into that data and to convert it into something useful to solve current problems, to seize emerging opportunities, and to plan for the future. But, where to start?

BI’s purpose

Let’s wrap our arms around what BI’s purpose would, could, and should be. Succinctly put, BI reports, provides online analytics, and delivers Key Performance Indicator (KPI) visualization and monitoring.

BI’s use

As we visit with our BI customers and industry leaders across the country, we’ve observed that decision makers use BI to measure, monitor, and act on clinical quality outcomes, financial analysis, operational performance, cost management, compliance, and market-specific information. Executives use such information to take direct action, as needed, and to work with their teams to better align performance with company and facility-specific benchmarks/goals.

BI drives development and market acceptance

The evidence is clear that no one thing has been the agitator for BI acceptance and growth. Rather, the following factors have each played a contributing role:

• Federal and state health reforms
• Availability of healthcare-related data
• The imperative to identify and control costs
• Quality Assurance and Performance Improvement (QAPI)
• The need to increase customer satisfaction
• The demanding and complex regulatory environment, such as PBJ reporting, HIPAA, etc.
• Cloud-based computing technologies
• The availability of data through IT adoption
• Health Information Exchanges (HIEs)
• New value-based payment models
• And others

BI Stakeholders

Who uses BI? Here is a “short list” of those who rely on and use BI:

• BI software and services providers
• Healthcare providers
• Healthcare payers
• Accountable Care Organizations (ACOs)
• Managed Care Organizations (MCOs)
• Health Information Exchanges (HIEs)
• Investors/lenders
• Federal and state governments
• Researchers

All of these entities and people have a stake in the BI world and they all have some influence on how providers conduct business.

What this means to you

If you haven’t yet fully caught the larger vision of what BI has become and could be, you need to do so now or you will be left behind. In today’s world, the old manual ways of gathering and processing data, responding to the information gleaned, and taking action are too slow and cumbersome. Besides, some stakeholders, such as government agencies, are not giving you a choice. I highly recommend that you conduct an assessment of your organization’s BI needs today and in the future and devise a plan to help you ramp up as quickly as possible. A sure bet, is to look at existing BI tools, like PCT’s primeVIEW, designed for LTC providers, like you.

Discover how easy it is to integrate staffing and census data with PCT's PBJ Reporting Platform

PBJ is just around the corner. So, what is it and what does it mean for you?

PBJ, or Payroll Based Journal describes what CMS requires you to submit online, effective 3Q 2016 and due 45 days after the quarter ends – that’s November 14.  From there, it will become a routine requirement for all SNF providers. And it comes with a kick in 2017 – a Five Star Rating kick. You are probably familiar with PBJ, but let’s net out the essentials so you can understand and act with some urgency. 

Background: With the passing of “The Improving Medicare Post-Acute Care Transformation Act,” or IMPACT Act, providers must submit “payroll and other verifiable and auditable data” electronically to the Department of Health and Human Services. It’s objective? Improve transparency and reduce potentially fraudulent reporting. You can check out the tedious details on the CMS and Federal Register websites:

• FAQs: Electronic Staffing Data Submission Payroll-Based Journal System
• Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection

The Change: In short, PBJ is the CMS’s latest push to keep providers honest when reporting labor hours and census – and eventually, will critically impact your 5 Star Rating.

• Every quarter, providers must use the online PBJ system provided by CMS to report the hours staff – AND contractors – were paid to perform onsite services for facility residents, excluding paid time off (e.g., vacation, sick leave, etc.).
• The PBJ system will only allow XML file submission – one per facility – and/or manual data entry at this time.
• CMS started collecting staffing and census data through the PBJ system on a voluntary basis beginning on October 1, 2015.
• Submission will be mandatory, effective July 1, 2016. Providers will be required to file both staffing and census data no later than 45 days after the last day of each fiscal quarter (i.e. for the quarter ended September 30, 2016 electronic reporting must be completed no later than 11:59 pm EST on November 14, 2016).

Don’t be lulled by the November 14 3^rd quarter reporting deadline. Collecting this data and preparing it for submission will take time – lots of time (and money) – especially if you are trying to do this manually.

There is a way to make this PBJ requirement easier to swallow. We proactively added a PBJ tab to our primeVIEW business intelligence dashboard to help our clients. New clients can also purchase this component on a stand-alone basis to meet the CMS mandate.

Our PBJ Reporting Platform empowers providers to:

• Integrate cross-facility data from employee and census systems
• Manually enter and append contractor data to existing file
• View/monitor a summary of employee and contractor hours
• Automate mapping of labor codes to CMS codes
• Export one all-inclusive XML file per facility for quarterly upload

With staffing and census playing a key role in the CMS’s Five Star rating and compliance, providers can’t afford to waste critical time building reports and checking data. An already-built solution quite simply frees up your time, so you can focus on proactive performance management.

The first mandatory reporting period, starting July, will be here before you know it. The time to act is now. 

And, if PBJ is the first major step you’ll take to aggregate all of the performance data you need to affect your Five-Star Quality Rating, check out our business intelligence blog. 

As the reimbursement world changes from fee-for-service to pay-for-performance models, demonstrating value is key. To be able to compellingly demonstrate value compliant with payment model expectations, providers need to be able to know how well their facilities are performing today. The technology needed to effectively identify and communicate such value is available through business intelligence (BI). As mentioned in a previous post, BI can also be useful in helping providers share information with stakeholders, investors, and even referrals sources.

Let’s assume you’ve identified a particular hospital which shows considerable potential as a referral source to one of your facilities for patients requiring the kinds of services that facility specializes in. With BI, you can effectively tell your story with data-driven information, easily retrieved and configured for presentation. You can bring demonstrated improvement trends in rehospitalization rates tied to clinical best practices and specific diagnoses. Statistically, you can also show how competently your facility treats in-house as well as community-acquired pressure ulcers, physical restraints, falls/accidents, significant weight loss, medications, infections, etc.

You can confidently share with the hospital’s executives discharge information length-of-stay and admissions/discharges information, Five Star ratings compared to peers, and inspection results, such as fines and deficiencies, and quality measures you can present in chart or graph form with trends and benchmarks to state averages. A further indicator of quality within the context of Five Star ratings is labor. BI gives you the opportunity to compare your staffing to 5-Star, 4-Star, and 3-Star requirements.

If your clinical software enables your clinicians to uniquely identify hospitals, you can specifically demonstrate to your audience how well you serve the patients they have discharged to your facility.

What’s most useful is that BI already generates this information for you automatically. You can export it and reconfigure it to meet your audience’s needs. So, what’s required? A BI tool tailored to your organization’s mission, objectives, and best practices, and the opportunity to share your story, to demonstrate your value to the community and the care continuum you serve.

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.

“If you build it, they will come.” For those of you who are Field of Dream fans, like me, yes, I admit this is a misquote. (It should read, “If you build it, he will come.”) But for the purposes of this blog, we can take some liberties and Hollywood should forgive us.  Let’s assume you and other members of the management team are persuaded that business intelligence (BI) is THE way to go to improve performance through data mining and KPI reporting automation. You’ve determined that outsourcing BI makes the most sense and you’ve purchased and are ready to implement the best, most cost-effective, and easy to implement solution available. You’re ready to go, but what about those further down the decision chain? Just because you’ve made the decision, doesn’t mean they will follow. Are they ready? Will they use it? How can you be sure?

Not surprisingly, we have noticed that unless leaders take certain steps, they will be frustrated by implementation’s fitful nature. They spend more time trying to get manager buy-off than solving the problems and seizing the opportunities BI reveals. So what’s required? Leadership. Leadership of change. (I give credit to my mentor, Dr. D. Tyler Nelson, PhD, who over twelve years ago introduced this to me and I now share its highlights with you.)

Change is only the beginning

First of all, change is only the start; it’s a beginning. It’s situational. Over your career how many times have you seen new initiatives introduced with a big announcement, training programs, perhaps a new policy and procedure manual, only to see them at best take longer to be implemented than desired or at worst die of inertia? Why? Lack of effective transition management. A successful transition is essential if the change is to work as planned. In this case, helping people transition from the old reporting habits to enthusiastically embracing BI.

“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everybody gets busy on the proof.” - John Kenneth Galbraith

Transition starts with and ending and ends with a beginning

To be brief, while change is simply situational, transition, on the other hand, is psychological.  It’s guiding people through the process of:

• Realizing an ending to the old ways,
• Acknowledging and dealing with the sense of loss associated with the ending,
• Letting go of the old ways,
• Seeing the vision of the new when the new isn’t fully operational, and
• Embracing and making a new beginning.

Change management is to understand the desired outcome and how to get there; transition management is to convince people to leave “home”.

As the BI champion, you’ll succeed when you acknowledge that transition starts with an ending (of the old) and finishes with a beginning (of the new).  It starts with the ending your BI users will have to make to leave behind the old ways of reporting.  Within the bullet points above are the keys to what you must do to help your users move through transition to:

• Significantly reduce the negative effects change can have on productivity
• Shorten the length of time from the inception of BI implementation to the achievement of the final desired performance targets. i.e. the use of BI to achieve your organization’s goals
• Minimize the decline in productivity that naturally follows before full implementation is realized

How’s it done?

In short, our successful clients have made BI part of their management culture. It starts at the top; all decisions are referenced and based on the KPIs viewable in the BI dashboard and reports. One COO refers to the primeVIEW dashboard, PCT’s BI product, during the monthly facility financial review. His regional staff and facility leaders must be just as conversant with the KPIs displayed as he is. Not only do they look at the prior month’s financials, but also at the present situation revealed in primeVIEW. It’s the expectation he has established that. “I am using it; so should you.”

In another company, management accepts only reports viewable and generated by primeVIEW. No other reports are accepted.

At the beginning of its primeVIEW implementation, another customer clearly stated to its management team what is going away, that primeVIEW is replacing it, and clearly described how it will make their lives easier. Because managers no longer have to manually prepare reports, they can more productively spend their time making decisions.

Conclusion

One last point, not everyone transitions at the same pace. Each person is different and that’s where leadership comes in to play. As the BI champion you have to acknowledge where your team members are in the transition process and help them to:

• Leave the past behind,
• Get through the wilderness of reporting uncertainty, profiting from it, and
• Embrace new attitudes, behaviors, and identity (as decision makers, not data gatherers)

While BI tools, like primeVIEW, can be easy to learn and use, each organization’s leaders must ensure that transition is skillfully managed and sound leadership principles applied. It’s putting people and processes together to achieve a certain end – full BI implementation.

Change + Human Beings = Transition