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?

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Over the last several months, this blog has covered topics focusing on various aspects of IT and its impact on long term care. In our Thanksgiving Day blog, we observed how important IT has become to all of us – in how we work, how we communicate, how we entertain, how we educate, how we conduct business; IT is everywhere. Although slow in adopting technology, LTC providers have made significant progress in understanding, valuing, and embracing IT as a powerful tool to meet ever-changing challenges. For example, twice we demonstrated this fact as we momentarily digressed from IT-specific topics to alert readers about changes to billing therapy services to Medicare and avoiding workforce-related lawsuits.

These are trying and potentially dangerous times for the economy in general and long term care in particular. The vital role that IT can play in helping LTC providers survive reminds me of the African gazelle. The gazelle can reach a peak speed of 48-50 mph outpacing many of its predators. However, the cheetah can reach 0 to 60 mph in about 3.3 seconds with a top speed of 70 mph. You do the math. Since gazelles are a favorite meal for cheetahs, the difference between life and death is sustainability vs. spurts of brilliance. Cheetahs can only sustain such high speeds in bursts; gazelles on the other hand can maintain their top speed for miles. They can also make sharper turns and initiate quick changes of direction with minimal reduction in speed. Cheetahs cannot. Although slower, gazelles have the advantage if they are alert, sure-footed, and responsive to threats and opportunities.

Likewise, to survive and thrive, to outpace the “cheetah’s” of poor reputation, burdensome and sometimes conflicting regulation, competition, and reduced reimbursement, LTC providers must be on guard, quick to respond, and nimble. However, they also need vision. To blindly charge day-to-day into the fray without a clear understanding of what is going on around them and within their operations, can be suicidal. Data mining and business intelligence can help providers discover, discern, and act on the data they already have. In real time, digital dashboards can reveal business-critical information (Key Performance Indicators – KPIs) displayed in ways that easy to understand.

In 2011, we also discussed how important protection of your IT assets and data is and why disaster plans must include IT. “After the fact” is too late. Also, IT asset management (ITAM) can help providers to track and protect their IT assets, use, and storage.

Just over the horizon loom major changes in health care, ACOs being one of those changes. The significance of ACOs to IT in long term care can be found in the need for interoperability and IT infrastructure. Whether ACO’s pose a threat or an opportunity will depend on the specific market served and the provider’s willingness and ability to respond. Being uninformed and ill prepared is like a deer facing on-coming headlights. The prospect of becoming health care road kill is not appealing.

Question: IT is here to stay, are you on board? In what ways has IT helped your operation?

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.

Introduction

An operator of over 35 facilities in four states has been using its digital dashboard to effectively manage census, labor, collections, and MDS information. The company’s BI/digital dashboard project manager cited three reasons that it has become an increasingly successful day-to-day management tool.

Reason #1 - Who needs to see what?

Through planning and coordination with its dashboard developer, in this case – PCT’s primeVIEW, this provider has carefully identified who needs to see what. Senior management, together with key corporate department heads, regional VPs, and the IT team, compared the information displayed by the dashboard with roles and responsibilities throughout the organization. From senior management to corporate departments to regional staff to facility administration, the real-time reports were aligned with accountability and action. For example, while senior management may want a global view of Key Performance Indicators (KPIs), such as census, labor, collections, MDS-driven information, critical to them, they did not necessarily need the granularity that the drill-down function afforded to regional staff or corporate department heads. Accordingly, management is able to review reports from primeVIEW which give them the ability to globally assess and address trends, practices, and policies

Historically, view of the dashboard at the facility level had been limited to the administrators and executive directors. However, recently, the company granted permission to department heads to view their specific department KPIs, particularly labor. This gives them the ability to scrutinize such issues as overtime or who may be “milking the clock.” For example, are some employees adding 15 minutes to their punch time in non-productive activities (or malingering)? Because the system refreshes the clocked-in and clock-out times by employee, department heads can identify such issues as they happen. 

Reason #2 – Personal Training

Training is critical in two major areas:

• How to access and use the tool and
• How to apply critical thinking to day-to-day tactical and long-term strategic problem solving

Because the system is intuitive and easy to use, most follow-up training takes place on a case-by-case basis after the initial orientation and training. Their BI project manager views the dashboard throughout the day and can tell over time who may need additional support and training tailored to the individual’s needs.

Critical thinking applied to problem solving helps managers effectively resolve problems or seize opportunities. Regional staff works closely with their facility counterparts to interpret dashboard information and create workable action plans.

Reason #3 - Refer to the dashboard regularly; make it a habit

Because the dashboard puts actionable KPIs at the fingertips of those who need it without having to go through someone else, managers can respond quickly. This requires the discipline to refer to the dashboard regularly. Those who do, benefit.

What have been the benefits?

The Project Manager reports that the corporate and regional teams can readily identify the problem facilities and can proactively respond before the issues get out of hand or opportunities are missed. This has resulted in a marked reduction in unnecessary costs and the discovery of opportunities to improve resident/patient services.