Rest assured. LTPAC Clinical executives can know rather easily.

What keeps you up at night? When I ran SNFs, many things would intrusively leap onto the stage of my dreams, stealing the limelight. Their discordant presence would dash the quiet and restful performance currently playing, causing me to start into a sudden and unwelcome wakefulness. It was one thing to steal the limelight, it was another to completely take over the show and lock the stage door to my more sedate and slumber-inducing dreams. Stifling a cry, I would sit bolt upright in bed, beads of sweat on my furrowed brow. One of those frequent limelight-stealing imps was a nagging doubt about my facility’s compliance.

Compliant to what? Federal and State regulations? Fire and safety? The Fair Labor Standards Act? Safe Harbor? HIPAA? Corporate standards and objectives? The list goes on and on, each list member competing animatedly for my attention. “No sleep tonight,” I’d groan. But times have changed and so has technology potentially barring the stage doors to unsolicited dream disturbers.

In the days before automated data mining and business intelligence (BI)-generated dashboards and reporting, I would have to make a mental note to investigate if and how compliant we were, recognizing that the research alone would take quite a lot of time, assuming no interruptions (silly me), sorting through charts, files, and printouts. But today WITH BI at a manager’s fingertips, those with compliance concerns, including clinical managers, have ready access to critical Key Performance Indicators (KPIs). With Business Intelligence, clinical managers can conveniently view a variety of KPIs which they can make their own. (I’ll get to that shortly.)

Let’s take a look at some of the KPIs clinicians can view to discover in measurable terms if their areas of concern are compliant. With regular input either directly from the data which resides within their clinical application automatically “pumped” into the data warehouse or keyed in directly, clinicians have access to frequently refreshed information. This information can include such KPIs as in-house-acquired or community-acquired pressure ulcers with the number of residents with pressure ulcers at what stages and at what percent of the average daily census over a month’s period of time or trended over a 12-month period.

Restraints? Weight loss? Anti-psychotic use? Infections? Readmissions? Falls/Accidents? Sentinel events, such as dehydration or fecal impaction? Indwelling catheters? Pain management? Hour per patient/resident day compared to state standards and to budget? Overtime usage? And more. If the data exists, the information can be viewed in the BI dashboard.

Now, I referred earlier to managers making KPIs their own. How about comparing the KPIs against benchmarks the clinical team has created based on regulations and company/facility-established standards, usually set to exceed the regulatory requirements? It’s all in one dashboard. No longer do clinicians have to wait for reports to be researched, compiled, published, and distributed. Log in and find out. No more uncertainty. Just discover. Take action. Get results.

With BI, this potentially sleep-disruptive concern can be put to rest. It’s called peace of mind. Take a dose of BI every day and sleep well.

To somewhat freshen up a term that can become stale due to overuse or, possibly, misuse, I would like to spin “business intelligence” (or business analytics) and convert it to “intelligent business.” Sometimes, playing with words (which is fun for me at times) can reshape our paradigms. “Business intelligence” implies the use of systems and processes which simplify the retrieval of data and its conversion into actionable information readily accessible to decision makers in real time[1]. But business intelligence goes beyond technology tools; BI is indeed "intelligent business" decision making. But first, let’s talk about BI’s/Intelligent Business benefits.

BI’s Key Performance Indicators reflect the organization’s mission and objectives.

I like the concept of each organization focusing its decision making on its mission and objectives. BI helps significantly to do just that, because executives and management can identify and align Key Performance Indicators (KPIs) to the broader organization’s mission, goals, strategies, and culture as well as to each of its business units’ objectives. The magic of BI is that the information displayed can be rolled up or drilled down to specific levels of interest and responsibility within the organization. Let’s say that the COO, who likely would never log into his or her organization’s clinical application, can view a consolidated corporate view or an expanded view of all regions’ or facilities’ clinical KPIs. Likewise, a department head can view his or her specific KPIs benchmarked against department-specific goals.

BI fosters quicker data-driven solutions.

Yes, successful decisions are often based on “hunches”, but in today’s LTPAC world executives and managers have to make and report on specific data-driven KPIs. Before technology truly enabled BI, decisions were often hunches based on information manually extracted from old data, assuming that the information was possibly a trend. It was like trying to drive a car exclusively looking in the rearview mirror. But for businesses to function intelligently with BI, the information needs to be organized and displayed in ways that fosters comprehension, timely quality decisions, and, may I add, accountability. BI also enables managers and executives to retrieve and view data in ways that are specific to their responsibilities and needs.

BI crosses data silos for multi-dimensional views.

Let’s take labor management, for example. For years LTPAC providers have analyzed labor hours and dollars based on hours and dollars per patient per day. Manually, that would mean reconciling time card totals with the census tabulated and reported by the nursing department. However with business-critical enterprise-class software, providers are now using time and attendance applications for labor hours, payroll applications for labor dollars, and clinical applications for the census in aggregate, by payer type, by clinical unit within the facility, and so forth. But each application may be from a different vendor. To get them to talk to each other and to consolidate and convert that data into actionable information instantly requires data mining and BI technology.

BI displays convenient and useful information

BI can also display the information in ways useful to the decision makers. I’ve hinted at this throughout this blog, but the magic to BI is its intelligent use. It starts with identifying and aligning KPIs to the organization’s mission, objectives, strategies, and, yes, culture (but that is a topic for another day). Once selected, KPIs determine how data is be collected, combined into useful information, and displayed in consumable formats. Because the KPI-driven information is available in real time and actionable, executives can make data-driven decisions right now. Now that’s intelligent business.

[1] Lest we get off on a tangent here, I am going to use Merriam-Webster as my source for defining “real time”: “the actual time during which something takes place <the computer may partly analyze the data in real time (as it comes in) — R. H. March>.” (Italics added) In this instance, BI generates information in real time as soon as the system has access to the data (as it comes in).  In the case of most of our BI customers, that means refreshing the data available in their respective data warehouses several times a day – as frequently as each customer wants to have its data updated.

Likely you read the article in the November 14, 2014 McKnight’s Daily Update entitled, SNF staffing data will be submitted quarterly, payroll vendors might be responsible, CMS officials say, which reported that CMS has launched a pilot to solicit information directly from providers’ payroll systems. The crux of the matter is the lack of confidence in the accuracy of the information providers are reporting to CMS annually to comply with Five Star Rating information requests.

Further, in a previous McKnight’s article, dated November 13, 2014, entitled 80% of nursing homes report misleadingly high staffing levels, Center for Public Integrity claims, the Center for Public Integrity claims that “more than 80% of skilled nursing facilities might have inflated registered nurse staffing levels on the Nursing Home Compare website.” I have a hard time believing that reported registered nurse staffing levels were double that which Medicare cost reports reveal. If that is the case, some providers must be extremely short sighted. Or the investigative journalists at CPI don't know how to read cost reports. The New York Times further fanned the flames of controversy by claiming that providers “ramp up” their staffing levels before a known inspection, allegedly using that time period as the sample for reporting purposes. These two articles seem to indicate that providers have two issues to deal with when it comes to reporting labor information, e.g., accuracy and integrity.

Technology can ensure reporting accuracy and timeliness

So what’s a provider to do? Assuming providers have integrity, let’s discuss accuracy. In the past, when I was running buildings, I had to collect the data and create the reports manually, cross-checking multiple times to make sure the reports were accurate - a laborious, tedious, and time-consuming task. Providers today, however, have a much easier and time-saving alternative - automated data mining and business intelligence (BI). Retrieving, compiling, and repurposing the data into useful, relevant, timely, accurate, and actionable information is fully automated through data mining and BI technologies. The data comes directly from the provider’s time and attendance and payroll systems, combined with its clinical and financial software. The BI tool retrieves that data and stores it in a data warehouse from which it creates reports usually viewable in a dashboard. Further, the reports can be as “real time” as the provider needs them to be. As soon as an employee punches in or out that data is stored and therefore information can be retrieved and reported throughout the day.

Business Intelligence can be a tool to use to take action, to make sure that labor is compliant with budgetary and regulatory requirements. It can also be a reporting tool readily disseminating accurate reports to stake holders, managers, and even to regulatory agencies. Even better, such BI tools already exist, such as our primeVIEW dashboard. With it providers throughout the day are able to view staffing levels, observe overtime, identify who’s on the clock and who’s not, review part-time employee hours, and assess labor trending. It can also generate the CMS 671 report for the Long Term Care Facility Application for Medicare and Medicaid. This kind of rich reporting goes beyond CMS requirements and has proven useful to providers across the country to help them save money and improve business processes.

If you haven’t already, I encourage you to look into Business Intelligence to not only run your business, but to comply with such reporting requirements as CMS will mandate for all providers. Through business intelligence, such information is accessible, accurate, and painless…well, at least the process is; the results may not be. But that is why you want BI in the first place. Address the pain before it gets out of hand. But that is for another blog posting.