Who could have guessed there would come a time when terms like
"electronic document exchange" and "Web-based functionality" would
come tripping off providers’ tongues almost as frequently as
acronyms like "DMERC" and "HCPCS"? Welcome to a new day in the home
medical equipment industry, one in which information technology
(IT) is as important to providers’ bottom lines as offering
the latest products.
Advances in IT tailored for HME have also brought another word
into providers’ business lexicon: automation. And according
to some experts, to boost productivity and profit in the
competitive market to come, providers won’t be successful
without it.
"While manual processes do work, irrespective of the size of the
company, all providers have to embrace technology in one way, shape
or form," says Jeff Frankel, president of Trac Medical Solutions,
Schenectady, N.Y. The company markets CareCert, an Internet-based
system for processing CMNs online. "Technology is synonymous with
greater efficiencies, which are synonymous with greater
profitability, and with greater profitability you’ll have
better care being provided.
"The industry has tried to squeeze as much cost out of procuring
product as we possibly can," Frankel continues. "You can try to
extend the life of a concentrator ... but you can only go so far
with that before you have to start looking for other avenues to
managing your business more effectively. That’s where IT
comes in."
Factor in the administrative simplification mandated by HIPAA
and federal reimbursement cuts set out by the Medicare
Modernization Act, and providers are being pushed to automate their
operations, according to Weyman Perry, vice president, sales and
marketing, for Duluth, Ga.-based Fidelis Software, which developed
the Brightree online application.
"The types of things that were ‘nice to have’ are
becoming ‘must haves’ with the increasing price
pressure from programs like Medicare and Medicaid," Perry says.
"Personnel costs—workflow efficiency and accuracy—are
one of the areas [with the] greatest potential to squeeze out
additional productivity gains, thereby allowing a business to
remain profitable in the face of reimbursement cuts.
"In addition," Perry points out, "having the data available to
analyze critical issues like payer and product line profitability
are becoming necessary for culling out unprofitable portions of a
business."
Jim Clark, president of Miami-based SoftAid, which offers
inventory-management software as well as a Web-based business
management program, suggests looking at the benefits of technology
in terms of both hard and soft costs. "Hard costs are things like
increasing revenue and decreasing costs. On the revenue side,
especially in health care, you look at things like proper billing
or reduced denials. Technology can help on the expense side with
labor costs, [which is] the biggest cost in most companies, across
industries. If your staff works more efficiently, you can reduce
labor costs.
"Soft benefits, on the other hand, are the peace of mind of
knowing that your systems and records are secure, having a more
manageable workflow and workday, working in a more organized manner
and knowing you’re in compliance with government
regulations," Clark says. But, he explains, "there are no tangible
dollar figures you can attach to [these benefits, though] it is
generally a major benefit to improve efficiencies in your business
or personal life."
Functionality to Fit
A myriad of process management tools are available to HME companies
today. Along with the patient-management, billing and
inventory-control functions that providers have come to expect from
a business package, today’s HME IT applications also offer
capabilities including:
Collection data. Memphis-based RemitData, for instance,
uses electronic remittance devices to collect payment data from
health care providers and to provide productivity enhancements,
sorting transactions by the reasons they were denied or from
highest to lowest dollar. "This lets providers pinpoint what they
are doing right and what they are doing wrong, and gives the staff
the ability to go after things that will bring in the most money in
the shortest time," explains CEO Bentley Goodwin.
With this information, providers can compare their denial rates
with those of other companies and to an average rate, as well as to
a "virtual company" that bills the exact same products. "When we
create these virtual companies, it allows us to compare apples to
apples and oranges to oranges instead of an apple to a mixed-fruit
basket," Goodwin says.
Executive-level operations. Providers can use technology
to outsource complex functions such as accounting and budgeting.
Randy Harrod, a certified public accountant and owner of Harrod CPA
Group in DeLand, Fla., provides an application called e-CFO that
performs the functions of a "virtual CFO," specifically, resource
management.
"Accounting is basically scorekeeping, whereas financing is
managing resources, taking the information out of the system and
extrapolating it in a way that allows you to make decisions on it,"
says Harrod, who is a former COO of Medicare Rental Supply in
Georgia and CFO for InHome Medical in Florida.
Integration of handheld devices. With connectivity
available between IT systems and handheld or wireless devices like
cell phones or personal digital assistants (PDAs), employees can
ramp up productivity. Delivery drivers can get route and traffic
information delivered to their PDAs, for example, and by avoiding
traffic or not getting lost on the way to a patient’s home,
add time for more deliveries each day.
SoftAid’s Clark describes a more high-tech scenario with
real-time claims processing or point-of-care settlement: "When a
piece of equipment is delivered, that information goes into the
PDA, comes back to the provider in real-time and can be billed
electronically as a claim to the payer. The payer could
automatically adjudicate the claim, decide what to pay, then
forward back a response. When this happens in real-time, before
leaving the patient’s home, you know what you’re going
to get paid, and you can collect the copay or balance." The Promise
of the Internet
For Lee Hartz, general manager of Management by Information
(MBI), Sherwood, Ark., the future is "all about integration and the
transfer of applications to the Web browser." Hartz and others see
greater online functionality as another boost for HME IT.
"In traditional Windows applications, the user interface for the
system must be programmed into each component of a system, which is
different for every vendor. With browser-based applications," Hartz
explains, "applications from different vendors and components such
as e-CMNs can integrate seamlessly because they are all designed
around a common interface—the Web browser." MBI’s
i-emphsys is a browser-based home infusion pharmacy and HME product
that "manages a provider’s business from patient intake to
collection of [accounts receivable]," Hartz says.
Fidelis’ Perry counts the benefits of an Internet product
like Brightree in "low upfront and ongoing cost, high
functionality, flexible connectivity and operation in a
real-time—versus a batch-mode—environment. The
foundational change in the platform will change how employees get
their work done, how they are trained in their jobs, how they hire
and manage employees, how salespeople deal with the operational arm
of the company and their customers and how they interact with
manufacturers."
Atlanta-based CareCentric, which owns the Mestamed, Dezine DME
and MSS product lines, has just completed Ac-cura.net, a system
that is built on Microsoft’s .NET technology. This type of
Web-based application "opens all kinds of doors of communication
outside one’s business, with employees working from home,
with manufacturers, with payers, with drivers on the road," says
Mark Kulik, the company’s vice president of sales and
marketing. SoftAid, which markets the Windows-based DMEOffice for
automating order entry and inventory management, also markets the
Web-based ManageDME, the benefits of which are "anytime, anywhere
access--just like using any Internet browser" such as Netscape or
Microsoft Explorer, says Clark.
"A provider with multiple offsite warehouses can go online and
request inventories, managing the process from remote locations,"
he explains. "With real-time, when you place an order, the
inventory is then moved from ‘inventory.’
"You may have minimum reorder levels, where if inventory falls
below certain levels, the system will automatically reorder it.
Manufacturers are allowing electronic data interchange (EDI) from
major vendors for the vendor to electronically date a purchase
order and for the manufacturer to fill the order and send the
shipping information to providers and electronically invoice."
Browser-based systems typically are available by renting or leasing
the browser space from the vendor, or by installing a server and
related equipment. If providers lease the browser space, the vendor
is responsible for upgrading the applications and providing
security and backups. The benefits of leasing include lower costs
upfront and the convenience of handing over responsibility for
server maintenance to an outside party. The downside is the service
remains an ongoing expense because it is on a lease.
For providers with one location, experts agree the lease option
is preferable. But for any size company, and as with any IT
purchase, they suggest that providers should investigate carefully
when considering an Internet solution.
"Online [application] users are at the mercy of a third party
that is responsible for maintaining the system and ensuring that
data is properly protected," cautions Michael Barish, president,
AnCor Healthcare Consulting, Coral Springs, Fla. "Also, online
applications are still relatively new and do not have the proven
track record for successfully handling the business needs of HME
companies."
A Paperless Workplace
Another resource gaining HME owners’ attention is document
imaging. The technology is being heralded as the next big thing in
HME IT, if only because it is easily adopted (the only hardware
required is a scanner) and has an immediate impact on business
operations.
"Document imaging is the next leap, an important next step,"
says Dennis Nasto, vice president of sales, marketing and customer
support for Secure- Care Technologies, Austin, Texas. "It’s
essentially taking all of [your] records and putting them into
electronic form. We’re really moving toward a paperless
environment."
"Document imaging is an example of technology that increases the
ability to service the customer as well as improving the
operational efficiencies of an HME company," explains Esther Apter,
CEO of MedForce Technologies and president of Healthcare Management
Solutions, both in Monsey, N.Y. MedForce offers document imaging
through its MedForce Scan.
In any HME office, Apter points out, "files need to be accessed
continuously throughout the day to verify information, check on
previous deliveries or pull documentation needed to process or
appeal a claim.
"Instant, simultaneous access to the files saves at least four
minutes each time the file is needed. This includes the time it
takes to get up, go to the filing cabinet, pull the file, find the
document, copy it, put the original back in the file and put the
file back in the cabinet. The four minutes does not take into
account the time to look for the file or document if they are not
in the cabinet or in the right place in the cabinet.
"Document imaging also enables multi-location [companies] to
access documents from any of the locations," Apter adds.
"An average person in a DME billing department retrieves a
minimum of four files or documents (including copies of EOMBs) per
hour," she estimates. "If that person’s salary is $30,000 per
year, the cost of retrieving each of those documents is a minimum
of $7,000 per person per year. That is money that can be spent more
effectively. Plus, if you add those minutes back into each
person’s day, you should see at least a 30 to 40 percent
increase in productivity."
Plugging Into the Future
According to CareCentric’s Kulik, IT is one of the most
important assets for DME providers, second only to employees. "You
can have all the computer systems in the world but not have great
employees; likewise, you can have great employees, but if your
software miscalculates [a claim, the employees] don’t
matter.
"Given the complexity of reimbursement today—with all of
the different regulations, payers, prior approvals and
copays—you’ve got to have a system that can keep track
of these things," Kulik states. "There’s no room for error,
especially when margins are tight."
"The software and IT solutions used to manage a ...
provider’s organization can be the tool that facilitates
growth and profitability—or the opposite, the reason the
company’s growth is stunted," Apter believes.
RemitData’s Goodwin agrees. "A properly implemented IT
solution can make your staff much more productive by utilizing
tools available within the IT infrastructure that you can’t
get using manual processes," he sums up.
"Everyone is always asking, ‘can you do more for
less?’ If you can’t, somebody else can."
