An at-home healthcare organization finds reduced accounts receivables and increased clinical efficiency at the end of a complete system-change rainbow.
Does anybody prefer the hospital to home when they are ill? Cold, impersonal and overcrowded, versus, familiar surroundings and loving care—not a tough choice. Just the thought of entering a hospital can impart stress, and stress impedes healing. That aside, some patients are simply too frail to leave their homes for treatment. As the country’s aging populace grows increasingly dependent on primary care, what is an already stressed healthcare industry going to do? Clearly, organizations that treat patients at home represent a growing and appealing trend in American healthcare.
An at-home healthcare organization finds reduced accounts receivables and increased clinical efficiency at the end of a complete system-change rainbow.
Does anybody prefer the hospital to home when they are ill? Cold, impersonal and overcrowded, versus, familiar surroundings and loving care—not a tough choice. Just the thought of entering a hospital can impart stress, and stress impedes healing. That aside, some patients are simply too frail to leave their homes for treatment. As the country’s aging populace grows increasingly dependent on primary care, what is an already stressed healthcare industry going to do? Clearly, organizations that treat patients at home represent a growing and appealing trend in American healthcare.
Season of Change
Home Health & Hospice Care (HHHC) is an independent nonprofit organization with more than 250 clinical and administrative employees. It offers home healthcare, hospice care and supportive services to folks of all ages and circumstances in southern New Hampshire and northern Massachusetts, and is a result of a merger between three organizations—the Nashua VNA, Community Hospice of Nashua and the Valley Home Health/Visiting Nurses Association in the neighboring town of Merrimack.
HHHC managed their administrative operations with a home care solution from Delta Health Technologies since 1992. It encompassed billing, admissions and scheduling, but it did not include clinical reporting or an electronic record. Prior to that, HHHC used the One Write system, a handwritten, paper-based method for recording and storing patient information. “Most of our business goes to Medicare, Medicaid and the private insurances,” says Ellen Sorensen, HHHC’s IT director. “We did electronic billing with Medicare and Medicaid, and paper for all the insurances and self-payers.”
The prioritized data became the basis of 13 RFPs, some of which went to the new kids on the block—application service providers (ASP). She notes, however, that though their programs were functional, the ASP companies had no proven track records or customer base on which to place confidence.
HHHC invited seven non-ASP vendors onsite to conduct demonstrations during the two years it took to complete the process. Eventually, they narrowed the field to four, which included Misys Healthcare Systems. Sorensen then convened the “SWET team,” HHHC’s aptly monikered software evaluation team, composed of Sorensen, the finance director, and the home care and hospice directors. She also invited staff clinicians from every discipline in the field to participate.
They sat through final demonstrations, evaluated the vendors and unanimously chose Misys Homecare. It offered a drop down menu-driven interface, and point-and-click functionality that the team found intuitive and easy to navigate—something they strongly desired after years spent on the DOS-based Delta system. The other vendors’ products also were Windows-based and menu driven, but the SWET team preferred Misys Homecare’s single-database system.
Unqualified Support
Misys reps gave HHHC multiple phone numbers and e-mail addresses with which they could reach support personnel. “We could get the answer we wanted when we needed it. That was a big deal,” Sorensen says. The company’s network services department briefed Sorenson on the equipment, and how, once they were functional, the field devices would interact with HHHC’s communications network. Their enthusiastic support impressed Sorensen, and it was a decisive factor in HHHC’s choice to go with Misys Homecare. “We really liked how much time the sales person (Joyce McFadden) spent with us,” says Sorensen, “and she was willing to refer us to anyone in the company to talk to. That’s unheard of.”
Sorensen also was unsure of the number of hours she should contract for training and implementation, so she spoke with the Misys implementation manager before committing. “He went through the whole thing with me in detail—week by week and hour by hour—what we would do and what we would need.”
Espenshade’s first site visit lasted four days, during which he reviewed HHHC’s processes. Over the next four months, he tutored the HHHC staff and by June they were ready to go live with the back-office systems. As each patient’s doctor’s orders (Form 485) or Medicare Oasis expired, HHHC migrated them from the Delta system to Misys. By mid-September, all of the patients who had been in the Delta system were recertified on Misys Homecare, and the clinical system went live.
Immediate Benefits
When the time came for the clinicians to train on the new system, the administrative staff already had three months of hands-on experience under their belts and could assist them. Sorensen says that was an unanticipated benefit of the three-month split between the office and clinical go-lives. She tracked the clinicians’ productivity as they trained and found most were proficient after only a few months. HHHC now has 70 clinicians on staff entering patient data on laptops during, or immediately after a patient visit.
“The access to information is unbelievable,” says Sorensen of the immediate benefits. She notes that before moving to Misys Homecare, it was not unusual for them to find loose paperwork or incomplete charts. HHHC’s LPNs and social workers often had visited patients with little or no accompanying information, and spent an inordinate amount of time briefing each other on patients’ conditions and needs. “Now they have [the patient’s] whole record in front of them. They can see what went on before; they can write notes, and they can complete their case conferencing on the computer. [Misys Homecare] reduced a lot of the voice mailing that used to go back and forth.”
Efficiency and the Bottom Line
Misys designed Homecare with templates that can be tailored to fit precise needs. For example, they can be customized to be disease or discipline specific. “Say you have a patient with congestive heart failure,” explains Sorensen. “Rather than making the clinicians pick from a long symptom list, we created a CHF problem list with best practice for goals and interventions.” According to HHHC’s CFO, accounts receivables dropped by $800,000 out of $2 million in the first year alone. Sorensen says, this is the biggest benefit on the nonclinical side, citing access to clinical information and the timeliness of receiving it as the primary instigators of the reduction. “The office and billing staffs were spending too much time tracking things down,” says Sorensen. “With Misys Homecare, we can tell where things stand at any minute, so bills are going out quicker, which is good for cash flow.”
HHHC now completes most auditing up front, and Form 485s and Oasis tracking are completed sooner as well, which shortens the billing cycle. “The big difference is access to information,” says Sorensen, “When we audit patients’ charts proactively, the quality department can impact current care by guiding staff in best practice.”
A financially healthy Home Health & Hospice Care benefits New Hampshire and Massachusetts residents in ways that matter most. When fewer people need to stay in hospitals, or stay for shorter periods of time, it benefits us all.
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