What do you do when your company’s revenues drop by 30 percent and the causes—increased expenses and reduced reimbursements—show no sign of abating? If you’re healthcare provider First Choice Home Health and Hospice of Utah, you try to boost efficiency and productivity, and you succeed by providing Windows Phone mobile phones with Allscripts Mobile Homecare software to the clinical and paraprofessional workers who make home visits to your patients. The new tool for accessing patient information and reporting on those home visits has increased productivity and reduced expenses, saving First Choice U.S.$500,000 a year. It has also reduced hospitalization rates by 4 percent, increased cash flow by 100 percent, boosted security and compliance, and reduced employee turnover.
Alarm bells have been going off at home health and hospice providers throughout the United States as expenses have risen and reimbursements from insurance companies and Medicare continue to decline. At First Choice Home Health and Hospice of Utah, that alarm took the form of a 30 percent decline in revenues.
The increasing amounts of paperwork and regulations associated with home healthcare have added to business uncertainty and risk for First Choice, which, in turn, have added to costs. Business processes and a growing regulatory burden have also made it increasingly difficult for First Choice to submit claims promptly. The company was receiving Medicare reimbursements, on average, 90 days after delivering its services—a significant drag on cash flow.
To counter these issues, First Choice needed the most efficient systems possible. But when it came to the business-critical systems that managed patient visits made by home health aides, hospice aides, physical therapists, and other clinical personnel—and that turned the records of those visits into claims—First Choice had outgrown processes that had previously served it well.
Some clinical and paraprofessional workers used portable computers to document their patient visits, others used paper. Either way, the field staff had to return to First Choice every day or two to deliver their reports, and those reports had to be rekeyed into the practice management system. As the company’s geographic service area grew to cover more than 3,000 square miles, each round trip to the office could take 40 minutes or more, with many field staff driving 25,000 miles a year to submit their reports. The company’s travel reimbursements to its employees grew—but the opportunity cost of this travel was even more worrisome.
“Anytime that our clinicians were in our office, or traveling to and from our office, was time that they weren’t with patients,” says Beau Sorensen, Chief Financial Officer at First Choice Home Health and Hospice. “That’s time they could have been improving patient outcomes, time they could have been providing revenue-generating services.”
||We’re using Allscripts Mobile Homecare on Windows Phone to accelerate cash flow on Medicare reimbursements by 100 percent. Given the economic pressures on healthcare providers, that’s significant.
Chief Financial Officer, First Choice Home Health and Hospice
There were other concerns to address, as well. The more health-related information that clinicians had about their patients, the more they could do to help improve outcomes for those patients. But information in the field wasn’t always available or up-to-date. And when field workers returned to First Choice to file their reports, more hurdles arose. About 5 percent of paperwork was misplaced before it was processed, requiring clinicians to recreate it—which both delayed the generation of claims, and generated an understandable degree of frustration on the part of employees. Meanwhile, the file room had reached its capacity, requiring First Choice to find increasingly inventive ways of maintaining files that wouldn’t stop growing. Six people worked full time to enter data from clinicians’ reports into the practice management system and to maintain the file system.
“We needed ways to boost efficiency and productivity, reduce costs, and increase revenues,” says Sorensen. “Our existing systems weren’t doing enough of this. We knew we needed a different solution, but we didn’t know what to do.”Solution
First Choice refined the requirements for its different solution. It wanted a highly mobile, low-cost solution that would support clinical and paraprofessional workers in the field. That solution had to be sophisticated enough to be useful, but not as sophisticated (and expensive) as a full-blown electronic health record (EHR) system. It had to be able to work without an Internet connection because many of the 3,000 square miles that its clinicians travel have uneven wireless coverage. Yet, it also had to work in Internet connected mode, to get data back to First Choice quickly when possible without requiring clinicians to drive to the company to deliver it. Finally, security for the patient information that the solution would handle was a must, both because it made business sense and because federal law required it.
First Choice considered moving all of its clinicians to portable computers equipped with broadband “air cards” for wireless connectivity using cellular data service, but the cost was prohibitive. Then the company turned to healthcare technology solution provider Allscripts, with which it had already worked. A few years earlier, Sorensen and his colleagues had embarked on a plan to digitize as much of the company’s operations as possible, as a step toward the achievement of a truly paperless environment. They looked closely at EHR and practice management (PM) solutions from a handful of healthcare-specific vendors. “We chose the Allscripts EHR/PM solution because Allscripts had the most credible roadmap to a paperless system for healthcare providers,” says Sorensen. “Its Homecare solution has been fantastic.”
Sorensen applies the same appellation to the app that Allscripts provided for his company’s mobile challenge: Allscripts Mobile Homecare™. The solution is a phone app that combines time and attendance functionality with clinical functionality that’s specifically designed for the home health aides and similar paraprofessional staff, as well as clinicians performing revisits who now use it at First Choice.
Allscripts designed its Mobile Homecare application for only one phone platform: Windows Phone.
“We talked at length with Allscripts about the phone for Mobile Homecare, and they made a great decision in putting it on Windows Phone,” says Sorensen.
|Figure 1: Allscripts Mobile Homecare takes full advantage of the |
Windows Phone user interface, making information easy for clinicians
to find and use.
For example, Sorensen cites the unknowns and uncertainty surrounding the submission of applications to the Apple App Store. “Apps can take weeks to go through the Apple approval process, and if the app is rejected, the vendor may not know why,” he says. “In healthcare, we need regulatory releases as soon as possible in order to upgrade and train our staff. We can’t have unpredictability in software availability—we can’t take the risk of having to go back to paper until things are straightened out.”
Sorensen also was inclined to view the Google Android operating system as problematic for First Choice. “We needed a platform for an enterprise-class application,” he says. “With Android, there are a variety of versions of the operating system, and equal variety in the hardware specs for the devices. We’d need to figure out which ones had the right screen sizes, chipsets, and encryption for us. There’s also an increasing amount of viruses and malicious software directed against Android, posing a tremendous HIPAA-violation risk for us.” HIPAA is the Health Insurance Portability and Accountability Act of 1996.
In contrast, Sorensen saw tremendous upside in the choice of Windows Phone. “With Windows Phone, we saw stable, consistent hardware and software, which makes for efficient device management,” he says. “We saw a rapid and transparent app release process that would make regulatory updates available to us when we needed them. The devices are aggressively priced. It was only later that we realized how great the battery life is—our people get a full day using a data-heavy app before they need to recharge.”
First Choice adopted the Allscripts Mobile Homecare solution when Windows Phone was launched in November 2010. The company put the application on the Samsung Focus, a popular Windows Phone.
Patient care with the Allscripts Mobile Homecare solution begins as it always has at First Choice—with a medical assessment of the patient and the creation of a care plan and schedule for implementing that plan. Allscripts server-side software pushes patient and schedule information to the phone of each clinical and paraprofessional worker in the field. The clinicians view and work with this information through an interface that takes full advantage of the Windows Phone “Metro” design system, especially its panorama format, with which users can flick through several screens’ worth of information without leaving the application page (see figure 1).
The field workers use the app’s integration with Bing Maps and global positioning system capability to map the most efficient routes from patient to patient. During each visit, the clinicians use the app to record the results for each scheduled procedure or measurement. The clinicians also have access to the patient’s health history, so they can put the patient’s current health in context and offer appropriate advice. When the visit is over, the clinician hits “send” to transmit the visit information to First Choice. There, the clinical data is evaluated by medical personnel while administrative data is forwarded to systems, including the practice management system.Benefits
First Choice is using Allscripts and Windows Phone to reduce costs, increase cash flow, boost security and compliance, improve clinical outcomes, and reduce employee turnover.
Saves $500,000 Annually in Rent, Labor, and Travel
First Choice has achieved its primary goal in adopting the Allscripts Mobile Homecare solution on Windows Phone: It has succeeded in boosting efficiency and reducing cost.
The cost savings come from a variety of sources. By eliminating paper-based clinicians’ reports and automating the process of generating claims from them, First Choice has vastly reduced staffing requirements for maintaining its file room and keying data into the system. First Choice previously needed six full-time equivalents (FTEs) for these functions. Today, the work is handled by 25 percent of a single FTE—a savings of 96 percent in staff resources. Far from needing a larger file room to handle the ever-growing number of clinicians’ reports, First Choice, which has digitized the previously filed paper reports, has eliminated its file room and moved to smaller offices, saving U.S.$120,000 annually.
Travel is a key area of savings for First Choice. The company uses the Bing Maps and global positioning system capability in Windows Phone to calculate clinicians’ mileage for purposes of reimbursement. This eliminates the overestimation of mileage that often occurred previously. About 70 percent of clinician travel to and from First Choice is also eliminated, since clinical workers no longer need to continually return to the office to deliver reports. Clinicians also travel on more efficient routes than they did previously, again thanks to the phone’s capabilities. All together, First Choice uses the solution to save about 25 percent of previous travel costs—about $60,000 annually.
“We save $500,000 a year through our use of Allscripts Mobile Homecare and Windows Phone,” says Sorensen. “And this is all on nonreimbursable expenses, so it’s especially valuable to us.”
Beyond this hard savings achieved with the Allscripts Mobile Homecare and Microsoft technology, First Choice also sees soft savings. “We’re a Microsoft shop from the desktops to the servers to the web,” says Sorensen. “It’s what we know. So a Microsoft-based solution fits in here beautifully. For example, we already use [Microsoft] Exchange Server . That makes putting our enterprise email on the phone really easy. Anything that simplifies IT management also increases productivity and reduces cost.”
Hospitalization Rate Down 4 Percent
Beyond using Allscripts Mobile Homecare and Windows Phone to boost productivity, cash flow, and other operational measures, First Choice also uses the technology to enhance the quality of care it provides to patients—“improving patient outcomes” in healthcare parlance.
One way that First Choice uses the technology to improve patient outcomes is by making patients’ charts always available to the clinicians treating those patients. In the past, clinicians would have only the information they brought with them to patient visits. Now, as new issues or concerns arise, clinical workers use their Windows Phones to instantly access the most up-to-date healthcare records that can help them to act more proactively or decisively to help their patients.
The benefit to First Choice’s patients is measurable and remarkable. The rate at which those patients require hospitalization has declined by 4 percent, supporting the Centers for Medicare and Medicaid Services’ 30-day readmission prevention measures for certain diagnosis-related groups.
“Our patients are able to stay in their homes—and out of the hospital—longer, thanks to the heightened level of care that we can provide by using Allscripts Mobile Homecare and Windows Phone,” says Sorensen.
Speeds Cash Flow by 100 Percent
First Choice also sees better and faster reimbursements since adopting the solution, which translates into greater cash flow and increased revenues. Streamlining of virtually every phase of the process of generating claims contributes to the increase in cash flow:
||We’re a Microsoft shop from the desktops to the servers to the web. It’s what we know. So a Microsoft-based solution fits in here beautifully.
Chief Financial Officer, First Choice Home Health and Hospice
Previously, it took two or more days for information about a patient visit to reach First Choice for processing. Now, virtually all such data enters the First Choice system for processing within a day of the visit.
Previously, about 5 percent of paperwork was misplaced prior to processing, causing a delay while it was found or recreated. Now, all patient visit information—created directly in Allscripts Mobile Homecare on Windows Phone—is entered without loss or delay.
Previously, the company’s “revenue days outstanding”—the time between the patient visit and the Medicare reimbursement for that visit—took 90 days. Now, First Choice has cut that waiting period in half, to 45 days.
“We’re using Allscripts Mobile Homecare on Windows Phone to accelerate cash flow on Medicare reimbursements by 100 percent,” says Sorensen. “Given the economic pressures on healthcare providers, that’s a significant benefit.”
And it’s not the only financial benefit that First Choice sees from the technology. Because clinicians don’t have to spend time creating and sometimes recreating reports on their patient visits, and because they don’t have to make daily round trips to First Choice to deliver those reports, they now have the time to make an additional patient visit a day, up from six per day previously.
“We’re seeing a 17 percent increase in clinician productivity, thanks to Allscripts Mobile Homecare and Windows Phone,” says Sorensen. “And that increased productivity is directed entirely to revenue-generating activity. It’s a real help in dealing with declining reimbursement rates.”
Boosts Security and Compliance
First Choice would not have been able to adopt Allscripts Mobile Homecare and Windows Phone—and reap significant financial benefits—if the solution fell short of meeting stringent government requirements for the security of patient information. Happily, the technology does meet these requirements.
Windows Phone and the Allscripts Mobile Homecare app are each username and password protected, granting access to the app and its data only if a user has both sets of usernames and passwords. Further, all data on the phone is encrypted; Windows Phone uses native application encryption based on Application Encryption Standard-128 to prohibit access to Allscripts Mobile Homecare files and data from other applications or viewers. Data in transit between a phone and First Choice is encrypted with a Secure Socket Layer certificate. A lost or stolen phone can be deactivated remotely, with the Allscripts app, and data wiped from the device.
“We have always been careful to meet HIPAA requirements, but with Allscripts Mobile Homecare and Windows Phone, we meet those requirements with a higher level of security than we’ve ever had before,” says Sorensen. “Similarly, we use this technology to help insure that our charts are in compliance with federal regulations. Being 100 percent in compliance is a lofty goal, but, with Allscripts Mobile Homecare and Windows Phone, we are closer to that goal than we have ever been.”
Increases Employee Satisfaction and Reduces TurnoverMicrosoft Health
Even First Choice’s employees are happier with the solution. Previously, the company heard employee complaints from time to time over the need to recreate missing paperwork. One or two employees would even leave the company each year out of frustration. Since deploying the solution, those complaints have stopped—and not one employee has left over missing paperwork.
Microsoft technology can help healthcare practitioners and insurance providers in giving patients the best medical care and coverage possible.
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