The information engines inside today’s rehabilitation settings can provide horsepower that shape business success and patient care from a highly informed perspective. There is an expectation, however, that integrated software solutions will help practices control their data in a way that adds productivity and improves financial footing. To help readers understand the end-to-end benefits available from today’s software products, Rehab Management asked a panel of industry insiders to highlight the critical characteristics that rehab facility administrators and owners should know when considering the move to a fully integrated system.
Participants in this roundtable include the following: Jason Keele, chief executive officer, 1st Providers Choice; Eldad De-Medonsa, PhD, president, Billing Dynamix; John Wallace, PT, chief executive officer, BMS Practice Solutions; Jerry Henderson, Founder and vice president, Clinical Community at Clinicient; Amy Orr, vice president, sales, ClinicSource Therapy Practice Management Software; Sharif Zeid, business director, MWTherapy by MerlinWave Inc; Ricky Gomez, director of sales and marketing, Planetrehab; Steve Presement, president, Practice Perfect EMR + Management Software; Karthik Rao, PT Practice Pro; Andrea Cassese, director of PTOS Software, Patterson Medical; Ken Schenley, vice president, Quick Notes Inc; Raintree Inc; Ron Reed, product manager, ReDoc by NetHealth; RevIgnition; Steve Gottfried, vice president, sales, SourceMedical; Daniel Morrill, PT, MPT, chief executive officer, TheraOffice powered by Hands On Technology; Nelson M. Aviles, PT, sales manager, Therassist Software LLC; and Heidi Jannenga, PT, DPT, ATC/L, chief operating officer, WebPT.
How can an integrated software system help practices meet Medicare compliance requirements?
Jason Keele: The use of fully certified therapy software ensures therapists do compliant Medicare documentation and visit notes. The integrated software automatically generates the G-Codes and modifiers, bills the encounter, and pushes into visit notes. This makes it simple to comply with PQRS.
Eldad De-Medonsa: By using a system that integrates scheduling, documentation, and billing into a single system, all stages of your patient lifecycle can be monitored automatically for compliance problems. The right system can notify of potential problems before they become a risk. Is a patient missing appointments? Has a therapist failed to bill out a visit or sign off on their note? The best systems will alert you of these problems.
John Wallace: The strength of an integrated system is that it is one application running with one database. This allows for maximum performance as well as a seamless user experience. For the purposes of counting and tracking—a large part of meeting payor requirements—a fully integrated scheduling, documentation, and billing system allows the most accurate and quickest response. For the compliance requirements that require integration of clinical and billing data, like the therapy cap, PQRS, and FLR, an integrated system delivers maximum flexibility to gather the appropriate information for reporting.
Jerry Henderson: With a truly integrated system, documentation and billing information is in a single system. The tight coupling of documentation with charge capture and claims processing ensures that what is documented always matches what is billed—which is essential for compliance. A single system also provides compliance support tools embedded into the entire patient workflow. Triggers, alerts, notifications, and automated reporting features help guide front desk, therapist, and billing staff through the process to meet specific regulations at specific times during the patient visit and enforce compliance.
Amy Orr: The best software systems are HIPAA compliant and ONC-ACB certified, and help ensure Medicare compliance by having built-in reporting templates, automatically recording everything you’d need in the event of an audit, including integrated functional limitation reporting support. A good system should help clinics stay ahead of the curve by automatically updating the software system as regulatory changes occur.
Sharif Zeid: Integrated software is a very important part of the modern practice’s compliance toolbox. Software can help by enforcing standards, providing reminders and alerts, and fostering an environment focused on compliance. Integrated software also helps practices by creating consistency in documentation from visit to visit, and from clinician to clinician within the practice. Practices should take advantage of all tools available in addition to good clinical judgment through education and experience.
Ricky Gomez: An integrated system enables practice owners/managers to standardize documentation and best practices across their entire organization. They can make sure key fields, dates and billing codes—especially G-codes—are entered and adhere to compliance guidelines. Having the ability to centrally structure their software makes it much easier for a practice to maintain its compliance.
Steve Presement: Medicare compliance, in a nutshell, is about preventing things from falling through the cracks. Have PQRS and Functional Limitation measures been entered when appropriate? Does a charge exist for every scheduled client, does a note exist for every charge entered, does the charge justify the scheduled time, does the note justify the charge? Because these checks and balances span billing, scheduling, and documentation, really the only way to ensure compliance is to use a fully integrated software solution.
Karthik Rao: By having rules and warnings programmed into it, giving the user/s early warnings and notifications on when to be adding additional data. Having the correct data preloaded, saving users having to study and look up correct coding and submission rules.
Andrea Cassese: It reduces mistakes that may occur when you have to enter CPT codes and patient information twice, but it also saves time with automated tracking and alerts to remind you of documentation requirements.
Ken Schenley: There are definite advantages to an integrated system, but most practices simply want a good billing system along with a solid and compliant note system. Proper documentation is critical to avoid medical/legal issues and audits.
Raintree: Integrated medical software helps providers reduce the complexity of managing the mountain of regulations, rules, and requirements by building into the background all the things providers need to stay compliant. The software helps the providers create defensible documentation, correct billing, and coding all while protecting privacy and ensuring program compliance. Without an integrated EMR and practice management solution, it would be nearly impossible for a medical provider to comply with all the regulations, rules, and requirements of Medicare and Medicaid.
Ron Reed: An integrated software system should provide specific tools to facilitate completion of Medicare required documentation, such as PQRS, FLR, etc. This information should flow seamlessly into the billing components and onto the claim. Alerts and comprehensive reporting will assist in monitoring success.
RevIgnition: From a billing and coding perspective, an integrated software system will help the practice code procedures and treatments correctly as well as create defensible documentation for those treatments. In addition, an integrated system will help practices stay compliant with regard to billing, privacy, and Medicare regulations.
Steve Gottfried: There are core data elements that need to be available for practices to comply with Medicare requirements. At a high level, the documentation must justify and match what is being billed. Having one system in place to manage this process is very beneficial. In addition, a good EMR program will aid the therapists with recommendations and requirements for completing a compliant note.
Dan Morrill: A coordinated team effort is necessary to complete the requirements to successfully submit claims and receive payments. Front office, back office, and clinical staff all have roles in the organization and execution of providing care, collecting correct data, and submitting to Medicare Intermediaries. Well-designed integrated software help practices centralize billing and clinical data, check for errors, and remind everyone when things are due or required. At the end of the day, the most successful clinics create workflow processes that are easily executed with the help of an adaptable integrated software solution.
Nelson M. Aviles: From the point the therapist enters the practice, scheduling software can easily identify that person to users as a Medicare therapist with some identifier. It can also ensure that the therapist is scheduled as 1-on-1 for the therapist, as well as count and track visits. Between the clinical and billing functions, an integrated EMR can track and manage treatment minutes to time and assure that 8-minute rule requirements are being met. Most importantly, all of these pieces of important clinical data are easily retrievable, reportable, and stored for use or future recall.
Heidi Jannenga: Integrated software systems typically feature built-in documentation safeguards to ensure the user successfully jumps through every one of Medicare’s hoops. Cloud-based software solutions offer an additional compliance perk in that they are flexible: vendors can update the software constantly to ensure it’s always in tip-top compliance shape. Furthermore, such updates typically occur automatically and require no effort on the user’s end. Lastly, software systems with integrated compliance features allow a clinic to go totally digital, thus reducing—and eventually eliminating—paper files and storage that clutter an office.
What should a physical therapy practice consider most in deciding whether to move to an integrated software system—or change from the integrated software system they currently use?
Jason Keele: First, consider the feature set and ease of use. Second, consider the cost of investment, any reoccurring costs, as well as terms of the agreement. And, third, consider the availability and quality of training and support.
Eldad De-Medonsa: The system that is selected must add value to a practice, while providing the foundation for that office to grow around it. The best systems work as well for an office seeing 200 visits as it does for one that sees 2,000 or more per month. The most important aspect in any integrated system is its ability to fit the practice’s workflow and make staff work in concert across the entire patient lifecycle. It is also critical to know what kind of support is available.
John Wallace: They should thoroughly vet all the components of the system and not focus 90% of the effort on the EMR component. Also, they should talk to long-time users as well as new users about their use of the system and their onboarding experiences. A powerful system is only as good as the training and support you get after you commit. Also, owners should be clear that whenever you change systems there is potential for the need to change and optimize practice workflows.
Jerry Henderson: Under-standing the difference between a single, integrated system and a system interface is critical. Some solutions say they are integrated, but they interface with a third-party billing solution. With a truly integrated system, all clinical and financial data lives in a single database to give you one source of truth. There’s never a need to re-enter data because all data is in the same database. Reporting capabilities are also a critical consideration.
Amy Orr: Can it quickly and easily handle all scheduling, billing and practice management—in addition to SOAP notes and documentation—in one integrated system? Is it easy to use and implement? Is it HIPAA compliant and ONC-ACB certified? Does it have customized templates for reporting, care plans, and therapy SOAP notes? Is it cloud-based, yet secure? Can I try it before I buy it?
Sharif Zeid: Three critical items that every practice should consider are: 1) What functions will the system provide now? 2) What is the total and true cost of the system? 3) How will the system grow and change with the practice? As today’s healthcare landscape is changing nearly daily, practices should seek out systems that can meet the needs of both today and tomorrow at rates that are affordable.
Ricky Gomez: Ease of use should be paramount. Reporting, especially the ability to create customized reports, is essential. Finally, seamless integration between all aspects of the software should greatly improve practice efficiency.
Steve Presement: Primarily, is the software solution you are investigating truly integrated? Is it from one company, it is launched using one icon, and do you call one entity for support? If the answer to any of these questions is “No,” then you are not dealing with a truly integrated software solution; you are dealing with several solutions that may or may not properly communicate. This will ultimately lead to data inconsistencies and finger-pointing from the various software vendors when problems arise.
Karthik Rao: Some initial investment will be required, be it money, time, or both. The more you dedicate, the bigger the reward. Also, do your research and don’t rush in. There are a lot of products out there, so make sure you find the one that works best for you. At all times, remember what is driving the decision to make the change or move. Do not settle, and above all, do not make a purchase decision based solely on price.
Andrea Cassese: Be sure you will get comprehensive training and support to guide you on how to pull all the features and data together to ensure you get the most out of the system. It is also important to understand the key metrics and features you want and need so you can make your evaluation.
Ken Schenley: It is important that the system purchased meets your specific needs as a practice. Ease-of-use is critical, as is portability. Try to find software that works anywhere, such as those on Android or Apple tablets.
Raintree: The owner or administration should look comprehensively at operations, growth plans, and profit drivers, etc, before selecting an EMR and PM solution. The worst thing a practice can do is select a software solution based on what that software does, rather than what the practice actually needs. The second thing is to focus on how the software works, functionality, flexibility, ease of use, and scalability. This is a software system that you will be using for years, so it needs to work for you today and wherever you are in the future.
Ron Reed: Give thoughtful analysis to your business goals, and look for solutions that would help you realize those goals. Consider including your staff in multiple product demonstrations, and request similar practice references from the vendor.
RevIgnition: Billing and collections is one of the most important aspects of a practice that many times gets overlooked when selecting an EMR solution. Any practice looking at a new integrated software solution should clearly understand their revenue cycle needs and business growth plans. Their software solution should expand with their business and give them the tools and features needed to effectively manage their current revenue cycles as well as handle their growth.
Steve Gottfried: A practice should think about what metrics they are looking to improve on or change, and whether they are related to marketing, maximizing visits, therapist productivity, or something else. It’s beneficial for practices to collect current metrics—if available—and discuss improvements they are looking to make. When evaluating available options, it is also helpful to have these in mind to assess the ability of the vendor to affect performance.
Dan Morrill: An honest review of the business is a good place to begin any software search. What do you do well? What can be improved? How do you objectively measure performance? Once workflow processes are reviewed and documented, use them as a blueprint for evaluating the integrated software. A great software package has the potential to improve your clinical and business success.
Nelson M. Aviles: Be sure to have some specific ideas of problems software can address in mind and an understanding of how they negatively impact your practice. Also, have a good understanding of your network infrastructure as well as your alternatives. If you’re just starting out with a program, having it hosted is usually best. If you have a network in place, knowing what it will take to have that new software perform optimally on an existing server will assist in ROI and avoid unpredictable costs for maintenance and upgrades.
Heidi Jannenga: Practice leaders should first consider whether the system is designed specifically for physical therapists. If your EMR is designed for an MD instead of a PT, you’ll likely have to implement Band-Aid fixes and workarounds to ensure you can complete your documentation compliantly—and thus, get paid. Secondly, consider whether it’s server-based. If your EMR runs on a server, not only do you have to worry about securing your patients’ protected health information, but you’re also responsible for updating the system to ensure it’s equipped with the latest compliance features. It’s also vital to know whether the software vendor provides free training and support.
How well do most practices use the data generated by a fully integrated software system to positively affect the bottom line?
Jason Keele: Practices do really well at utilizing their data to become more efficient, reducing expenses and increasing revenue. When using a fully integrated system that includes billing, scheduling, and documentation, it eliminates the need for duplicate data entry into multiple software programs. The patient checks in from the patient scheduler, and the information flows through an automated check-in process. The visit note is then created as the patient is seen and bill is automatically generated. Can that data be overwhelming? No, the system is set up to be very user-friendly, and reports are easily comprehensible and customizable.
Eldad De-Medonsa: Most practices only use a fraction of their system’s capabilities. A well-designed system will make sure that it presents important information in a simple and streamlined way, providing the option of performing deeper analysis if desired.
John Wallace: Practice owners shouldn’t confuse having data with using data. All systems have lots of data. The question is, is that data searchable, usable, and actionable? In the frenzy to meet staff desires in an EMR, many owners do not spend enough time vetting productivity reporting, revenue tracking, billing and collections efficiency, and outcomes reporting. Most owners rely on spreadsheets of relatively meaningless data “they have always used” that are put together and analyzed by staff instead of real-time data that reflects key practice indicators for success.
Jerry Henderson: The practices that do a great job utilizing reports to manage their practice use a few key metrics to monitor the health of their practice. If one of the key metrics is not in normal range, then there are more detailed reports that are available to point out the root cause. Rather than providing endless reports, it’s more useful to provide a summary of the metrics. We call the concept, “data driven coaching.” Our customers are using the data every day to make decisions that impact their bottom line—whether finding ways to keep therapists’ schedules full, improving case management, or making sure they are billing and collecting what was rightfully earned as quickly as possible.
Chris Almond: If the data is overwhelming, the system is probably too complicated. Software trying to be “everything to everybody” can be loaded down with features and functions that some therapists will never need or use, causing clutter. To avoid this, find a system created specifically for your field of practice. One way some of our clients are using data to affect the bottom line is automatic posting of remittances, which essentially eliminates a full-time employee position. Automated appointment reminders help reduce no-shows, and total integration between session reporting and billing ensures data does not fall between the cracks.
Sharif Zeid: Practices use reporting to track clinical progress, monitor compliance, review collections and billing, and more. Fully featured systems come loaded with a substantial number of reports to help practices track, measure, and manage efficiently and effectively. The key to avoiding being overwhelmed is for each practice to identify its key metrics and then rigorously check progress towards specific goals through the course of each month and year. There are many ways to measure a practice’s health and status, such as looking at number of patients, number of visits, revenues, number of referrals, etc.
Ricky Gomez: Reporting is the key to using the data. A system can house all the data in the world, but if the user can’t get to the data and/or massage the data via reporting, that severely limits the ability to ascertain important information from the data.
Steve Presement: Examples of simple, easy-to-obtain bits of information and functions that can be performed to substantially affect the bottom line include: tracking patients who have stopped attending; tracking referral sources that have stopped referring; automated reminders to patients about upcoming appointments; and identifying patients not living up to their prescribed treatment plans. Digging deeper into billing practices, clinician productivity, cancellation and no-show rates, and reasons, will also add to the bottom line. All are easy to identify, easy to analyze, and easy to enhance.
Karthik Rao: Never has the data been described as overwhelming. Why? Because it is not presented as such, but carefully and neatly arranged into their correct departments. Most practices quickly realize and learn the potential to positively affect their bottom line by being able to analyze the data they believe will make the most difference. This allows them to make the necessary changes or improvements to areas they believe are affecting the bottom line, and easily view the results.
Andrea Cassese: The data can be used to help manage a business in a variety of ways. It allows one to better understand therapist productivity in terms of visits, charges, no-show percentage, note completion, etc, as well as patient mix and financials. It can tie all the pieces together that are needed to run the business.
Raintree: Data used in the right way can positively affect profits, but it is easy to become overwhelmed without a clear understanding of a business’ profit drivers. Many physicians and medical providers are becoming more business minded in a traditional sense and are seeking EMR and PM solutions that give them the tools to help them see their business in terms of hard numbers. As practices become more sophisticated, they look for additional data that helps them become more efficient and profitable.
Ron Reed: Access to statistical data allows a practice to be proactive instead of reactive. Can that data be overwhelming? In some cases, yes it can be overwhelming. If prior to the adoption of an integrated software system a practice did not manage the business by metrics/data, then they may have a steeper learning curve. We provide additional services to assist our customers in using the data to identify and implement operational improvements.
RevIgnition: Many practices are becoming better at using the data available to them to make decisions about their business. An integrated software system allows a practice to easily generate reports that offers a better picture of the health of their practice. This is especially true for billing and collections. An integrated system provides the practice the data it needs to ensure revenue cycles and revenue streams are effectively managed.
Dan Morrill: Someone famous once said, “If you can’t measure it, you can’t improve it,” so understanding your data is vital to understanding the strengths and weaknesses of your business. Great software organizes the volume of data so that you can answer questions and improve your business. As software developers, we are seeing an evolution from old paper single reports to much more powerful modeling tools that help forecast and identify issues before they impact your business’s bottom line.
Nelson M. Aviles: Not as well as they think. It can be easy to miss out on simple things that can add visits or improve marketing. For example, tracking a therapist’s frequency and duration, then forecasting and identifying those therapists who aren’t compliant with their scheduling is often easily overlooked. Another example is using a waiting list for people who want specific appointment times to erase scheduling dead spots that happen with cancellations. Pointing out this type of “low-hanging fruit” is critical. A vendor will know these functionalities are there, but they are either being ignored by users or not being enforced by management. The best way to maximize the use of data and keep it from becoming overwhelming is for good communication between practices and their software vendors.
Heidi Jannenga: Data can be overwhelming when not presented correctly. But data is essential to bolstering bottom lines and effectively running a business. Thus, your software system should absolutely present data in a user-friendly, digestible, and accessible format. That way, you can use it to inform business decisions, marketing strategies, and employee management efforts. The software system’s support team should always be a phone call or email away to help better analyze the reports.