In a changing payment and regulatory environment, hospices are zeroing in on factors such as data collection, effective revenue cycle management and electronic medical record (EMR) interoperability. Providers that are leveraging technology to achieve these aims need to implement these systems carefully, including education for staff, according to Jennifer Maxwell, CEO and co-founder of Maxwell Healthcare Associates and a strategic advisor for the home-based care tech company Medalogix.
Medalogix is a portfolio company of private equity firm The Vistria Group. The hospice and home health solutions provider merged with Muse Healthcare earlier this year under the Medalogix brand.
Maxwell told Hospice News that she and co-founder Tom Maxwell launched their consulting firm in 2016 in response to increasing competition in the hospice and home health industries and an envolving regulatory and payment model environment.
Maxwell recently sat down with Hospice News to discuss the challenges lying ahead for hospice technology adoption and optimization, and how providers can stay ahead of the curve.
What are some of the most important elements for hospices to have in place to deliver the right care at the right time? Can you elaborate on that issue and what you see as common concerns?
It’s really about delivering the right care to the right patient with the right resources. Health care is going to be a continuous change of regulations, finances and patient demographics. I’ve been in the home health and hospice space for so long in business development and consulting, and I knew that there was a niche need for this care but didn’t know how to explain that need until we started getting further into what truly is a three-pronged approach. It’s people, process and technology for the future of health care. If you don’t have all three, then it’s like three legs of a stool — it’s not going to stand on its own.
Your technology should be set up appropriately as a kind of foundation for business operations. In working with home health and hospice agencies that report these kinds of problems, it’s often that they saw a technology solution, thought it was really great, but they didn’t really look at what their operations are today and how that will look differently with new technology in place. You can’t just put technology in place to fix the problem. You’ve got to make sure that it maps in correctly, it feeds the goals of the organization, and it has efficiencies within it so that from front field staff to the back office, it’s ease of use for everyone. The technology in and of itself is obviously expensive, but if you don’t have buy-in from your end users, the technology is not worth anything to your organization. You need to have the people involved in the process change, and have change management to be able to implement the technology appropriately.
What do you see as the biggest challenges that hospice providers face when it comes to technology optimization and operations?
Referrals, patient intake and admission, scheduling and eligibility are four key components that can break down any care for a hospice patient and create chaos for the organization. It’s making sure these four things are streamlined, managed and understood.
The billing component has raised regulatory scrutiny, as it relates to all the required documentation. The packaging of getting documents over for reimbursement is huge. At the end of the day patients are not going to be seen in a timely way if you’re not going to be able to bill them timely, it decreases your revenue stream.
We’re seeing a lot at the front end with high staff turnover. Recruiting and retention right now is a big challenge. Regardless of optimization on the whole, we’re just seeing a lot of agencies struggle with clinical staff and having to turn away referrals. It’s heartbreaking having to turn away a patient who needs care. How can we make life efficient for end users of technology within a hospice organization, and how do we help them recruit better?
When you think about interoperability and other technology that can bolt into their EMR, there’s some great tools and things that can help with redundant tasks and workflows that are required for agencies to see patients, bill patients and stay in compliance.
What would be your biggest piece of advice for hospices in terms of the key data pieces to monitor and analyze? How can they shape operational best practices around this information?
I would say staffing levels and patient census levels are important.
With census, it’s knowing your referrals and conversion rates. How are you getting in referrals? What are their visits per benefit period? If you’re taking in a lot of patients and they have really short lengths of stay, then you have capitation issues that you only get paid for so much per patient per year. If you keep that churn, then you’re not going to get the full benefit of that patient’s stay. You could dive into your cost per visit by discipline, and then look at your census, your length of stay, your conversion rate. There’s a lot of scrutiny in the documentation of patient stay in the last seven days, so ensuring that documentation is really good, watching your cap liability, and then leveraging technology to help you do more with less.
Robotic process automation is a huge deal, and there is a lot of that up and coming. Also, knowing the criticality of your patients based on using a monitoring tool that can rack and stack your least in need to your highest critical patient. Managing patients with the use of technology and optimizing all technology not just the EMR, but also making sure it’s feeding data to the clinicians, the medical directors, and everybody on staff to know exactly where that patient’s needs are today, tomorrow, and trending.
Using artificial intelligence functions to continuously learn that patient makes for better success for these agencies. Embracing the technology for the future is really the way we have to go to be able to care for more patients with less resources and do it with the highest level of quality that we can.
What are the largest hurdles on the horizon that technology could ease for providers?
You can use predictive analytics beyond patient care to know how your staff is performing. If you’re seeing their behavior change over time, what could you do differently to support them? Data can help to find out what their needs are.
Employee satisfaction is going to be huge for agencies to be sustainable within their budgets as well. If you think about the cost, some agencies have more than 100% turnover rate in certain areas and it’s a high cost to incur. It’s also really a competitive issue between agencies, because they’re offering sign-on bonuses and things like that to keep these clinicians and staff while the next agency is doing something a little bit different. At the end of it, when I’m talking to clinicians and those end users that are out in the field or in the back-office, it’s making sure that you have the right technology for them and make it easy to use. Be mindful about the technology that you implement, so that you have happy employees that are able to be at the bedside and be providing the care that patients need.
Also, it’s having a systematic approach to how you onboard, train, and teach the why behind the technology. It’s a continuous cycle, you don’t do it once and assume everybody gets it. This is continuous quality improvement to make sure that you’re meeting your employees needs.
How do you see the hospice space moving as far as interoperability is concerned?
I do see that we will tip the needle here within the next two to three years, and we’ll see some movement on all kinds of new legislation and ideas. The pandemic created innovation beyond what we’ve normally done. It’s sad to say, but there’s a great opportunity to see new and greater things happen, and even increase the quality of care that patients are receiving in their home.
You’ve got patients that love technology in their home that is helping them continuously be independent, but that is another burden of cost on the provider. There’s still some work to be done when it comes to telehealth and what we do with it and what remote patient monitoring and artificial intelligence devices we put in play. There’s a lot of companies that are really trying to get creative right now.
Interoperability is coming and we’re seeing more than just technology companies pair up with all of the EMR out there. We’re also seeing providers working and learning more about how to move upstream from risk-bearing entities. They want to monitor that patient journey before they hit home health or hospice and get data going both ways.
Companies featured in this article:
