by Linda Scott, MSHA, RN
The one-two punch of PDGM plus COVID-19 is driving rapid evolution of the use of technology in home-based care delivery. The first radical change in reimbursement in 20 years, PDGM, was viewed as a significant threat to organizations' survival just last year. Then, within the first three to four months of 2020, COVID-19 forced dramatic changes where technology proved invaluable, and many organizations have felt the additional pressure to rapidly figure out new ways of managing patients without being physically in their presence.
The need for innovation trend has been developing since before home health providers first had to encode and transmit OASIS data 20 years ago. At that time, we relied on CMS to provide software for us to handle that transaction, and today, only a very small percentage of providers are still using the CMS provided HAVEN software. Even with the high percentage of organizations that have adopted more advanced EMR solutions, many have only incorporated variations of an electronic medical record, secure communication portals for staff/patients/referral sources, electronic education/training, and the data analytics/benchmarking tools available to them.
The COVID-19 pandemic continues to stretch our technology skills. The need to not be physically present with a patient has resulted in many agencies heroically and rapidly implementing variations of a telehealth program while still carrying on business as usual within their existing EMR. As post-acute care providers, we continue to evolve and survive amongst all of the changes and demands of servicing our patients/employees and referral sources remotely.
An August 2020 industry poll conducted during a webinar hosted by BlackTree Healthcare Consulting found that 45% of agencies responding had a 100% remote workforce, and 43% had some variation of remote workers and in-office workers. All indicated plans to continue remote work as a temporary or permanent option. Although staffing was noted as a primary concern by 42% of the attendees, the productivity and commitment displayed by the new remote team members have balanced organizational and employee satisfaction.
Billing is where the post-acute care market typically focuses on their use of technology, for the precise reason that it improves critical revenue cycle results. Ideal billing solutions have evolved to match information gathered at intake with the completed plan of care elements and generate an accurate bill format for the assigned payer all within cloud-based solutions. The added benefit of patient data available in real-time over a secure Wi-Fi connection to all care team members has enriched the ability to coordinate excellent patient care, but also requires a demand for new skills across our workforce.
To date, many agencies have assigned technical software tool management functions to an administrative staff member, topics such as telecommunication, internet access, a new user account setup for all systems, and essential helpdesk functions to name a few. It is potentially valid that if you employ a group of workers who were "born with a device in their hands," then the remote work scenario is more straightforward. Having used various technology for fun and education their whole lives, their fundamental understanding and comfort level with technology and software is often quite good. In comparison, staff members with fewer technology skills will have more challenges transitioning to and living in an electronic environment.
The administrative staff member may have the comfort level and understanding to adequately support a small group of remote workers. However, supporting a larger staff, with more diverse user needs, more complex network environments-branch offices, and remote work environments, for example, may demand higher skills and more hours. Applying the economic principle of "build or buy" helps guide those decisions through the lifetime of the organization. Knowing the strengths and diversity of our workforce helps with planning. Ranging from those "born with a device in their hands," who have used technology for fun and education their whole lives, to those with minimal exposure to our digital world, our workforce needs to be part of our execution strategy, and possess the skills required for the role we have them in today.
Certain operational activities, implementation of an EVV application with a large PCA staff, for example, may require a temporary expansion of the team. Outsourcing to firms or individual contractors is a flexible staffing plan to address growth, change, and the ever-necessary Plan B. Is that also the best plan A?
Transitioning to a higher tech environment reliant on digital processes and data analysis demands a human resource strategy that must define, source, screen, hire, and train for a different skill set. More focus on soft skills, like aptitude, willingness, a desire to learn and grow, the ability to reason and think critically, and openness to change becomes essential in an environment where accountability and nimbleness are critical. From entry-level admin to clinical staff to the CEO, everyone must be comfortable in a technology environment.
Beyond working to build a user community that is savvy of technology and possesses the adaptive attributes needed, the company will likely require some level of highly technical knowledge and skills. Even with the use of a Web-based EMR, where home health agencies purchase software as a service (SAAS), and there is no server to maintain or version updates to install and test, the agency still will need some in-house technical skills.
The review of vendor provided EMR updates and release notes, for example, and development of user skills ongoing, is key. Network management and security, telecommunication function, and various desktop applications, including operating systems skills, are needed. Equipment must be updated, needs change, and growth demands more devices, more applications, more remote users, and more information security challenges. Change is a constant, and the agency must possess or purchase the expertise to lead, drive, and support those changes technically.
The Human Resource strategy builds the use of technology into each written job description. Organizational skills, attention to detail, analytical and problem-solving skills in a collaborative team environment, and aptitude for efficiency and learning are some of the personal characteristics and skills agencies must seek in filling positions with the right staff. Up to date training, adapted to the user's level of learning, is needed to be able to maximize the return on the technology investment made. The use of data in decision making, including episode management and patient care decisions, must be demanded and demonstrated at the highest levels to guide the development of this philosophy.
A clinical team conference supported by summary information on diagnoses, functional limitations scores, as well as a thirty-day visit view, can proactively establish plans of care and goals that achieve great outcomes at a great value.
The integration of financial, clinical, and operational functions has always been essential to success in home health. Accessing information through a technology platform that links all patient data in meaningful ways for review enables understanding of your truth. With understanding of the truth, the facts generated by your data, the team can decide on any changes needed, and plan action. Our skill set has to keep evolving for success in this new paradigm.
About Scott Solutions
Founded and led by Linda Scott, this consulting firm specializes in home and community-based care. As an RN, Linda blends her clinical and executive management training and experience, bringing over thirty years of home care practice and a broad, strategic yet detailed perspective to her work. Medicare certified home health agencies, private duty providers, and individual families working to establish independence in the community are among those she serves. She can be contacted at Linda@scott-solutions.com or scott-solutions.com.
©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org