* ECPN * January/February 2001

Information Systems
Accucare Bedside Information System

Validate your reimbursement

Dawn Warren, Manager of Audit and Compliance, MaineHealth

In today's healthcare environment, those in the long-term care arena are taking the brunt of the effects of changes in the regulator system. This is not the intended outcome, nor is it necessary. The question is, "How effectively am I running this business?" Unfortunately, for those who have yet to learn, the key to success is proper documentation.

Documentation is the only proof of what the caregiver does for a patient who is unable to do independently for him- or herself. In long-term care facilities, shortages of staff, low pay rates, and lack of resources are every day occurrences. Very few facilities have the required staff or the internal motivation to maintain the return on the elderly investment. This is the business; the care is the humanity. Creating a successful business--although deeply intertwined with compassion for humanity --is the first step to success. The second step is to meet the mandatory requirements needed for proper reimbursement.

There are many downfalls within the system: inadequate tools to document the required information to support the billing practices; failure to educate those who input the data; and overwhelming pressure for the caregiver to provide the required physical service verses taking the time to adequately document the patients' needs. Healthcare providers are motivated people, but the requirement to document patient care is a business skill often lacking or hastily done. Unfortunately, this is to the detriment of the residents and the long-term care facilities.

There are dozens of documentation tools available for healthcare providers. Unfortunately, pen and paper are the tools of choice, though offering little incentive to do more than copy the last fifteen days of patient care. There are facilities that opt to have the nurse document patient care from descriptions provided by the aides, but this can create an end-of-day bustle to blurt out, "no change," so everyone can go home. There are also facilities that document patient care with minimal aide input; however, the details of these notes are probably minimal, as well. And then, there are the facilities that go all out to purchase high level technology that, while serving specific purposes, is overrated and over-complicated for the basic needs of the environment. During a busy day of patient care, who has time to learn and utilize the full potential of some of these high-tech documentation systems?

Accucare (Spokane, Washington) has recently introduced a documentation tool for capturing patient data in a self-explanatory, user-friendly manner. The tool provides the document-as-you-go incentive, with no end-of-day hassles, such as writing, coloring circles, or herding to the desk to give the usual report. The Accucare system is easy to navigate and simple to use. It has push-button options and user-friendly verbiage to report the mood, physical capacity, mobility, appetite, and current or potential sentinel events of the patients.

The Accucare system accumulates the data by patient, which then can be transferred to a host computer at the long-term care facility. Multiple reports can be run via the host computer by individual patient files to quantify the requirements of the patient and support the billing via the MDS vehicle. The host computer stores the information in the database, allowing access for creative reports, as requested by each independent facility. This is a real incentive. The Accucare documentation tool is a mobile, self-explanatory, use-it-and-go, documentation-capturing device with minimal time constraint on the long-term care clinician. Accucare gives the clinician the ability to capture patient data at the bedside, which enables the nursing staff to build the plan of care and recognize change in status of each patient.

Traditional pen and paper documentation methods often lack the useful information needed to support the level of care billed via the MDS vehicle. Often, the only legal document acceptable to any individual's medical insurance carrier (or family or lawyer or guardian) is the document written by the patient's caregivers. If nothing is written or inadequate documentation is provided, what can be assumed about a patient's care? If the documentation for a patient is "as usual" and the patient dies, why? If a patient's status at the long-term care facility is documented as "no change," why is the patient now in the hospital? These are valid questions and thoughts. Isn't it time to change the business?

It is unnecessary to allow much needed revenue to slip away when the actual care required for any one individual is far exceeding what is in writing at the end of the day. Numerous homes have used incentives, time banks, and other means to capture that much required information. The problem lies in the regulation verses the education. The governing insurers want the bill and the supportive documentation for a patient's care in writing--requirements one would expect from a mechanic who works on one's car. Just as there are a validation methods to check what the mechanic did to the car, there should be validating methods for the invoice the long-term care facility submits for reimbursement to support the care it provided for the patients. If the documentation does not exist, whether by pen or computer, the validation does not exist. It is time to look at your business and the tools you utilize to capture the data. ***

For more information on Accucare's bedside information system, call (800) 425-8487.

Ms. Warren has worked in the consulting and speaking capacity for the last fourteen years, providing on-sight trouble shooting analysis of issues and seminars on compliance in health care. She is the manager of audit and compliance for MaineHealth.