Becoming higher tech starts with right questions
Becoming higher tech starts with right questions
Here are four steps to take before starting
Many practices undergo a computer conversion hoping to achieve enhanced efficiency and productivity for their billing systems. With the right system, that means a little short-term pain for long-term gain, says John Hayford, vice president of the Fairfax, VA, health care consulting firm Virginia Health Care Consultants.
Failing to appreciate the need for adequate planning long before you sign on a vendor’s dotted line can have disastrous consequences. Hayford has come up with four questions you should ask before undergoing a computer conversion. If you answer these first, you can make informed decisions and avoid unpleasant surprises.
1. What features do you absolutely need from this new system, and what features can you do without?
To get the most bang for your buck, conduct a "needs assessment," says Hayford. Gather input from as many personnel as possible who will be affected by the new computer system — everyone from the providers and managers to the staff who enter data and analyze reports generated by the system. Allow everyone to come up with his or her "wish list" for what functions they’d like the new system to provide. The more people you involve in the planning process, the more they will feel personally vested in your conversion. For example:
• Administrators are interested in specific reports with customized formats.
• Providers may want a built-in medical record that defines codes and charges.
• Data entry personnel are interested in concise, simple screens.
• Schedulers may want a computerized appointment module.
• Billers need insurance data profiles that are easy to access and import, and simple functions for generating electronic and paper claims, as well as patient statements.
• The system needs to be able to perform multiple functions by various users simultaneously.
2. What is your budget for this project?
When considering a new computer system, keep in mind that the cost of a new software package may be only the first in a series of events that necessitate further spending, Hayford says. Beyond the cost of the basic software itself, be prepared for potential added expenses, including:
• additional or different cabling, plus labor;
• additional telephone lines, jacks, and modems;
• a different operating system (DOS, UNIX, Novell, NT, etc.);
• upgraded hardware (many new systems require more memory and bigger hard drives);
• additional terminals;
• licensing fees;
• training;
• software support maintenance agreement;
• technical support maintenance agreement;
• future upgrades;
• additional "modules" that perform scheduling, accounts payable, or word processing functions.
Sometimes, it’s easier and cheaper to keep some functions separate on personal computers, rather than buying an "all-in-one" package. One of Hayford’s clients discovered that its old computer’s internal e-mail, word processing, Internet provider, and other software were not part of the new system. The client mistakenly thought those items could be "loaded on" without recognizing the implications of operating systems and software licensing restrictions. So be sure to select the features that you truly need, and plan carefully.
Hayford says you also should give some forethought to the configuration of your new system in terms of the location of terminals, cables, printers, modems, phone jacks, etc. Evaluate whether your office can accommodate the new system without the need to drill through walls, route cables over ceilings and across hallways, or other costly "improvements." You may want to obtain the expert opinion of a computer hardware expert or ask potential software vendors to perform this assessment for you. Be wary of a salesman’s assurances that there won’t be any problems.
3. What is your expected time frame for the entire conversion process?
Adequate time must be allotted for evaluating software packages from multiple vendors. "It’s critical that you and your staff be able to verify the capability of any system you may purchase by having each vendor arrange a working demonstration," he says. "Invite personnel to attend who will actually use the product so that they can see how well it measures up to their initial wish list." Everyone should be able to judge the software’s capabilities, strengths, and weaknesses for themselves. Think in terms of putting each product through a "test drive" that addresses the key system requirements for your organization, beyond the vendor’s standard sales script.
It’s helpful to develop a formal evaluation tool or checklist for comparing products and vendors on the criteria most important to you. During your evaluation, contact other providers that have made a conversion or currently use a product you’re considering. Ask for their impressions, both positive and negative, of the product as well as the vendor, both before and after the sale. Be sure you talk to the people who actually use the product on a daily basis, not just those who selected the system or signed the check, he says.
Once you choose a software package that best suits your needs, insist on a line-item contract so you know exactly what you’re getting. This contract should encompass all of the budget-related items discussed previously (customization, installation, cabling, training, upgrades, ongoing support, etc.). Check to see if the contract specifically addresses licensing arrangements, which usually carry extra costs and protect you and the vendor from future conflict. In the case of any "extra" items, demand an amendment or addendum to the contract so you’ll have recourse in the future should you need it.
For billing systems in particular, Hayford says it’s important for your office to clean up or clear out as many of the accounts receivable as possible from your old system. This should be done well in advance of implementing the new system. The more accounts that are purged, the less total data you’ll have to convert to the new system. You’ll need to make a determination about how much of this will be written off as bad debt, and then do so before the conversion, he adds.
"Also, if you haven’t done so recently, update your CPT and ICD-9 codes before changing to the new system. Your goal in all of this is to minimize extraneous detail so that you’ll only convert data that is pertinent to the new system," he says.
Your conversion project time line should include arrangements for your staff to receive focused training. "Focused" means hands-on with minimal distractions, Hayford says, "preferably not at their work stations during normal business hours." In the ideal world, you’d be able to close out the old system on a Friday and start with the new system the following Monday. Unfortunately, things never go quite that smoothly. Consider the possibility that after training is completed, you may need to run "dual systems" temporarily as your staff transition from old, comfortable routines to the new, improved, and unfamiliar system.
4. Do you have any other options besides converting your computer system?
You certainly can keep the system you have, provided you can accept its limitations and you know that upgrades will be available if you can’t. In particular, be certain about your system’s Y2K compliance. Alternately, it may prove worthwhile to consider outsourcing your billing functions. To make an informed decision, perform a cost/benefit analysis wherein you consider the expenses related to the recruitment, skill level, training, and retention of staff, as well as the substantial investment in hardware, software, periodic upgrades, and maintenance agreements, he says.
Remember, money management is the single most important aspect of the business side of health care. Your practice’s financial success profoundly impacts your ability to deliver cost-effective, quality patient care.
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