Home Care Software Solution: What You Need to Know to Choose the Right EMR with Kristen Duell
Choosing the best home care software solution, an EMR, is hands-down, one of the biggest decisions an agency will make and it affects everything from daily work flow and documentation to billing and posting payments.
Whether starting out or looking to change EMRs to something that has progressed and will meet your needs, this blog will give you the questions to ask and points to ponder.
This piece was taken from an interview with Kristen Duell of Kantime and two of our home health billing specialists.
You can listen to the full interview on the Home Health Revealed Podcast, episode 3. Kristen is the executive vice president of sales and marketing who oversees the marketing and business development team at Kantime.
Kantime may be the number one software solution for enterprise software across the post-acute care market from hospice to home health, to home care, to therapy and palliative care.
If you want to speed up the process of choosing a home care software for your agency, you can discuss this important decision with a revenue cycle management expert for free by clicking here.
What is an EMR in home health? What should agencies look for?
It’s becoming more rare that you run into an agency that doesn’t have a software solution or doesn’t have experience with a software solution in this day and age. It is the single most important decision that an agency is going to make. So make sure that you really understand what it is that the EMR is going to do for you and make sure that it’s going to fit your needs and your organic or your acquisitional type growth.
It has ramifications that can really determine the level of success that your agency is going to have, and the care that your patients are going to receive. So make sure that not only is it user-friendly but that it’s adopted and that it’s able to document and also flows all the way through to billing. That is what’s going to differentiate things for you and it’s that payer diversification piece.
Many agencies come in and start looking for a particular segment or a specific payer. As you grow within this industry, and as we’ve seen it evolve over the last 17 years, you have to diversify your payer sets in order to really stay relevant and to provide the care for the patients in your neck of the woods.
You need solutions that are able to scale with you. This is where agencies have fallen into some major challenges because they select solutions that meet their needs initially, whenever they’re first starting out or they’re focused on a niche area market, but it’s not a solution that’s going to be able to scale with them.
And if it is a solution that says that it’s able to scale, you sometimes still run into bumps and bruises because of how they’re actually executing on that scalability.
Do you know how often most agencies are with a particular EMR?
Well, that’s a good question. I think what we see is whenever you sign up with an EMR, because it is a significant cost for the agency, they stay with it up to four or five years, at a minimum. Just to be able to get your ROI back and just because of the pain and the challenges that it takes to implement all of that change across large organizations.
This is a four to five-year decision. It’s not just a one to two year decision and if this doesn’t work out, let’s move somewhere else.
What are some of the things that agencies forget to look for within the functionality of an EMR?
It’s really interesting because a lot of the leads and opportunities that come to different electronic vendors, whenever you’re doing the searches, and whenever you’re really looking at how they arrive at your doorstep, it’s usually because of a symptomatic problem.
It’s not just because they want to find a new EHR or EMR, right? It may be because they need something that’s more user-friendly or to be able to easily schedule. They need to be able to integrate with their XYZ partner. It’s those types of things that start the thought process of dissatisfaction with customers.
It’s [questions] like who has good customer care or, who’s got this piece on EVV that’s able to meet the regulatory requirements. And then that really is what starts the process for them of realizing there is a bigger problem. It’s not just, I need to find a way to integrate X, Y, and Z. I actually have a massive issue here that could be resolved if I just change out my, my one vendor, my EMR, and find somebody who’s better fit for the purpose.
And some of the biggest sales that I’ve made in my career have been from opportunities coming to us and sayin, “Hey, I just need to solve this one little problem.” They were like, I’m not interested in buying the full thing, but low and behold, what they actually needed was the full EMR.
Are there certain home care softwares that are better in different states?
It really does depend on what your payer mix is. Medicare can be similar across state lines, but that can be different for somebody that’s servicing unique private payers, private duty, Blue Cross Blue Shield, Aetna or Medicare advantage, or if they are servicing Medicaid.
If you know, one state, you know, one thing, right? That’s the old adage there. So really make sure that you actually choose an EMR that is able to handle all of those needs. That’s a very important part of the due diligence process that agencies have to do. And you really do have to ask those questions because if you don’t ask them, then assumptions are made and, you know, a lot of vendors won’t come clean with the fact that maybe they don’t have everything built out for the state Medicaid program that you’re needing it for.
So really making sure that you get down to that level of detail is very important. So you mentioned some regulation issues, and I know as agencies are getting into electronic medical record systems, and a lot of the questions that they’re going to have are around training and types of support that they can expect from an EMR.
What training and support are needed when adopting a new EMR system?
That’s another really important one. And it might actually be the most important part of rolling out an EMR: setting the tone for how it’s going to get rolled out.
Who’s going to get trained? Definitely don’t make assumptions during that process. It’s a two-way street. It really is. A lot of agencies will come on board athey need to teach one person, then they’re going to roll out that information.
So making sure that you ask all of those questions about how that will be executed is critical. But the best recipe for success is whenever you guys partner together. Do you have a dedicated project team on both sides? Have expectations that are clear on what your go live needs are, what the regulatory requirements are for those go live needs.
One of the competitive advantages that Kantime really brings to the table with this is our onboarding portal that we’ve developed ourselves. It’s interactive and it’s within the database and it allows agencies to really be able to enter the data within their environment and follow the task plans to be able to see who’s responsible for what and where things are left. So solutions and tools that are going to help you and support you at being able to go live, that’s absolutely important. But at the end of the day, I think we can all agree that it boils down to excellent communication and expectations.
Is it worth the investment for an agency to do an onsite implementation versus a remote implementation?
It was by far, a way, way better experience for them and for the vendor and that relationship [to do an on-site implementation] than if they did it remotely.
What type of experience have you guys seen in those two examples?
Without a shadow of a doubt. I agree that you can accomplish a lot remotely. And I think if we learned anything from this past year, we learned that lesson that we can do a whole lot effectively remote, but that when given the option, in- person is always going to be more beneficial and effective, because just from a human nature perspective, we thrive and do better when we’re collectively together as a group.
You’re able to ask questions, you’re able to see people’s reactions. You’re able to catch the side conversations and are really able to help people work through the challenges that maybe they’re not voicing during a robocall.
This is an important decision. This is an important rollout so make sure that all of your people are not getting distracted and questions are being answered. It might be a little bit more costly to have on-site training for the whole thing, but that’s hand over fist on what the return is and the level of success.
What should agencies be looking for with respect to work flow?
An area that agencies have always struggled with is recruiting talent, right? And the clinician is such a big portion of the agency. And a lot of agency owners want to make sure that the software is really good for clinical documentation. Because if it’s good, they can go out and see more patients. And the system flow works really well.
With the labor shortage, as it is right now, reaching devastating lows and the impact that that’s having across the board with our industry, this is very real, very serious. It hasn’t happened in over 50 years to be in the situation where we are just, from an economic perspective and labor shortage perspective across the board.
So make sure that you’re making a decision as an agency that isn’t going to upset your clinical staff and have them leaving to go somewhere else. That should be everybody’s number one priority. From a solutions perspective, you want to make sure that obviously you’re able to bill and pay. You can’t sacrifice either of those so the solution should be designed in a way that’s going to enable your clinicians to have the best of both worlds.
To mandate somebody to use a solution is pointless if it’s not user-friendly. Having a system that prompts them to do it right the first time and really manage the job, those are key pieces to making sure that the clinicians work life stays in balance and they’re able to drive successful billing, for revenue cycle management, which I know is near and dear to HealthRev Partners.
And one of the differences with how our system is set up is in the backend.It’s done and configured correctly in the backend so that the clinicians don’t ever have to worry and they can deliver and provide care and document things so that it’s captured within the system and that everything triggers appropriately.
What do you mean when you refer to the “back end” of the solution and why is that implementation piece important?
You see a nice product. You want to purchase that product. You want to use that product but it doesn’t just come ready to roll.There’s work that has to be done with the solution. It has to be configurable. You’re able to configure all of these different payer rules in the back end, which is done through your implementation and your rollout, where we do a discovery phase.
In the discovery phase, we’re really understanding what your payer rules are, what the regulatory requirements are, and we’re configuring it with you and showing you how to do it so that you can maintain it and go forward as you add new payers. That’s so important in the beginning because the clinicians, whenever they start using the system and entering new census and patient data into the system, they’re not having to make decisions on what the payer requires from either an authorization or an order. It is going to automatically prompt them to enter the required fields and the required data.
Kantime does a great job with that. HealthRev Partners sees so many companies that are struggling with billing and it’s really a direct reflection of their EMR and how that is set up. We talk with people all the time about having the proper setup. Within their payers, making sure all that is set up the correct way, flowing through the EMR, the correct way.
Tell us a little bit more about how important online training is as you continue to grow.
After you’ve rolled out a solution, it doesn’t stop there. You’re going to continue to hire people. You’re going to continue to expand your organization. Hopefully you’re seeing new levels of success in your acquiring or you’re organically entering new markets. You’re going to have to bring people up to speed or you’re going to have turnover.
The age-old problem that we’ve had is recruitment and retention. Kantime produces a university and an e-learning site that we keep up to date with every single one of our releases, where there are interactive videos, notes, and there’s also, e-learning, which takes you through and allows the users to actually practice doing XYZ process like entering a new order, entering a new authorization, an Oasis documentation form – all of that is within a test database so that they can see it and it also goes through a graded process. So then from a leadership perspective, you’re really able to see that a person has it. That’s a very important piece of this ongoing education and interaction that you can have with a solution.
Can you talk a little bit about the importance of data in relation to agency decision-making?
One of the things that I really find enjoyable is the data. So when you’re an agency owner, you want to see that big picture perspective and you want to have something that’s a little more objective to help you drive your decision-making. EMRs can really help agencies leverage that decision-making process with data. Data is only as good as how you use it. Everybody has always talked about big data. The reality is the user-friendliness and actualization is what allows you to dive in and make it meaningful.
A lot of agencies have felt that technology has really fallen short on that. So it’s been a big emphasis to not just provide you with data, but allow you to drill straight down into invoice level and see what’s holding a patient up or what’s holding the process up or where are we missing clinical documentation?
From a usability perspective, and as an end user in the system, data that you can drill into and click all the way to the lowest level of where that data resides and resolve it right then saves you so much time rather than having to click and point and go elsewhere. There’s also the Data as a Service, in addition to the data that is provided with the software, so if you have a very large organization that has multiple locations and multiple states and you have a C-suite somewhere else or a franchise, being able to roll that data up, to be able to see, which locations, which regions are doing well and be able to make different decisions based off of that, and being able to slice the data any way you want is valuable.
What advice would you give an agency to ask the right questions so that when they’re looking for an EMR, they’re not deceived?
I do want to say that I believe that as an industry and even speaking on behalf of not only Kantime, but my competitors, I believe people are getting better about this.
I have hope that those tactics are in the past. And that they’re far and few between, I hope, but you can’t, you know, Hope Is Not A Strategy. I love that book. As an agency owner, and as an executive in this industry, you have to do your due diligence.
Making these decisions and purchasing solutions and rolling them out are the ones that have really done a great due diligence. If you’re able to, watch a lifecycle example from start to finish, following a specific patient through the entire process. Walk all the way through A to Z with the patient and the caregiver and see the billing and see the payroll get ready for processing and how that export happens and really walk through A to Z. It’s easy to lose the breakdown of the workflow of how you arrive in a demo. But if you’re able to watch a lifecycle of one example or multiple examples, that’s really going to help you be able to visualize and see that this is something that is really going to answer all of those needs that you have as an agency.
How many demos should an agency go through and who should the agency bring in to see a demo?
It’s quality over quantity because I think if you go into quantity, the agency gets numb.
The vendor can get redundant. It’s our job in sales and marketing to do great discovery and discovery isn’t one event. Discovery is a series of events where we’re understanding the challenges, we’re understanding the business case, and we’re understanding the payer mix that you guys have. Make sure that you’re working with somebody that has taken the time to get to know you and what your problems are.
Secondly, bring the correct people to the table. Don’t make decisions in silos. It’s not good for the business. It’s definitely not good for your job. It makes sure that you as an organization are making an effective investment.
Surround yourself with all of your specialists, making sure that they provide their insight and that you are documenting their feedback. That is going to really help you be able to make a more effective decision.
What are the top three questions an agency should ask an EMR company when they’re in a demo or even before they do a demo?
No software is perfect.
Foundation is first. The foundation of your solution. Super cheap may look pretty good but don’t overlook asking all the right questions and doing your due diligence because of price. And even this applies for the monsters out there. And I mean, the monsters that have been acquired and are acquiring all these different solutions and they’re building this Frankenstein product of all of these different pieces, it might be really easy to make an assumption on those.
Questions like am I able to have multiple time zones in my database? Am I going to be able to bring in different payers? Don’t only trust their marketing slick. Really dive deep and make sure that those things are true because you might find yourself quickly in a situation where all of a sudden you realize they don’t handle west coast time zones, or it wasn’t, it wasn’t built that way because it started out as a small solution.If you buy a solution that’s not reading the time zone for them and when they print off their schedules, they’re going to have mix ups across the board, it’s going to lower patient satisfaction across the board.
So understanding those pieces and payer mixes. Are they able to really handle it from a configuration perspective and get those questions out? That is probably the first one.
And then the next is going to be people. Who are you as an organization? Who are you working with? What does your leadership look like? What do your rollout plans look like? How are you going to support your customers? Get the references because that’s a really great indicator of how healthy that organization is and how healthy you will be as an organization.
How Does Price Measure up? Cost Versus Value
There’s definitely a difference in what it costs and then what the value of it is. I love to negotiate! Good negotiating is a fun pastime in my house but the reality is if you’re whittling somebody down to a price point and that’s what’s important to you, you’re going to pay for it somewhere. Value is where it’s at. The value of what you’re trying to accomplish.
We found Kristen’s candid conversation with us to be so insightful, honest and just down-right useful! When it comes to choosing a software, she broke it into three main considerations, (1) foundations, (2) people, and (3) strategy.
Consider the foundation of your software.
Is it a “Frankenstein”, pieced together software? Or does it have a foundation that can be built upon and grow with your agency and support your growth strategy? Choose a solution that can not only meet your current needs, but one that has the capability of growing along with you.
Bring the right people to the table.
Know your people and bring your experts to the table so they can ask the questions, give insight and provide feedback for function, implementation, and usability of a software.
Know the Strategy.
Where is the agency going? What does the path look like? What is the mission? What brings them here today and where are they going to be going tomorrow? If you can get those things answered, then that’s going to allow you to ask questions about the functionality of a potential software to better know if it is right for the future of the agency.
The cost of a software doesn’t necessarily equal the value it can bring. Consider the value a software can bring to the agency and whether that value is greater than the cost.