Documentation by phone tunnels through Mt. Paper
More than $100,000 a year in savings expected
A large Boston agency found itself buried in an avalanche of paper documentation 8,000 pieces each week from home health aides. The mountain of paper caused problems with billing and payroll as the Visiting Nurse Association of Boston grew to an annual business of 2 million hours of home health aide service each year.
"We wanted to come up with a way to solve that, and through brainstorming we came up with an idea to provide telephone documentation," says Eileen Freitag, MBA, president.
That was three years ago. Since then, the agency has been using a computerized telephone documentation system that was developed jointly with Boston-based software company Logicon Inc. The agency’s 400 aide employees use the system, and soon all of the contract aides also will use it, Freitag says.
The agency’s goal is to cut five full-time data-entry positions at a cost savings of more than $100,000 a year once the project is fully implemented, says Fran Lorion, vice president of information technology and chief information officer for the Visiting Nurse Association of Boston.
"We will definitely be able to see the kinds of savings we anticipated early on," he says. "These include a decrease in data entry, a decrease in filing, and much stronger management control with regard to reporting."
There have been other important quality improvement benefits to the program, including faster reports and more precise documentation of aides’ work hours, Freitag says.
The program provides excellent documentation that aides are working the number of hours for which payers are being billed, she notes. The federal Health Care Financing Administration in Baltimore approved the system to be used for billing purposes, Lorion says. "And the reason we can do that is we can validate the actual location of the home health aide," he adds.
"From a quality perspective it really tells you who was there when they were supposed to be there and who was not, and there’s even a higher level of satisfaction among aides because chances are their paychecks are correct," Freitag explains.
Lorion says the quality of data has vastly improved with the aides who are using the telephone documentation system. "And the timeliness of the data is much better," he states. "We can report to management on those home health aides that are on the system within 12 to 24 hours."
This compares with a lag time of one to two weeks for those aides who still use paperwork documentation.
The system works this way:
• The agency sends patients an educational letter that explains how the aides will use their telephones to call a toll-free number for documenting the home visit.
• When the aide arrives at the home, he or she calls into the computer and punches in a code.
• The computer calls the aide back at the number registered as the patient’s home to verify that the aide is on the job. The computer records the aide’s identification code and the time the aide started the job.
• When the visit ends, the aide calls the computer and punches in codes for each activity he/she performed.
"We have everything we need to bill for the service as soon as the visit is complete," Lorion says.
The program’s main hitch has been homes without touch-tone phone service. But the agency soon will install a revised version that will solve that problem, Lorion says. The new version also will have caller ID so the computer can verify that the aides are in the right locations when they call in.
If the home doesn’t have a telephone, then the aide will complete the paper documentation using the old method.
Freitag says a quality issue arose when the agency first switched to the telephone documentation program. The aides’ reported hours dropped because initially they weren’t staying in the home for as long as they were supposed to.
So the agency had the program kick out a report for every visit where the aide started 15 minutes late or left 15 minutes early, she says. "So on a case-by-case basis, we could talk with the aide and say, You were supposed to stay 15 minutes longer.’ It became a good supervisory incident."
Since then the hours have rebounded to the correct levels, Freitag adds.
Logicon now sells the program, called Home Advantage, to other home health agencies. The cost varies according to the agency’s size, but an agency that wants to integrate the system with its existing payroll and billing could pay around $67,500 for the system. Smaller agencies could have access to the service without buying all the computer hardware by paying a per-minute charge, says Dave Sibor, director of health care systems for Logicon. Sibor says the latest version has been tested by several agencies.
Agencies could develop their own telephone documentation system, but Sibor and Lorion say it would be easier to buy an existing version.
"I wouldn’t recommend anybody do it from scratch," Lorion says. "It’s taken longer than we anticipated, and that’s caused some frustration."
Sibor says if an agency wants to develop its own system, it should work with a software company, rather than simply hiring a computer expert.
"Most agencies find out when they try to develop these types of applications that support becomes a problem," he explains. If the agency’s computer expert leaves after a couple of years, then there might be no one around who can fix future software glitches, he adds.
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