Nickels and dimes: The right way to collect data
Collect information you can benefit from now
(Editor’s note: In the first part of a two-part story, Home Infusion Therapy Management speaks with industry experts on the importance of data collection. This month, we’ll provide you with an overview of the benefits of data collection in the current marketplace. Next month, part two of the article will show you how one agency implemented a data collection system that is saving it money and helping it bring in new business. The agency also will provide a worksheet it uses to figure costs.)
When it comes to data collection, you’re likely asking yourself one of three questions: Why, why now, or where do I start? According to experts, few home infusion agencies are collecting extensive data for use in marketing and running their business, and there’s a good reason: It’s hard work. But nothing worthwhile is ever easy, and these same experts agree that even if you’re collecting outcomes and cost data, putting it to full use is the key.
Sure, you’ve survived this long without taking the task upon yourself. So why start now? The fact is, the industry is rapidly changing toward a cost- and outcomes-based system. If you’re not preparing yourself for the continued trend, you’re only falling behind.
Cost and quality at issue
In the current home care/home infusion environment, there are two areas for which you need a quality data collection system.
"The primary reasons are financial and patient outcomes," notes Joe Cabaleiro, the president of Excel Consultants in Cary, NC. "And the two are merging. You may have quality patient outcomes, but you need to know if another agency can achieve those same outcomes for a third of the price."
When it comes to attracting new business, particularly in the present capitated/managed care environment, he sees cost as the presiding focus.
"Managed care organizations are focused more on what’s your best price for a course of antibiotic therapy than outcomes," says Cabaleiro
Kathi Andrusko-Furphy, PharmD, president of Catalyst Information Resources, an independent consulting firm specializing in alternate site therapy, quality improvement, and outcomes measurement programs in San Clemente, CA, agrees.
"I don’t think we’ve gotten to the point where the clinical information is what they’re asking for yet," she notes.
However, that’s not to say patient outcomes should take a back seat. As the Joint Commission on the Accreditation of Healthcare Organizations implements it’s ORYX initiative (see story on ORYX, HITM, May 1997, p. 57), patient outcomes will likely share the limelight with cost concerns.
"As ORYX takes effect you’ll need outcomes that are better than other agencies, with fewer unscheduled re-admissions and fewer catheter complications,’" says Cabaleiro.
Andrusko-Furphy notes that costs may no longer be the issue in the near future, as most have already bottomed out. As a result, she anticipates managed care to turn more and more toward quality of care.
"As you move into the area of accountability for cost and quality, a lot of times, the only way to show quality of service is to document the progress of the care," she says. "If you had a goal, did you achieve it as planned, or did you achieve it with problems along the way, and if so, were the problems preventable or not preventable? What’s going to differentiate the providers in the next five years is going to be information, how they use the information, and it’s impact in patient care."
She also anticipates agencies doing a better job of sharing data with those within the organization who may benefit from it.
"Agencies often don’t stop to think how data impacts something as simple as if you’ve got a situation where weight is important, and nurses go out and weigh patients. Does that data get transferred over to pharmacy, and if it does, does the pharmacist do anything with it?"
For now, most agencies are simply collecting the data necessary to provide managed care organizations with the information they’re asking for. Although for now it’s predominately cost data, in the long run, you’ll likely also need patient outcomes data.
"I think it’s going to get down to who has the better outcomes and the lowest cost of care," notes Cabaleiro. "You have to understand your costs down to the nickel before you can take on a case, and I don’t know that many people are capable of doing that."
If you’re starting from square one, knowing where to begin can seem like a daunting task. Coming up with such data isn’t an overnight process.
"You can’t decide today I want to know how much everything costs’ if you haven’t been collecting data," notes Cabaleiro, who says he can’t emphasize enough the importance of not waiting until the last minute before you begin collecting data for outcomes or cost use.
Your first step should be figuring out what information you want to end up with, and work from there.
As Cabaleiro noted earlier, you may want to concentrate on costs if you’re looking to gain new business. And costs don’t mean ballpark figures. For cost figures to be worthwhile, they must include all costs of doing business and not those you come up with off the top of your head.
That’s the lesson Judy Lewis, BSN, president of Creative Health Care Services, a home infusion agency in Tempe, AZ, has for other providers.
"I was very good at looking at the cost of the drug, the cost of the nurse, the cost of the pharmacy, and all the products that went along with the therapies," she says. "What I was not capturing were all the general and administrative costs, and under capitation and tight cost controls, there’s no way we could have functioned that way."
New methods of tracking costs
She came to that startling realization three years ago when Creative Health Care’s largest client, CIGNA of Arizona, announced it intended to shift from fee-for-service to capitated bids. The announcement forced the agency to install new processes to capture cost information, changes that have been for the better.
Now, when Creative Health Care bids on a contract, it knows the price it quotes is accurate right down to the last expense. But getting there wasn’t easy.
"It was pretty cumbersome and difficult," says Lewis. "It was a lot of blood, sweat, and tears. None of us had been used to dealing with the minutia that are involved in making a very accurate cost analysis."
Such a detailed analysis, with the help of a consultant, required much more than simply looking at the agency’s books.
Lewis hired Frank Connell, the president of The Primus Center for Management Studies in Phoenix, whose background in the area of cost analysis for health care providers was put to good use getting the agency off on the right track.
"He helped me develop the internal tools to do the cost analysis, and then it just grew," she says. The process was not complex but did prove time-consuming.
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