Catch 22 Information Technology in the Long Term Care Industry Lisa Bembenick Jeff Gallagher AnnE Rice

“…the long term care industry has entered the computer age grudgingly--that is, slowly and with great difficulty.” Healthcare Informatics “Bankruptcies among the skilled nursing providers reached an alarming level today as post acute provider IHS filed for Chapter 11 protection, bringing the total number of bankruptcies across the U.S. to 1,651 nursing facilities.” American Health Care Association

The Problem Unsophisticated data collection tools Lack of decision support Lack of cost analysis tools Inability to conduct electronic transactions Linking of clinical data with financial and statistical data, and Capturing unique clinical data--Minimum Data Set (MDS), outcomes, and clinical care plans

The Problem, cont. Industry history of minimizing IT investment –1% of LTC operating budgets on IS Major healthcare vendors have stayed out of LTC LTC vendors have historically been under capitalized –no frills software

Driving Forces of Change Government –Medicare PPS Complete MDS to determine RUGs –HIPAA Standards to facilitate electronic data gathering and e-commerce

Driving Forces of Change, cont. Managed Care Payers –Low penetration of LTC market (1%) –LTC facilities need to provide cost data –Utilization and outcome data –Case management

Driving Forces of Change, cont. Clinical Care Givers –Comprehensive care plans to include: Interdisciplinary admission assessments data analysis to formulate resident-specific problems and measurable outcomes individualized interventions based on clinical protocols evaluation of outcomes and revisions to care plans

Industry Needs MDS PPS billing requirements Automated care plans Case-mix management Quality management Integration of financial and clinical data

Vendor Solution CARE Computer Systems –strategic alliance with SMS VistaCARE product –Clinical Application –Financial Application

Vendor Solution, cont. Strategic alliance is a positive sign Meets minimum industry requirements –MDS, Care Plans, PPS billing, etc Lack of integration between clinical and financial modules Additional development needed for Managed Care –For example: Contract/Credentialing