With last month's competitive bidding delay, the home medical equipment industry has dodged another bullet — at least for now. But does that mean providers should spend any less time analyzing their businesses to keep tabs on costs or to see where any hidden efficiencies might lie?
The answer, of course, is no; there are plenty of other things to worry about, rising fuel costs and continuing questions on oxygen reimbursement among them. Technological innovations that can improve the way your business operates are more important than ever and, in that spirit, HomeCare asked some of the software and technology companies seeking your business what questions they most frequently receive from you.
Keeping in mind that they represent only a partial picture of the products that are available, and realizing there are questions that will be application-specific, here are (in no particular order) the most common general questions these companies say they hear, along with their answers.
Q: Where do I begin?
While the seemingly endless options available in the world of technology are certainly a blessing, they can also be daunting. Given all of the possibilities, how does an HME decide which avenue to pursue?
Spencer Kay, president of Fastrack Healthcare Systems, Plainview, N.Y., tells HMEs to take a look at their operation as it is “right now” to see where technology can help. Find the most labor-intensive functions, like order entry, customer service or routing delivery drivers. “A lot of companies have too many people doing the same kinds of tasks,” Kay says, a situation that business management technology can help them improve.
Berkeley Heights, N.J.-based Authentidate also gets the question about where to begin, says Seth Loonan, the company's director of marketing. More often than not, he says, it comes from small- to mid-size providers who either have had a bad experience on the systems side or may not have automated at all.
“We typically tell them that you can't always tackle everything at once,” Loonan says. Not any one system — even his own — does everything for everybody, he says. “We tell them to look at the important parts of their workflow and the important parts of their paper cycle to see what's not working … and to try to focus on the system that will solve most of those problems most cost effectively.”
Kay says HME companies looking for new technology also tend to focus too much on billing. “Billing today in this world is simplistic,” he says. “Sending out a claim electronically, getting back an electronic remittance notice — all of that today is really very common and simple. For the most part, all the software companies do it.”
According to Kay, providers should also look at what functionality a software product can provide to the entire organization. Noting that HME is an inventory-intense business, he says inventory and delivery operations are where the costs are high and major inefficiencies can be found. Since HMEs are really about providing equipment, it's kind of a contradiction to focus on billing, he says.
“It sounds obvious, but when it comes to buying software, I'm not sure most people see that,” he says.
In addition, most companies don't make the most of the technology they already have, notes Edward Kutt, president of Diabco Medical Billing Systems, Delray Beach, Fla. “We have people that have been using our system for years and that don't utilize all of the features,” he says.
Diabco saw a recent flurry of interest in bar coding, a feature that was already a part of its offering. “I guess people are finally realizing that they need to find more ways to automate the things that they do,” says Kutt. “The systems are feature-rich, but users don't always take advantage of the existing features.”
Q: Should I select an Internet-based or a server-based software solution?
These days, providers have a wide range of choices, from specialized software that gets loaded onto the company's in-house equipment or a soup-to-nuts Web-based system. And according to Ed Bauer, sales manager for Deerfield, Fla.-based Noble House, figuring out which best suits your company's needs is critical.
“The question of a server-based system versus remotely-based software and database (ASP) is paramount in determining the choice of software,” he says. “For either of these solutions, PC hardware, printers and scanners, networks and high-speed access to the Web is required. Remote access to program and database can be achieved with either of these solutions.”
Companies also want to know what features they should look for, Bauer says. The answer? “Today's DME provider requires comprehensive, integrated software,” he notes.
“Features such as electronic claims submissions, automatic ERN posting, inventory control, automatic generation of recurring claims, denial management, document management and integration of data with other software products are all critical. The software program must also be intuitive and easy to use.”
Essential as well, says Bauer, is a software developer with a viable technical support function so that questions and problems are resolved quickly. “A provider's primary concern must be optimal service levels for their patients and therefore, increased sales and profits.”
Q: What do I need to buy, and how much will it cost?
Authentidate's Loonan identifies this as the top question his company receives.
According to Loonan, it's sometimes hard for providers who aren't “techies” to understand that with systems like his (SaaS), a secure Web server “fulfills all the things HIPAA and CMS need and want. They still ask the common question, ‘What do I need to purchase — hardware, software?’”
“The deepest we get technically into that is they need high-speed Internet of some kind — some type of broadband model, or pretty much anything that gives them faster [service] than dial-up — with an Internet browser … and that's all they need,” he says.
Scalability is another question in providers' evaluation process that frequently comes up, Loonan notes. “There are a lot of mergers and acquisitions in this marketplace. [Companies] can grow and shrink and add or delete locations … so people are concerned about that.”
With traditional software, the experts note, what and how much providers have to buy is dependent on systems and hardware the company already has — or what it doesn't. Needs range the gamut, and providers must ask their own questions here.
Loonan says the bigger question most providers have is how much money they will need to spend, but that, too, depends on the type of software or system they choose, what they want it to do and all of the company's individual circumstances.
“It's important for the little guys and certainly for the bigger guys because they may have a lot of workstations they've got to worry about deploying,” he says.
Q: How do you handle electronic exchange?
Gary Long, vice president of sales for Duluth, Ga.-based Brightree, says his company hears mostly about problems providers have with claims submissions. He says providers want to know, “Do you send electronic claims to XYZ payer and how do you do this? Do you also receive electronic remittance back from the payer and load it into your system?”
After enrolling your business to submit electronic claims, his system batches and sends those claims to the payer electronically while also keeping a record of that transmission, Long explains, adding that electronic remittance has been part of the system “for years.”
Authentidate's Loonan says HMEs also frequently ask whether systems can handle fax and/or electronic exchange as a hybrid.
Because there is still a lot of resistance on the physician side to stay with fax, this can be a big concern for HME companies. After all, he points out, “that's where they get 90-plus percent of their referrals.”
Q: What about reports?
Kutt says Diabco's No. 1 question concerns reports — HMEs want to know how to get, change and modify them, and write new ones. “There's a wide variety of different reporting,” he says. “We've dealt with it by including a report designer in our system.”
It takes training for people who aren't computer-oriented, Kutt observes, but the functionality is there. “With a little training, a lot of our users have gone way down the road and have completely done a lot of new reports for themselves.”
According to Ken Pereira, CEO and founder of Health Automation, Cranston, R.I., his company, too, gets this question often. Providers “aren't looking for canned reports when it comes to the big picture,” he says, noting that detailed data analysis is the company's most requested offering.
Larger providers in particular — those with multiple sites and business lines — “want to evaluate their businesses on their terms and get a picture of the current health of their organization right now,” Pereira continues. “They want to know the value of all stock in all warehouses at this moment … Business is in real time, so they need to know what is happening now, not a month from now.”
Q: Will the software reduce my operating costs?
“That seems to be a big issue,” says Fastrack's Kay. “What functionality can you provide in the software that will help me be able to accomplish more without having to hire more people, and at the same time, grow my business?”
This is particularly relevant with the continuing prospect of competitive bidding, Kay says, as providers of all sizes are becoming increasingly conscious of costs.
Authentidate's Loonan says HMEs also frequently ask his company whether or not its system shortens approval cycles and reduces unbilled revenues.
In investigating and investing in technology, he says, providers are “looking for cost justification,” and many are focusing on workflow.
Wayne Bailey, director of marketing and sales for Bonafide Management Systems, Thousand Oaks, Calif., says his company often gets questions about documentation forms management. People want to know if there is help for CMNs and other required documentation that can “automatically create and populate with correct data, automatically track ‘where and when’ the forms are and automatically track ‘when they expire,’” he says.
Q: Are you a software company?
Not surprisingly, this is the question most heard by Memphis, Tenn.-based RemitData, says the company's Michele Story, director of marketing. The answer to that question is “No,” she says. Rather, the company offers Web-based productivity tools and benchmarking that can compare a provider's performance to that of their HME peers.
Another question providers ask when looking at technology to help increase efficiency, she says, is, “Doesn't my billing system already do this for me?”
While billing systems can generate reports, Story says, those reports come from data that is already in providers' billing systems. RemitData “takes the raw ‘payer files,’ called ANSI 835 files, stores them in a database and produces reports and tools on this data,” she explains.
“This is not to say that your billing software is no good!” she emphasizes, pointing out the company's customers work with a number of different billing software vendors.
But when they are looking at areas like denials and underpayments, cash flow, collections and workflow, Story notes, providers today are on the hunt for technology and data that can help them better manage their business.
Q: How fast can I get up and running?
Lorraine Lodigiana, business development manager for Dynamic Energy Systems, McKinney, Texas, says this is one of the most frequent questions her company receives from HMEs, and it's something that deserves consideration. How much down time, if any, will there be for the business, and how much training will be required?
Providers want to know about “implementation, including training, configuration and consultation,” she says.
“With all the changes in the industry,” Lodigiana continues, providers are looking for technology “partners” to help them grow their businesses.
Q: How can you help?
“We find that many of our requests from clients and prospects mirror the growth and direction of the DME industry,” says Healthcare Automation's Pereira. “Much of what we have experienced lately is a reflection of increasingly sophisticated needs, due both to regulations and the need to stay competitive.”
Providers, he says, “are looking for ways to grow their businesses while cutting costs, all while staying current with the regulatory environment and industry trends.
“They are looking for sophisticated information tools that can answer the questions they have every day: How can we be more efficient? How can we track inventory effectively in multiple warehouses? How can we grow, both within our market and into additional markets? And how can that growth allow us to develop economies of scale?”
These are questions that today's technology can help to answer, Pereira says, because its abilities allow providers “to make business decisions now that will impact their bottom line tomorrow.”
Terms to Learn and Things to Think About
ASP - An application service provider (ASP) is a business that provides computer-based services to customers over a network. Software using an ASP model is sometimes called “on-demand” software or “Software as a Service” (SaaS). The need for ASPs has evolved from the increasing costs of specialized software that have far exceeded the price range of small- to medium-sized businesses. Through ASPs, the complexities and costs of such software can be cut down. In addition, the issues of upgrading have been eliminated from the end-firm by placing the onus on the ASP to maintain up-to-date services, 24×7 technical support, physical and electronic security.
SaaS - In the Software as a Service model, an application is hosted as a service provided to customers across the Internet. By eliminating the need to install and run the application on the customer's own computer, SaaS alleviates the burden of software maintenance, ongoing operation and support. Conversely, customers relinquish control over software versions or changing requirements; moreover, costs to use the service become a continuous expense rather than a single expense at the time of purchase.
Source: Wikipedia
Make a List and Pile on the Questions
If your HME business is like most, according to Jay Williams, national sales manager-HME, for QS/1 Data Systems, you've probably got technology needs that are completely different than those of your competitors. That means you'll need to do your homework and ask the questions that make sense for your individual company.
But for starters, he says, you can begin with the four basic categories of questions that most everyone asks. Here's Williams' breakdown:
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Who are you?
This is really an important question, Williams says. “A company may offer a great software program, but if the company is not stable, you could be stuck with a program that might disappear.”
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Tell me about your company.
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Why should we pick your company over another?
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How long have you been in business?
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How long has your HME program been on the market?
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How many employees do you have?
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How many locations do you have? Do you have an office near me?
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Have you ever won any industry awards or recognition?
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How can I know that you are going to be in business next year? (“This question is especially [relevant] with all the changes that go on in the HME industry,” Williams says. Providers should ask why the company — not just the software — is the best.)
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How many training and support employees do you have for your HME product only?
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Is your programming staff located in your offices or somewhere else? If somewhere else, is it U.S.-based or overseas?
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Do you develop your own programs or do you contract them out or resell someone else's programs?
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How is implementation and training of my new program handled?
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How quickly can I go live with your software?
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How many people do you have in software support for just my HME program?
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What percentage of support calls get answered when I call in?
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If you have to return my call, how long does it take to get a support call back?
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3. What are the major features of your software? Why is your software better than your competitors'?
These kinds of questions vary greatly based on providers' needs, Williams says, but recent hot buttons include:
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Do you offer an installed or online/Internet-based version of our software? If not both, why? What are the advantages and disadvantages of each?
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Do you have integrated document imaging or interfaces to the major HME document imaging players?
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Do you have any GPS tracking or routing integrated into your software?
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What technology do you have to help me with refills on supply items like diabetic supplies, CPAP, ostomy, urological, wound care and oxygen cylinders? Do you offer an interface to a patient management system or do you offer your own IVR (Interactive Voice Response)? What about shipping interfaces to DHL, FedEX, UPS or USPS?
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Do you offer an integrated, full-featured POS? Is it compliant with the new IRS Flexible Spending Account regulations for 2009?
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What type inventory control features do you have — bar coding, quantity tracking, serial numbers, lot numbers, depreciation, automated purchasing, etc.?
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What type automated delivery features do you have? Routing, PDAs, laptops or tablet PCs for confirmation of delivery from the field? What about electronic signature capture both in the store and in the field?
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Can you do direct electronic claims at no charge to Medicare? Medicaid? Commercial insurance?
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Can you do eligibility checking with Medicare? Medicaid? Commercial carriers?
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4. What will it cost?
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How much will it cost me up front?
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What are my monthly/annual software support costs?
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What are my monthly/annual software maintenance costs?
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Unless I purchase additional software, what other costs might there be?
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Historically, when there has been a major upgrade (like from DOS to Windows), was this free or did you charge for the upgrade?
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Online/Internet-based versions:
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What are my set-up and installation fees? What does this cover?
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What are my training fees? Do I get trained on all the modules I purchased for this price?
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What are my monthly fees? How many simultaneous users does that include? How many locations with separate inventory and accounts receivable tracking?
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How much extra per month to add an additional user? An additional location?
Installed versions:
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What are the up-front software purchase costs? Do you offer leasing?
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What are the costs to add additional users in the future? Additional locations?
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What are the monthly/annual fees?
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How much extra per month to add an additional users or locations?
“The best advice I could give someone is to make a list of the features you need to run your business today and where you see it in the next three to five years,” Williams says. “On that list, note which features are ‘must have, can't live without.’ These should not exceed 5 percent to at most 10 percent of the features on your list.
“A good candidate will meet 80 percent of your needs, as no software vendor will meet 100 percent of your needs. Be willing to change how you do things 20 percent of the time,” Williams advises.
For information on the companies in this article, check these Web sites:
Authentidate: www.authentidate.com
Bonafide: www.bonafide.com
Brightree: www.brightree.com
Diabco: www.ar-express.net
Dynamic Energy Systems: www.dynamicenergy.com
Fastrack: www.onlyfastrack.com
Healthcare Automation: www.healthcare-automation.com
Noble House: www.nobledirect.com
QS/1: www.qs1.com
RemitData: www.remitdata.com
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