We all are looking for ways to do more with less. At home, simple changes, such as installing a programmable thermostat and turning off the lights when not in the room, can make a big difference. But have behavioral healthcare organizations looked at their business functions this way? As we perform work-flow analyses with behavioral healthcare organizations around the country, we repeatedly encounter organizations sustaining unnecessary overhead by not adopting simple changes.
For example, organizations using administrative staff for data entry are choosing to pay a premium for information. Their work flow probably is something like this:
A service provider interviews a consumer.
The service provider handwrites documentation.
Administrative staff enter the information into a software program.
Billing staff reenter the information into a billing system.
Multiple data transcriptions increase expenses and do not enhance organizational value. They're unnecessary overhead in the organization's budget-like leaving the lights on.
In addition, reentering data is like playing the “telephone” game, in which the original message can change significantly as it's passed around. But data transcription is not the only source of errors. When organizations rely on administrative staff for data entry, they often turn off the logical business rules that information systems use to enhance the data's quality. After all, staff trying to complete data entry of thousands of lines of information can't be interrupted with system warnings. Yet disabling these critical checks erodes data quality and software decision-support functions. Also, costly correction cycles can occur when the data-entry staff find the paper documentation to be inaccurate and need to consult with service providers. So not only have some organizations created unnecessary overhead, but they are getting poorer results for their efforts.
The trickle-down impact is profound. Because of the frequency of errors, additional billing work must be done to generate a clean charge.
Although some systems will allow a claim to be submitted despite errors, the staff has to rework a rejected claim, lengthening the cash-flow cycle. As flawed data move through the organization, reports are issued to track caseloads, productivity, and budget compliance, so an error on one claim can affect results in many places. It's as if these organizations are leaving the lights on and turning up the heat when no one is around.
The time delay of information availability compounds the problem. Data collected on Monday sit in an in-box waiting for administrative data entry, typically 48 hours behind. Thus, Tuesday's reports won't be accurate and up-to-date. Inaccurate reporting can justify service provider concerns about changing processes and moving to an electronic medical record (EMR), so they cling to paper more tightly. It's as if with all the lights on and the heat turned all the way up on a freezing night, the cleaning staff have opened all the windows.
There is a cascading impact of the seemingly innocuous choice to indulge service providers with administrative staff to enter information instead of pushing data entry to those who identify the information. To ensure efficiency and quality, the data collector clearly is the best person to enter the information into a software system. This is the simplest and most foundational aspect of using an EMR system, and yet it so often is a stumbling block.
As behavioral healthcare organizations look for ways to enhance their ability to perform in challenging financial times, a back-to-basics look at agency processes just may be what is needed. Turn off the lights in rooms without any occupants, and make service providers responsible for entering data.
Joseph Viger is Vice-President of Operations at The Echo Group, which provides enterprise software applications and contracted billing services for behavioral healthcare organizations. The Echo Group is a member of the Software and Technology Vendors' Association (SATVA).
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Behavioral Healthcare 2009 March;29(3):56