PHOENIX — While it remains difficult to quantify how investments in technology are paying off, some skilled nursing providers say they are buying into more options because today’s margins don’t afford them missed opportunities.
A trio of providers and an executive for one of the sector’s largest post-acute tech firms say they have embraced technology from virtual reality-assisted therapy to advanced EHRs to staffing calculators that will better prepare them for changing standards.
“At the end of the day, the theme of healthcare is moving away from fee-for-service and more toward pay-for-performance,” said Chris Eamiguel, CFO for Creative Solutions in Healthcare, the largest single provider in Texas, last week at the eCap West Summit. “That’s where we’re headed, so it’s very important for us to invest into technology solutions that allow a better clinical outcome.”
Whether it’s partnering with a provider on remote patient monitoring to decrease rehospitalizations or creating their own proprietary metrics to capture broader staffing intelligence, Creative has made increasing commitments to technology tools over the last decade.
Eamiguel’s work refining data collection at Creative helped lead to the creation of DataIQ, a sister company that serves about 1,200 facilities across the US. Other operators often ask about return on investment.
It’s a perspective Eamiguel wants peers in the sector to pivot away from.
“The reality of it is, every single operator is different. What is important to them, what they are succeeding at, what they are not succeeding at,” he said. “Really, the [question] is, ‘What is the opportunity lost by not investing in the technology?”
Back office prowess
Eamiguel came to create back office solutions because he was personally responsible for making daily reports — including on holidays.
Working from profit and loss statements completed in 45-day cycles or with figures too general to reveal much in the way of insights wasn’t helping corporate leaders help their administrators produce meaningful change. Eamiguel’s goal became to produce stats that would explain what was happening and begin to ask why.
One area ripe for examination was overtime and meal break pay, he said. The team created a performance indicator that tracked and managed those numbers at the building level.
“Ultimately, that ended up saving us about $3 million and, at the size of the business now, that could translate to about $10 million,” he said.
Clinical concerns
“We are behind in post-acute care,” said Sue Coppola, RN, clinical advisor for Sabra Healthcare REIT, noting a common refrain in the industry.
But it’s not just the government’s lack of funding that has held up innovation. Some investors also still don’t understand how automation can drive performance.
“How many vital signs are still being taken by a blood pressure cuff? How many are using a Dinamap, which is automated, but doesn’t connect to an EHR?” Coppola asked. “These are just the simple things that impact accuracy in the vital signs and team member time. Those two factors are significant.”
She said she heard similar questions about return on investment when she tried to talk her board into making a $2 million electronic health records investment.
“I said, ‘You have financial investments that you’ve made, you have business intelligence that tells you how you’re doing financially, but I have nothing. Running 376 buildings across 38 states, and I’m blind.’ I said, ‘I need data. I need systems. I need processes.’ If you want to have better operational results, you will begin to look at the clinical and the intersection of clinical, quality and operations.”
The argument was a powerful one. Two years after they backed her request, she was able to show “significant” return on investment in quality and staffing arenas. She sees the layering in of the right technology as a must for the sector, and has encouraged Sabra to help its operators move the mantle forward.
Sabra invested in the development of a pilot of in-room monitoring that cut falls from 28% to 8%, partnering with Ignite Medical Resorts, whose CEO, Tim Fields, moderated the panel.
Fields and a colleague also outlined the company’s use of virtual reality programming that allows patients to rehab with the aid of a headset, while therapists monitor what they experience and achieve on an ipad. It’s become a great option for patients who prefer or need to do therapy in isolation in their own rooms, said Chief Therapy Officer Matt Thengil.
No matter the use, Coppola insists getting results through tech initiatives depends on one critical factor: accepting staff input and making sure any solution is one that can be embedded into the workflow on a daily, monthly and quarterly basis.
“The challenge that happens right now is, are we including our team members. It’s not that the technology isn’t working or with some tweaks that it won’t work. It’s the team member involvement,” she said. “The technology is a solution. [Staff] may be very opposed to AI. However, if you bring a nurse along, and you educate the nurse and the CNA and the team member as to what’s in it for them, they will come along.”
Security in action
For its part, EHR giant PointClickCare is putting security and insights at the top of its to-do list, said CFO James Yersh.
“AI is the biggest buzzword that’s out there,” he said. “Our responsibility, we have many, but specifically focusing on AI, No. 1 is making sure that your data is secure … and with the regulations you need to comply with, how you’re going to use it for AI. It’s an evolving world, and the rules are going to continue to change.”
He sees significant promise in predictive AI, which can “surface insights” rather than leaving staffers in a reactive mode when conditions. That can help during a staffing shortage and also improve patient outcomes.
“It’s using all of this data and then flagging things for people. That’s definitely something where that will drive success,” he said. “There’s not enough time in the day to (manually) go through and comb-through files and non-electronic records to find what’s going to go bump in the night.”
Being able to see, react and share results matters even more in an increasingly value-based environment, Eamiguel added. Data is needed to land referrals, contracts with accountable care organizations and better-paying contracts.
“If you don’t have a foothold on your data points, your metrics, your quality, you’re going to be held hostage by those contract negotiations,” he said. “You’ll have a unique opportunity to cherry pick the things your company does well and focus on those instead of just getting an earful from the other side of the table about what you need to do better.”
