From left: Louis Rocco, COO, Alan Laudauer, CEO, and Elia Guarneri, CPA, vice president of information technology.

Imagine you are a physical therapist on a house call when the client asks how long it will be before his new wheelchair is ready. You could call the office and ask around—a process that might consume many precious minutes of therapy time without yielding a firm answer—or you could flip open your laptop computer or handheld personal digital assistant (PDA) and check the client’s electronic file via a wireless Internet connection. Total time required to give a reliable answer to the client: maybe 30 seconds.

If you are on the payroll of Landauer-Metropolitan Inc in Mt Vernon, NY, you will soon have capabilities such as this and many more at your disposal, thanks to this forward-thinking home health care provider’s commitment 2 years ago to transform its operations from a dependency on paper-based documentation to a reliance on documentation maintained electronically.

In other words, to create for itself a paperless office.

Time and Money Saved
While there has been much discussion about paperless office technologies in recent years, Landauer-Metropolitan is one of the first in the home health care field to really put paperless office technology into practice on a large scale. The result has been some amazing time and cost savings.

“We’ve halved the number of full-time employees needed for filing—down from eight to just four,” says Louis Rocco, COO. “Over in our confirming department, we were able to eliminate four other full-time employees. And, in addition to the savings on wages and benefits from those eliminations, we have also cut our spending on envelopes, folders, and paper charts by upwards of $2,000 a month.”

In addition, Landauer-Metropolitan—which employs 220 at two locations and provides one-stop home health care services to the five boroughs of New York City plus most of Long Island and northern New Jersey—is sharply reducing the time inherently wasted in the physical processing of paper.

“Our billers, customer-service people, and prescription-order fillers all have access to the patient chart right at their desk,” Rocco says. “They no longer have to walk over to the chart department to get the information they need. Before, when staff would take that walk, they would frequently stop along the way to chat with colleagues, and not always about job-related matters. Sometimes, the information they went to the chart department to obtain wasn’t available because it hadn’t even yet been added to their patient’s chart due to the general slowness of the manual process.

“But now that they access the charts from the computer terminals on their desks, they’re not wasting time on unproductive trips to other departments, and as such they have far fewer occasions to engage in social visiting with other employees elsewhere in the building. They are just a lot more productive now as a result.”

Ending the Paper Chase
The inefficiency of paper was evident to executives at Landauer-Metropolitan for a long while prior to the company’s decision to create a paperless office.

“When we’d go to close our month-end sales reports, billings, and receivables, we’d wind up with 8,000 pieces of paper to deal with—and the larger the company became, the worse the problem got,” recalls Elia Guarneri, CPA, vice president of information technology. “Finally, it got to the point that we’d had enough and realized it was time to do something about this.”

For Landauer-Metropolitan, a $42-million-a-year company carrying in excess of 4,000 respiratory, mobility, enteral, DME, sleep-testing, and rehab products in support of its various clinical service lines, all of the billing functions were already computerized by the time efforts to create a paperless environment got under way. However, there was still much to do.

“We started by adding to our existing system some scanners so that we could transform each paper document into digital form,” Guarneri says. “We would run the paper through the scanner and then save the resulting digital document as a PDF (portable document format) file, which we would import into a database on the computer’s hard-drive. We’d then make a permanent backup of the file by burning it onto a CD-ROM disc. To facilitate access to these electronic files and database records, we developed a company-wide intranet system. When it was all put in place, our employees could, with a few clicks of the mouse on their desktop personal computers, retrieve the exact information they needed, rather than having to physically search through those 8,000 pages of paper just to find the three pages of information they needed.”

This worked so satisfactorily that company officials soon began looking to replicate the concept in other areas of the business. First to be considered was delivery-ticket functions.

“Once we scan the delivery tickets into the system, not only is their information accessible at every desktop in the office, but the computer then automatically uses that data to update and confirm each order and present it for billing,” says CEO Alan Landauer. “The system also automatically records the lot numbers and serial numbers from each delivery ticket, which can greatly simplify and speed up our ability to respond to things like product recalls ordered by the Food and Drug Administration.”

The company next turned its attention to payor explanation-of-benefits (EOB) paperwork. Manually processing EOBs was a source of many problems for Landauer-Metropolitan.

“It would take our posters days to go through the several hundreds of pages of information in just one EOB and manually post each line in the computer,” Rocco says. “A lot of the items in one of our typical EOBs are for $30, $50, $100. In our situation, we might receive a check for $40,000, which would mean there could be 10,000 patients referenced on that one EOB. That’s a lot of posting to do by hand. And a lot of potential for human error.

“Now, we just scan each EOB and the system automatically posts the payment. The system also records denials and denial codes, which allows us to very easily trace each denial back to its root cause and make the necessary corrections.”

Making a Big Idea Small
Landauer-Metropolitan is a big company and can, without flinching, afford the $500,000 it paid out to go paperless. But what about smaller enterprises—can they as readily afford to undertake such an initiative?

“Yes, it is possible for even small businesses to do this,” Landauer says. “There are many good, off-the-shelf hardware and software packages that you can buy at a reasonable cost to create, at the very least, a rudimentary document-retrieval system—the foundation of a paperless environment.”

As Landauer sees it, paperless is the wave of the future and the move to paperless office technologies may soon be essential for companies large and small.

“As an industry, we’re just on the cusp of understanding the power and uses of computers to promote efficiency,” he says. “And, unfortunately, as an industry, we’re not able to increase our prices. So we have to look inward if we want to do better financially. What we have to do is achieve greater efficiency. By being more efficient, we save money as well as increase productivity.”

Rich Smith is a contributing writer for Dealer/Provider.