Can you apply Robert Fulghum's classic 1989 book, All I Really Need to Know I Learned in Kindergarten, to modern-day technology? The answer is yes.

How great would it be if the whole world had cookies and milk at about 3 o'clock every afternoon, then laid down with blankets for a nap? Putting things back and cleaning up our own messes would be another sound policy. And wouldn't it be nice if, no matter how old we get, we chose to hold hands and stick together? It turns out that the lessons of kindergarten are remarkably applicable to the HME world.

I have been on both sides of the fence when it comes to being a provider and now a vendor. As a provider, it was not all that long ago that I would stare down at the pile of invoices and check requests that covered my desk and ask: "How did I get here?" Then I would go home, drink my milk, eat my cookies, and take a nap.

Each day brought another problem or another expense. Occasionally, I got so mired in the operational aspects of the business that I forgot what it was all about—the patient.

Now, as a vendor, I provide services to the people that provide the services. Guess what? The view is not that much different. I still have trials, problems, and expenses. The best part is I still get that warm feeling inside at the end of the day when I help a provider with a problem.

Providers are seeking advice on technology and how to leverage it against what seems to be the constant downward pressure on reimbursement, and the constant upward trend in documentation and compliance. The solutions I recommend do not always involve the products I represent. I do this because in kindergarten I was taught to play fair and share everything. I also spent several years on the provider side and respect many vendors in the industry.

PLAY FAIR AND SHARE

While I was sitting in the sandbox, it was obvious that I could not build the best sand castle by myself. Two topics fall under this theme—data warehousing and open architecture.

Data warehousing describes the process of pulling information from various software solutions into a centralized location or data center. By using a robust reporting tool, you can draw data from various topics by linking tables and data that would not normally coexist—providing you with a comprehensive view of your business. This view aids critical decisions by providing real-time information instead of mounds of segmented data.

The product that I used, Crystal Objects, is a business intelligence software solution. There are several choices, but some of the crucial features are schedule import and scheduled reporting to various tools such as sending reports to fax, e-mail, or a push to an intranet site that can be viewed from any computer with access right. In addition, the solution should have logical linking solutions to assist in creating the proper correlation between tables of information.

OPEN ARCHITECTURE

Open architecture is the second aspect of sharing. Remember those sandbox dynamics? Without proper tools, the sand will have no shape. Technology partnerships are becoming prevalent, but proper shape requires open architecture. Assuming that one solution can do everything is an old concept.

All practice management systems do something right, but to assume that denial management, document imaging, specialty intake, and truck routing/global positioning systems (GPS) can be handled by one technology vendor is outdated. Efficiencies can be gained by allowing open flow of information—either by supplying a common API (application programming interface) or by using ODBC (open database connectivity)—that creates solutions and allows companies to choose best of breed.

Under this model, providers have the opportunity to find the solution that best fits their business model. You may be able to build your sand castle without these tools, but the drawbridge might not look so hot without the cool towers.

LOOK OUT FOR TRAFFIC

One of the most costly portions of any business is the cost of delivery. Oxygen providers have the enormous task of visiting most of their patients at least once a month. Doing so in the most efficient and cost-effective manner is paramount to increasing profit margins. Global positioning systems have come a long way. They provide you with a resource tool to efficiently route your drivers, manage time spent at stops, and effectively manage your employees.

Do you have drivers who, no matter how many deliveries you give them for the day, always get back 5 minutes before quitting time? Pushing as many deliveries as you can into 1 day safely is your goal. With GPS, you can track excess miles driven, long stops, dead stops, average speed driven—all of which can illuminate several issues.

I had a route driver who pushed the first 10 stops of a route into a 2-hour time span. The 11th stop took him an hour and 10 minutes. It turns out he was having peanut butter and banana sandwiches with a patient, while watching a soap opera together. Although it was comforting to know he cared for that patient, the other 10 were short-changed on their service needs.

There are several GPS vendors in the general market. I worked with a product called HMEGPS. You can get various options, such as online tracking, stop time, idle time, and average speed. GPS will assist you in pushing back the next purchase of that $50,000 truck.

PUT THINGS BACK

We live in a paper-intensive world, and it is not getting easier. Document imaging is no longer a luxury, it is a necessity. Case studies have shown that you can reduce your DSO, increase your cash flow, and improve office morale, to name a few goals. The return on your investment is timed in months and weeks instead of years.

Keep the "handcuffs" off your business. Don't allow the use of proprietary files that cannot be viewed with other programs. Insist that indexing values stay with your images, so if you decide to switch to another vendor, the export from system to system can be done quickly and without great effort. I would even request that this be placed in the contract.

Fit your vendor to your solution. Look for versatility, scalability, and solutions for all your files—not just your patient files. Online and installed solutions give you options of housing your own information or trusting the vendor to do it for you. If you go with the online version, check to see if they have lost any other company's patient files in transition. Security and reporting tools are also necessities. Check references and go beyond the ones they provide.

Following my own rules of sharing and playing fair, I will not only recommend my own program. Some practice management systems have built-in solutions, but they tend to fall short of what is necessary to become efficient. The providers that I recommend are MedFORCE, Imagesoft, and WebScan.

CLEAN UP YOUR OWN MESS

Mess and HME in the same sentence can mean only one thing—billing and reimbursement. I don't know if it is possible to clean it up, but you are certainly capable of taming it and making it manageable. To do so, you can enlist the help of several different products. The first step in using technology to tame the beast has been available for several years, but severely underutilized by our industry. I speak of the ANSI 835 or ERN. If you are still working with and receiving your EOMBs on paper, there is a better way. ZIRMED has numerous tools at its disposal, and can assist you with converting to electronic files.

So when you receive the electronic 835 file, what do you use to interpret the information provided in it? As with document imaging, several practice management systems have a built-in denial and reimbursement tool, and will work with a certain level of success. As stand-alone models, there are a couple of different tools to compare features and benefits with—D&R Manager by MedFORCE and Reimbursement Pro by RemitDATA. Each one provides slightly different functionality and different reporting capabilities. However, the core functionality remains the same with the ability to track denial trends, see reimbursement trends, analyze the success of your quality improvement efforts, track the success of your billing staff, and eliminate up-front intake errors that turn into back-end denial issues.

DON'T TAKE THINGS THAT AREN'T YOURS

Imagine you have grown your business to a great number of patients, and now you have to take care of their needs. Not only is it a government requirement that you take care of them, but also an ethical one. But do you want to employ two or three employees who do nothing but contact each patient to see what their needs are, to see if they are using the equipment compliantly, and to schedule your next appointment? MedSage Technologies has made a business of this. With explosive growth over the last few years, this company has made an art of calling on patients with an automated system that mimics a personal phone call. The only difference is that it works at a fraction of the cost of a full-time employee and three times as fast—not to mention more efficient and reliable. It also does not require vacations, water breaks, and personal time off.

The second efficiency is intake. Bringing in new patients, particularly in rehab and oxygen, can be a daunting task. Remembering every aspect and detail necessary to appropriately bill for your product and services is a skill that can be automated with a product that makes data fields required, gives you alerts when you make a mistake, tracks each step of the process, and then pushes the appropriate information into your practice management system. Rehab Information Technologies of New York provides this service.

The final problem deals with using technology to track your information when it leaves the confines of your business walls. The consistent push and pull of information back and forth from referral sources, physicians, hospitals, payors, and patients is an enormous task—especially when you add the latency of the response into the formula. The problem has been solved. Digital signatures, reminders, reports, tracking information, and much more are all rolled into one. Authentidate has a host of solutions at its disposal to turn what could be a nightmare into a sweet dream.

FLUSH

W. Edwards Deming, PhD, famous for his 14 Points for Management, said point five is "Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs." If it is not working for you, move on to something better. If it is working for you, ask the question: "Is there something better?" Gotta go. I am due for cold milk, warm cookies, and a nap.

Doug Stallbaumer is vice president of MedFORCE Technologies and Healthcare Management Solutions of Chestnut Ridge, NY. He can be reached via e-mail: .