This article is sponsored by Select Data. In this Voices interview, Home Health Care News sits down with Ed Buckley, CEO of Select Data, to learn about the emerging role of machine learning and predictive analytics in home-based care. Buckley discusses the challenges and opportunities for implementing this kind of technology, as well as the degree to which the home-based care industry is prepared in adopting and utilizing AI.
Home Health Care News: With more than 30 years in home-based care, what are some of the most significant changes you’ve witnessed, and what has stayed the same?
Ed Buckley: I was raised in a health care family. My mother was a home health nurse who became a nurse practitioner and, eventually, a professor of nursing. My father ran emergency rooms, so I’ve had the privilege of being in home health for over 30 years now. I started as an owner-operator of home health agencies and transitioned into the RCM space (revenue cycle management) where we focused on home health coding and OASIS review.
Throughout my career, I’ve seen patient needs grow more complex as people live longer with more comorbidities. Field clinicians are expected to be best-in-class while doing more clinically in fewer visits. The advent of the EMR was great for the home health industry, providing a data-capture tool, which increased accountability and patient care along with the corresponding outcomes.
The industry now needs to move forward into a real-time data delivery world. By empowering our caregivers with AI tools, we can move from a retrospective or analytics approach to patient care, to more of a prescriptive and actionable approach to patient care delivery.
Considering the current staffing challenges in home-based care, how can Select Data help home-based care agencies optimize their team efficiencies?
Buckley: Outsourcing an agency’s coding and OASIS review function to a quality partner frees up staff to provide more support and direct patient care. A quality coding provider should significantly reduce overhead, not only through efficiency but also by carrying the burden of regulatory compliance and industry trends, particularly around certifications of OASIS and coding staff.
Additionally, SmartCare, which is Select Data’s AI engine, allows us to deploy offshore resources and pricing while maintaining, and even improving upon, the quality that clients expect from onshore resources. This provides both cost benefits and a quality control mechanism. If an agency chooses to keep its coding in-house, they can use Select Data’s SmartCare AI engine to gain those same efficiencies and increase quality in a scalable way.
Other than staffing, what are the benefits of outsourcing coding, and what are the greatest risks facing agencies that choose to do their coding in-house?
Buckley: One of the greatest challenges in this field is maintaining consistent quality. Getting the coding and OASIS recommendations wrong creates unnecessary risk for the agency while leaving field staff exposed. The risk in not getting this right can be significant.
OASIS and coding drive outcomes across the agency financially, clinically and regulatorily. Take PDGM, for example. Two of the main components from PDGM are functional scores and coding. The primary code establishes the clinical category, and the secondary codes drive potential comorbidity adjustments. If agencies don’t get those right, they run the risk of lower outcome scores, which will affect them under both value-based purchasing and reimbursements.
Outsourcing partnerships that are dedicated to OASIS review and coding also provide process gains through the extension of your team. The bottleneck and backup of records is minimized, and the process of billing is completed more efficiently. A quality coding and OASIS review partner should be the agency field staff’s best friend. Their champion. As an outsourcing partner, our clients benefit from our coders’ use of the SmartCare AI engine as the findings are passed through to the field staff, ultimately improving outcomes, revenue and re-admissions.
The SmartCare AI engine maintains data consistency and the quality our clients expect, reducing audit risk and adding peace of mind, particularly amidst these staffing challenges.
What is Select Data doing in the AI space?
Buckley: Select Data’s SmartCare AI tool is very special. One of the biggest challenges in the post-acute space, including in home health, is the large amount of referral documents coming from a variety of sources. Over 80% of clinical documentation is unstructured and comes to the agency as either an image or a PDF file. Within our review and coding team, keeping up with those records has become an uphill battle.
The documentation can be anywhere from 20 to 300 pages long, and in order to ensure quality for our clients, we needed to review the complete record and identify all possible conditions and diagnoses. Our team knew that leveraging AI could provide a better option, so we launched an R&D division that led to the launch of our SmartCare AI tool. SmartCare utilizes industry-specific OCR (optical character recognition) to interpret these large referral files, providing computer readable text to our NLP (natural language processing) engine.
That allows SmartCare to apply clinical models and present searchable diagnoses within our UI, providing the user a form of “cliff notes” of the entire referral documentation in less than a minute. Additionally, the UI functionality helps users quickly identify pertinent details within the documentation.
With medical complexities and referral documentation continuing to expand, it is crazy to think that we expect clinicians, coders and intake departments to read and capture all of that information without some assistance from AI. The documentation process is becoming more important in our industry, and AI is a game-changer that will become standard.
How do you get leaders and clinicians in the home health industry to trust, utilize and adopt AI, and do you believe they’re ready?
Buckley: I think we’re getting there, and the staffing shortage has been a catalyst. More technology is being deployed and utilized to make life easier and support a better work-life balance. Think about all of the technology we use today that wasn’t available a few years back. There’s almost certainly a change management effort involved.
Users are a bit tentative initially, but after a few days of using the new tool, they claim they can’t live without it. We need to empower our staff by putting a big S on their chests and a cape on their backs. AI does not replace the individual. It makes that individual more powerful. Think of Superman. Once he puts a cape and suit on, he is capable of flying. We view AI as an empowerment tool for clinicians and field staff.
Keeping up with industry changes is an ongoing challenge for agencies to ensure success. What is Select Data’s role in educating clinicians and leaders?
Buckley: Data provides rationale to our client partners for all of the coding and recommendations we make at the record level, allowing each record to be a teaching moment. Because all analytical trends are reported at the clinical level, clinicians can focus on a particular area of opportunity, versus a one-size-fits-all education model.
Select Data also launched Spotlight, an on-demand e-learning set of sessions, utilizing trends and topics of interest. This is done on a regular basis because we believe that empowerment is the way forward. Knowledge is very important, but knowing how to apply it to reduce risk, improve outcomes and provide our staff with supportive tools is the key.
Finish this sentence: “The home-based care industry in 2022 will be the year of…”
Buckley: Driving clinical outcomes with lower staff availability. AI may become one of the most important recruitment and retention tools since the advent of the field device.
Editor’s note: This interview has been edited for length and clarity.
Select Data is committed to excellence, integrity, and innovation that empowers clinicians to deliver better patient care and agencies to achieve desired outcomes. To learn more, visit their website.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.
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