Rock-Pond to host Customer appreciation event at NHIA

Are you attending the NHIA Annual Conference in Dallas?  If so, we hope you will join us for an evening of appreciation and networking at the Cru Wine Bar in the West Village area of Dallas, about 5 minutes from the conference.

Come by and see us in booth #726 in the exhibit hall on Monday night or Tuesday and we’ll show you all of the cool new things we’ve been working on.  Then plan to join us for a special evening with our customers and friends on Tuesday night.  I’ve been attending NHIA conferences every year since NHIA began in the early 90′s and so it is always somewhat of a cross between a family/college reunion and a giant think tank.  Bring your ideas and friends and we’ll dream up the next big thing over a glass of wine.

CLICK HERE for complete information and complete the RSVP form.  We’ll see you there.

Can’t wait to Crú with You.

Pete Tanguay, President
Rock-Pond Solutions
501-450-6446

www.rock-pond.com/cru

Understanding Remote Access

Never has accessing your home or work computer from anywhere in the world been as easy as it is right now. With built-in remote features in Microsoft Windows and Apple Mac OS X as well as hundreds of third-party applications, there isn’t much you have to do expect actually do it. Every great technology innovation seems to come with even more risks that need to be paid attention to. The problem is that these remote access solutions are so simple to implement and use that often times the security vulnerabilities that they open up are overlooked.

Remote Desktop, sometimes referred to as Terminal Services, is Microsoft’s technology for allowing users to connect to a remote Windows system. Once connected to the remote system, it’s as if you were sitting in front of it. It’s obvious why this can be a problem if not done using a secure channel. This can be as easy as enabling Remote Desktop on your Windows 7 workstation, or as complex as an IT department configuring a single server to provide a virtual desktop to multiple users at the same time with heavy security policies in place called Group Policies. Remote Desktop has never been more secure as it is today with Windows 7 and Windows Server 2008. It’s been updated to include modern security techniques such as Secure Sockets Layer (SSL) and Transport Layer Security (TLS) as well as the ability to only allow clients to connect securely. Most organizations today only allow remote desktop connections once connected to a secure and encrypted virtual private network (VPN) decreasing the security vulnerability significantly.

You may have heard of, or even used Citrix. Citrix is similar to Remote Desktop but takes things a bit further. In addition to offering the same level of security and encryption benefits, it also allows for the “publishing” of specific applications rather than the entire desktop. This enables IT administrators to provide users with access to only the applications that they need. Many home infusion users will find that when they are using CPR+, HomecareNet, or Ascend remotely, they will connect to a Citrix server first. You may think the application is running on your PC, but it’s safely running at the office just as if you were at work!

Apple provides something called Apple Remote Desktop for Mac OS X, which allows Mac users to connect to their systems remotely. Not only that, Microsoft releases “Remote Desktop Client for Mac” which enables Mac users to connect to Windows systems remotely. Citrix also provides a Mac OS X client that enables the same functionality. Most VPN servers also provide some way for Mac users to connect, this give Mac users big hope for using their systems in a work environment!

Finally, there are lots of third party remote access application, such as CrossLoop, RealVNC, and GoToMyPc. These can be useful to quickly access other people’s system as well as your own through secure channels facilitated by the companies themselves. These often are perfect solutions, and inexpensive, for the home user who needs to access their home computer from work, or on the road.

If you’re a user, ask yourself the following question:

• What types of things do I need to access remotely?
• Does my organization facilitate the remote access that I require?
• How can I take remote access into my own hands using third-party applications like CrossLoop, RealVNC, and GoToMyPc?

If you’re an administrator:

• How can I take advantage of the built-in capabilities I already own, such as Remote Desktop, and extend that to my users?
• What types of applications and services do users need to access?
• What types of vulnerabilities do I open up when extending applications and services to remote users?

Being productive from wherever you are is not a convenience anymore, it’s a requirement. Keeping security and safety in mind is a must for both the user and the administrator, luckily technologies being developed every day are helping make this much easier.

Need some help? Rock-Pond works with remote systems every day, and faciliates remote access to people as well. We can help you navigate all of these options and opportunities.

Software Support – how does your vendor stack up?

I had this idea to evaluate the quality of software support by the most basic measurement – how easy was it to find the vendor’s phone number for support.  So I went to the CPR+ website and clicked on the contact us – saw a picture of their owners, their building and right there – their toll free number for support.  5 seconds.  Next I went to the Healthcare Automation website, clicked on contact us and there it was, the support phone number.  And then I went to the Hanns On Software site and one click and there it was.  So what is the difference between 3 and 5 seconds?  Nothing.  That’s not my point.  Read on.

So I went to the Microsoft site looking for the number to call for SQL Server support.  After 10 minutes of searching, clicking on “Contact Us” links, clicking on links that I thought surely I would get a phone number, I got nothing.  I clicked on SQL Server and all I could find was info for SQL Server 2008.  I guess they figure that if I am not on the latest release I am nobody.  This was not just random searching, I started by clicking on the support tab off of the main www.microsoft.com menu.  I don’t give up easy, as I have some real SQL Server questions.  I entered “SQL Server” in the search area on the site (something none of the home infusion software vendors had) and I got a Bing search results page.  Clicked the back button. Clicked on Products and found SQL Server.  Oh, I’m almost there.  Clicked on Contact us and got a “Ask Carey” prompt. 

I give up.

There is a lesson here.  All of the home infusion vendors started out using some legacy data format like .dbx or Access database files.  All of the home infusion software vendors have selected Microsoft SQL Server as the software to store all of the data that is put into their home infusion software.  The difference is that in the “old days”, the data base served the needs of the software.  The database was only designed to be used by the software vendor and when you had a problem with the software, whether it was related to the system, the database or the information in the database, you called the software vendor.

In today’s world, your data exists independently from your system and there are powerful tools, including SQL Server, that allow you to take control of your data.  Tools that are exponentially more advanced than your home infusion software.    You can still call your software vendor and ask them about the data in your SQL Server, but you’ll get a fairly narrow answer.  If you want to fully take advantage of the power of SQL Server you need to hire someone with this experience or contract with a company who has it.  One of the most powerful and underutilized applications you have in your business might be SQL Server, or some other Microsoft product. 

If you want to know about SQL Server (or CPR+, HomecareNet or Ascend), you can always call Rock-Pond Solutions.  You are already on our site, just click on Contact Us on the top of this page.  2 seconds.  Or enter “SQL” in our search box.  We do a lot with SQL and SQL Server and we have a search box, just like Microsoft.  Our mission is to help you extend the value of your information system investment. In late 2009 and 2010 we’ve been helping home infusion providers extend their systems through advanced uses of SQL Server and the opportunities are awesome.

You see, Microsoft is in the software business, not the support business.  They rely on other vendors, like Rock-Pond, to support their products.

File Transfer Methods – Not All The Same

In the middle of an already complicated computer world lies the age old requirement of being able to get files from one place to the next. It sounds simple on the surface, but with so many security and performance related issues popping up over the past few years, file transferring is more complex, and riskier than ever. Not only do you have to worry about making sure files get from here to there without picking up a virus, but you have to make sure that the only eyes that see them are those who were intended to. Now throw into the mix the fact that files today are significantly larger than ever before containing videos, pictures, presentations, and data.

The average user, especially the traveling user, argues that they are limited to what they can do, which is generally attaching files to an E-mail. This works, sometimes, but is starting to become obsolete with the massive amounts of spam & content filtering as well as file size limitations mandated by either the sending or receiving organization.

During the initial planning stages of Rock-Pond Connect, a tool developed by Rock-Pond Solutions to manage the deployment of report templates to its customers, several file transfer methods were looked at. The most significant goal of the project was to provide a way to quickly and safely transfer files while maintaining compliancy with the majority of organizations’ IT guidelines. This immediately threw out our good old friend FTP. FTP stands for File Transfer Protocol and is as old as network protocols get, dating back to 1971. It’s insecure, lacks encryption, as well as authentication. Most organizations’ networks don’t even let it in or out of the firewall, and it’s certainly not HIPAA compliant. SFTP was later released with a goal to build in greater security, encryption, and authentication. SFTP is in line with the popular “SSH (Secure Shell)” protocol which is the industry standard for accessing remote Unix-like operating systems. There’s also FTPS, which is an extension to the FTP protocol that adds support for Transport Layer Security (TLS) and Secure Sockets Layer (SSL). Don’t forget that you can always throw your files on a USB stick to accomplish the same task, but now there are new risks, like losing the stick itself! Luckily, there are applications (often times provided with the USB stick) that let you encrypt the data with a password in case of it being lost or stolen. The web is a popular file transfer method, also supporting TLS and SSL, but is mostly uni-directional, meaning the user is usually only pulling files to their system rather than sending them to another. Luckily, Rock-Pond’s requirement for Rock-Pond Connect was only uni-directional, from us to the client.

We ended up coming across a version control system called SubVersion, a quickly growing client / server version control system that efficiently synchronizes files between two or more systems while maintain history and backups. We compared it to our requirements, and it matched up perfectly. We weren’t in need of encryption as the files we are deploying are simply templates, not data. Even if we needed encryption, SubVersion can operate over the TLS / SSL HTTPS protocol.

One of the biggest selling points for us was the fact that our customers could get files from us using an “incremental” approach, meaning they only get what’s been changed since the last time they synchronized with us. This was important to maintain a small bandwidth footprint for ourselves as well as our customers. In addition, transfers take place quickly, and can repeat often.

As I work with home infusion providers around the country, one commonality that I come across is people’s desire to put files “somewhere else”, just in case. Not only that, people are often on a workstation and then traveling using a laptop. Often times a home infusion provider needs to be able to effectively get files back and forth with the company providing them reimbursement services, usually containing sensitive information.

SubVersion, though not a traditional file transfer protocol, has a place in each of these scenarios. For a backup solution, users can synchronize their files to a remote central repository for safe keeping with the ability to revert back to old revisions if need be. No more sudden panics because you accidently delete a file. For the traveling road warrior, you can synchronize your files to a central remote repository from your workstation and quickly pull them down on your laptop. When done with your laptop, synchronize your files and pull them down to your workstation. Two computers, same files. Lastly, to provide files to an outside organization, such as your home infusion reimbursement center, setup a remote repository and synchronize just the files that the reimbursement center should get. They can do the same allowing for a seamless sharing of files over a secure channel.

While there are many options, too many to talk about in this single blog post, SubVersion has met Rock-Pond’s needs well, both from an everyday internal use to a full customer file deployment solution. Look at your own file transfer needs and ask yourself these questions:

• Do you require encryption and fine grain authentication?
• Do you need to transfer files over the internet, and how often?
• What types of people do you need to share files with? How secure are their systems?

Establish file transfer policies and procedures and continue to audit them with today’s ever-changing technology developments. It’s easy to get your files from here to there safely and has never been so important.

How many infusion patients did we serve?

Regardless of what business you are in, it is important to know the number of customers served, where they came from and what services or products were provided.  Knowing the number of prospective, current and former customers and understanding as much as you can about them gives you valuable insight into your business.  Although we count “customers” and “services” a little different, this is no less important in home infusion therapy.

In home infusion therapy this is called census management.  Sounds simple, but not always so.  Patient census is most commonly referred to as the “midnight census” in a hospital.  That is, how many patients are in a bed in the hospital when the clock strikes midnight.  This is an easy count.  This number is referred to as a patient day and hospitals have been managing their census by patient days for years.  In home infusion therapy, we are not confined by hospital walls and there is more of a focus on the therapies that are being provided.  Therefore we need to manage by therapy days more than patient days.  In home care when we produce a census that counts each patient once, regardless of the number of therapies they are on, it is referred to as an unduplicated census.  So, we need to manage by therapy, focusing on key therapies, but also know how many patients we are serving.  Finally, since insurance companies typically reimburse by therapy, a patient with multiple therapies will cost less to serve than multiple patients, each with one therapy.  How well do you understand your patient and therapy census?

Some home infusion providers, and software vendors, fall into the trap of trying to identify the primary therapy.  The problem with this is when you only look at the primary therapy, you loose visibility of very important census and therapy information.  The second problem is that keeping up with the primary therapy as physician orders change is a tedius process and seldom followed through on.  This would be like tracking revenue by only primary payer.  It’s easy but it doesn’t give you a very accurate picture of your business.

The key to accurately reporting therapy and patient census is to be able to produce total and distinct numbers.  If you are using a system like CPR+ that does not allow you to establish specific cases by therapy, the therapy is only recorded at the order level.  It is carried through to the delivery ticket and is only accurate if you have only one therpy on a delivery ticket.  If we determine that a patient is served when a prescription is filled or a delivery made and have the ability to have total and distinct counts, we are able to see our patient and therapy census in total and in an unduplicated formats.  This is essential to census management.  This will also take out the margin of error that is caused by patients not being discharged on a timely basis and patients who are on and off service due to hospitalization.

So, how many patients did you serve last month?  How many therapies?  How many IV Antibiotic patients?  How many IV Antibiotic patients who also had other therapies?  The answers to these questions are just the beginning to understanding your business.

Rock-Pond Signs Agreement with NHIA to support DATA Initiative

Change in health care is happening rapidly.  Now, more than ever, the home infusion industry must come together to communicate the value of home infusion and lobby for it’s place in the future of health care in America.  The story simply can not be told or the case made with out data.  One of the top priorities of the National Home Infusion Association in 2010 is to establish a base data initiative that will provide the data needed to take the case for home infusion to Washington.  And this is just the beginning.  Data will be needed to support pay-for-performance initiatives when they are implemented in non-acute care settings and to support best clinical practices on an industy-wide basis.

Rock-Pond Solutions has signed a mutual agreement of understanding where Rock-Pond will provide FREE tools to any home infusion provider to mine their data source to extract and deliver the data requested to NHIA.  NHIA will promote this as the tool of choice to gather the data in a standardized and consistent manner.

Click here for more information.

CPR+ Revenue Analysis with Averages

When you need to report your revenue, a standard revenue report will do.  If all you are trying to do is get the revenue numbers to close the month, a standard revenue report will do.  The standard revenue reports available within the CPR+ system are to the left. 

However, if you need to analyze your revenue to determine why revenue is up or down (or how to make it go up or keep from going down), you need more than a standard revenue report.  Rock-Pond has developed two powerful revenue analyzers to help you see exactly what is happening.   The power is in the ability to group by up to 9 different key data items (Payor Type, Payor, HCPCS Code, State, Type of Claim, Billed Month, Revenue Code, Therapy and Patient) in up to 3 different grouping levels.  Although not every grouping option would make sense, this is over 700 different ways to print a report. 

The revenue analyzer with averages takes the ability to analyze, trend and compare groups to another level by providing an average revenue per day, calculated by using the number of days on the invoice.  For the first time you can compare the average revenue per day for different payers for each HCPCS code you bill. 

This example will help you see how different payers are paying the same product.  If you want to see how the reimbursement for specific payers has changed over time you could refresh the report and group by billed month within payer within HCPCS code.  The ability to spot trends and see variances will alert you to issues that need to be attended to.  They might be issues in your system setup, the accuracy of your billing staff or the viability of the payer contracts you have.  Regardless, if you are using standard revenue reports you may never know why your revenue is not what you expect it to be.

Complete Report Sheet for Rock-Pond Revenue Analyzer Reports.

Revenue Analysis by Payer

Recently I got a call from a customer who was trying to explain a drop in revenue for one of his sites.  Pharmacy production, patient census and even the payer mix seemed to stay fairly constant.  Yet, the billed revenue for the month was lower than expected.  After reviewing all of the normal areas (did we confirm all of our tickets, what was the change in the unbilled, number of billable days in the month, etc.), it was determined that they needed to dig a little deeper and they needed Rock-Pond to help them pull the information out of their system. 

Let me tell you what we found and then I’ll tell you what we learned.  We found that the payer mix and the specific drugs dispensed within a therapy and payer type caused a significant, unexpected drop in the revenue.  The therapy was IVIG and the payor type was Blue Cross.  Although the number of IVIG patients and the number of days on service did not change significantly, a couple of patients with higher priced drugs who had better paying Blue Cross plans were discharged and replaced with a couple of other patients, also Blue Cross, but with very poor reimbursement and with physician orders for drugs that had a much lower AWP.

When we were able to finally see the patient data side by side grouped by billing month within payer within payer type, it was clear that not only do some of our Blue Cross Payers pay better than others, but the variations at the drug level were very significant.  Put those together where both the drug and the payer reimbursement go down at the same time and it’s the perfect storm.

The lesson here is that you need to be able to look at your business from many different directions in order to truly see what is going on.  Just being able to analyze revenue by payer type or therapy type isn’t good enough.  If you can’t go to the drug level and the individual plan within payer, you are not going to be able to fully understand your business.  Finally, analyzing “what happenned” is not good enough either.  Once you learn what payer plans and drugs are going to be losers you must turn that into proactive policy at the time the patient is accepted.  Often a call to a physician indicating that you are not going to be able to accept the patient with their insurance plan / drug order will end up with a therapeutically equivalent order that you can afford to accept.  Let’s face it, if the health care providers go out of business, nobody wins.