Alexian Village.

"It's more important than ever for everyone to be on the same page"

Coordination is the key to PPS management at Milwaukee's Alexian Village, a non-profit congregate care retirement community with 108 skilled nursing beds, sponsored by the Alexian Brothers, a Catholic order based in Chicago.

"As part of the new compliance program, we've brought all of our billing and documentation systems into sync with the other Alexian Brothers facilities in Tennessee, St. Louis, and Milwaukee," reports Gary Mohn, chief executive officer. "We've learned together as a group to develop consistent procedures. From the standpoint of documentation, the attention required to meet the new rules is not necessarily dramatically different, but it's definitely more detailed."

The system-wide work has been complemented by local training. "We've sent people out, had groups in, lots of all-day sessions with the clinical, admissions, social services and billing people," says Mohn. "The hardest part was finding time to get the staff into the training."

Alexian Village was already in sync with other local health care providers. "The preadmissions part of the process was generally up to speed before PPS," he says. "We have relationships with three hospital systems, so the coordination with social workers and the data collection was in place. We've made that a more formal, prescriptive process, but that probably reduces stress in the long run."

"We also have an affiliate relationship with one of the hospitals, St. Mary's, and we've linked them to our computer system now," he adds. "There's a lot of communication between our health center staff and their therapy staff, which is absolutely critical. It's become more important than ever for everyone to be on the same page."

Mohn does not see the need--or rather the option--to shift service patterns under the new system. "We're a life care community, so ratcheting down our acuity levels is not something we can or would do," says Mohn. "Our residents rely on us for their continuous health care.

"We have to identify situations from the standpoint of outcomes rather than what's coverable," he adds. "We don't know what will happen when we get to the point of having to deal with the Part B issues."

In the meantime, his major complaint is with technology. "The computerization is a major difference in terms of new software, and we haven't found one that works well yet," Mohn reports. "There is definitely money to be made for anyone who can solve that side of things. "We've run into some bugs in terms of getting data transmitted, and the whole issue of multi-user stations, where if one person is doing one thing on the system, no one else has access to that data. These things all worked well on the DOS platform, but for Windows, nobody seems to have come up with the perfect system yet. And one of the biggest anxieties I still have is whether or not the people at HCFA are ready to implement their end of all of this."