Gorilla-buster.

Software to assist in running a nursing facility is changing, and that change is being driven by the 2,000-pound gorilla of late 20th century medicine - managed care. Long-term care providers are finding that managed care's reliance on detailed quantification is transforming both the process and the content of their data collection.

When personal computers began appearing in nursing homes, software was asked to operate on one of two levels: traditional bookkeeping functions and automating charting for resident care.

"A patient would come in with a broken hip," recalls software consultant Charles Bloom of Oceanside California's Competitively Managed Solutions, Inc., "the admissions person would type in the code for a broken hip, and the computer would spit out a whole bunch of notes on how to care-plan a broken hip and the supplies that would be needed. Now, with managed care and capitation, the computer needs to respond with the 'critical pathway.' Five years ago we didn't have critical pathways."

The emphasis today, for managed care, is on predicting outcome and cost - for which pathways of treatment yield the greatest rate of success for the lowest expenditure. In a managed care environment, a nursing home knows that it is going to be paid only so much for treating a broken hip. Payers and managed care administrators have analyzed treatment data on countless hip fractures to determine the lowest common denominator in the cost-outcome equation. If 90% of hip fractures can be rehabbed successfully using treatment plan X, then payment is going to be capped at what experience has shown to be the cost of treatment X.

"It's a total difference in the way we look at data," says Bloom. "The three big things wanted in health care today are predictability, accountability and profitability. Without those, you can't forecast, budget or admit. Unless software can do all three things, it isn't going to last in the marketplace."

Software companies are responding by beginning to put out programs that allow a nursing home operator to analyze outcomes from the perspective of cost. The programs of the just-arriving generation of long-term care management software are fully integrated to achieve this. That is, the medical and fiscal aspects work together in these programs to let a nursing home predict an outcome for a procedure, account for its cost and plan for profitability. Data are entered only once and can be analyzed in nearly as many ways as can be imagined. And the key is program integration.

"Don't spend your money three times," advises Bloom. "The cost of an integrated system isn't that much more than buying the parts piecemeal. Why spend money on a charting or MDS program, spend again on a rehab program that does critical pathways, and then still have to purchase a fiscal program to invoice, pay bills, and balance the books? Beyond that, there is the time it takes to move data back and forth among the three functions, and their separate upgrading costs."

All of this explains why we are crossing the threshold of a new age in nursing home management software. And perhaps it's about time. "Long-term care is the most highly regulated industry in America," says Bloom, "even more highly regulated in some states than nuclear power. No other industry has OBRA. The insurance company never says, 'Well, you poor guys have an OBRA requirement that says you have to do care planning every time there is a change of condition, and since care planning is a labor-intensive requirement, we will pay you for it.' Hospitals don't have this; pharmacies don't have it."

The new generation fully integrated programs are designed to handle data needs specific to skilled nursing, rehabilitation and long-term care. They are also easier to use than their predecessors. Windows-based, they rely heavily on the point-and-click attributes of mouse usage rather than keyboard-oriented scrolling, hunting and typing. The result is faster, easier data entry, and that means more data entered, and entered correctly, at their point of origin. Because the programs require the user to make choices off a menu rather than enter prose descriptions of treatment and procedures, everything is able to be expressed in yes or no absolutes. Data are quantifiable and can be manipulated in a way responsive to the managed care view of outcomes management.

"Software that lets you collect and analyze data in managed care terms is absolutely essential for nursing homes today," Bloom explains. "Just as essential is that the software be easy to use and quick to respond to changing requests. One of the interesting things about managed care is that, as we are starting to understand it a lot better, the insurance companies are upping the ante. They want more information, and they are constantly asking for more outcome per dollar. They want more for less. Nursing homes that have well-integrated software capable of analyzing treatment and quantifying outcomes are going to have a tremendous advantage in this market."

And that is why you will hear more and more in coming months of major long-term care software companies rushing to get fully integrated, nursing home-specific software to the market. That's good news for administrators looking for ways to cage a 2,000-pound gorilla.

David Patterson is a Contributing Editor to Nursing Homes Magazine.