Can we get that in writing? We better

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James M. Berklan
James M. Berklan

If you asked long-term care providers what their main concern is, you would think it would be "patient care," right? It turns out, that's not reality. Most providers, it appears, are consumed by documentation.

That's right: filling out forms. Not managing, not taking care of revenue or reimbursement, not regulations and compliance. Documentation — though I suppose it could be argued that documentation intersects with each of the other topics.

Still, it seems like a lousy pre-occupation when your business involves tending to frail, mostly elderly people trusted to your care.

Yet the No. 1 challenge listed in a polling of more than 1,200 providers was “documentation.” In fact, 21% who visited the Harmony Healthcare International website in 2014 said it was their biggest challenge. The other categories were: denied claims (12.1%), census (11.9%), business operations (11.6%), education and training (10.8%), revenue/reimbursement (10.7%), management (7.1%), patient care (6.9%) and regulatory/compliance (6.1%).

“Line” level workers (23.4%) clear and away were most concerned about documentation, compared with just 13.4% at the C-level (administrators, CEOs, owners). That's not surprising, considering who has to actually fill out endless MDS and nursing evaluation forms. But it's something bosses should take to heart.

The “Harmony Healthcare International 2015 Post-Acute Care Trends Report,” which was released last week, says C-suiters are more concerned about census (18.8%) and business operations (17.8%), as they probably should be. They better be focused on the future direction of the entire ship. But they also better realize their workforce is under a lot of pressure over documentation. 

The study also showed that frontliners place “educations and training” at a much higher worry level than the C-suite does (11.6% to 6.9%). The savvy top manager will remember that, and not only at annual employee appraisal time.

The full implications of the report are hard to lock in. Some might point out that visitors to a website for a company specializing in compliance matters would naturally be worried about documentation demands. But Harmony Healthcare lists “compliance, reimbursement, operations and denied claims appeal consulting” as its primary points of emphasis— not documentation, per se.

Concerns about documentation, however, were pervasive across most cross-sections of respondents. Every geographic region except the Pacific Northwest (where “education and training” was top vote-getter) named documentation the most urgent challenge. The most dominant showing overall was with first-year employees, where 37% said documentation was their biggest concern.

What I find perhaps most remarkable is that “patient care” as a No. 1 concern never rises above 8.4% for any of the responding groups. In fact, for most groups, the percentage was significantly lower. Is this because providers are so confident in their direct care? Or is it because they're being so distracted by non-patient care tasks? Maybe a little of both?

Kris Mastrangelo, Harmony Healthcare's president and CEO, comes away with one indisputable conclusion: The study “indicates that our industry is still very focused on the day-to-day tasks of getting the job done.”

She added that she believes provider priorities will shift more toward compliance and education in 2015.

Something says, however, that deep documentation worries aren't going to fade away any time soon. That might be a sad commentary on providers — but when it comes down to it, an even worse reflection of those who regulate them.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.