1. Perform a needs assessment.

Morrill: Look at the clinical practice and identify your biggest clinical and business challenges, as well as your strengths. Use this information to create your needs, wants, and dreams list; this process should rekindle fond memories of creating your Christmas list as a child. Encourage staff members to give their input to help solidify the clinic's wants and dreams.

2. Do a product evaluation.

Morrill: Once you establish your needs, wants, and dreams list, do the online/on-site demos to get an overview of the system. Try not to interrupt the sales presentation, because it is a great way to see the flow of the software from a user who is very familiar with the system. During the presentation make notes, and save your questions until the end of the presentation. You may want clarification on an aspect of the system, or perhaps other questions were sparked during the demonstration.

After the demonstration is complete, ask if there is a trial of the software available. If no testing option is available, that's a red flag. We test drive cars on real roads before we buy. Why should software to manage your practice be any different? The last step in evaluation of the product is to ask for references and take the time to contact them with questions you have about the system. References will be able to comment on the quality and availability of technical support and training for the software products.

3. Create an implementation plan.

Stone: Work with the software vendor to establish a specific and comprehensive implementation/training project plan for your clinic. Allow enough time for the therapists, clerical, and administration staff to study the user manuals and tutorials, and practice in the training database for weeks ahead of implementation. Schedule a realistic date to "go live" with the new system. If you are interfacing a new documentation system to your current billing application, the "go live" date is the day when all new patients are entered into the new system. The patients that were started in the old documentation method will finish out the episode of care in the old method. Plan to lighten the clinical load of the therapists for the first few weeks after the "go live" date.

Morrill: Make a decision and set a timeline for the software's implementation to evaluate its progress. Schedule meetings with your staff and your chosen software vendor to address issues that may arise. Many times it is a simple modification of settings or training issues that can lead to the stress of using a new software. Last, but not least, be patient and confident that your due diligence will make your practice more clinically and financially efficient.

4. Keep an open mind.

Petrie: Most PTs only look for software when the pain of not having that software becomes unbearable. Then, they get so focused on solving their immediate problem that will save them a few pennies, that they completely ignore other opportunities that will save them many dollars. As you compare systems, consider the long-term profitability of features you hadn't originally considered, which can cut your no-shows, reduce your claim denials, or increase your referrals.

5. Think 3 to 5 years ahead.

Petrie: Consider where your current software investment will put you 3 to 5 years down the road. Will this system grow with you horizontally—can you economically add users and locations as you grow? Will it grow with you vertically—does the company upgrade its software regularly to keep up with new technology and opportunities in the physical therapy field? Will it grow with you internally—does the company have a track record of integrating with other physical therapy technology solutions that you may add in the future?

6. Build complete staff buy-in.

Petrie: Software only works as well as the user controlling it. Start by giving your team all the training they need to become expert users. Then, insist they use the software as recommended. For example, SpectraSoft has worked with thousands of physical therapy clinics over the years. Based on that valuable experience, we have built many "best practices" into our software. When your people complete patient-intake forms fully, close out each day correctly, etc, you will start to enhance quality of care without even realizing it. Patient wait times and no-shows will drop. The reports your system generates will be more meaningful. And fewer critical tasks will "fall through the cracks."

7. Consider your billing procedures.

Stone: If you have an established practice, whether to keep your current billing application and interface with a documentation component, or start completely over with a new billing and documentation system, will significantly impact the implementation process.

Before any purchase, honestly evaluate your billing system as to whether it meets your current and future billing needs. If you are satisfied with your billing system and don't want to go through months of disruption by implementing a new one, find the best documentation application and interface it with your current billing program. Get references from the vendor of other clinics that are successfully interfaced and satisfied. Many systems today provide billing with mediocre scheduling and documentation components, and cannot interface with your current billing system. In essence, make sure you don't throw out your billing with the bathwater to obtain quality documentation and/or scheduling applications.

8. Analyze current workflow processes.

Stone: To minimize the impact of transitioning to a new system, analyze all of your clinic's current workflow processes of scheduling patients, clinical documentation, and billing. First, list the tasks that each individual must accomplish to successfully run the clinic for a normal business cycle, typically 1 month. From the administration, clerical, and clinical perspectives, examine all aspects of the internal paper flow; from a patient calling in to reschedule an appointment, to documents (plans of care, 700/701 forms, physicians' communications) that need to be sent out and returned with physicians' signatures, to how billing is generated and submitted, to how records are gathered and compiled for audits or appeals.

Identify all the redundant, manual, and/or expensive processes (like transcription) that will be eliminated by a practice-management system. Be aware that an implementation of any system will impact clerical job descriptions and/or eliminate positions. Prepare your staff as far in advance as possible of any potential changes.

9. Examine office productivity.

Brooker: Be sure that you are poised, after you initially set up the software, to achieve office productivity improvements. Either you are able to get the same amount of productivity out of a smaller team, or greater productivity out of your existing team. For example, are you or your staff still entering remittances by hand? You shouldn't be—at least not for a majority of remittances—since most insurance carriers provide electronic remittances that PTOS can import. Are you able to enter charges faster than before? Even small gains in charge entry productivity can add up to significant amounts of labor savings when multiplied across a vast number of charges. In the best-case scenario, charges are coming directly over from therapists in the course of their electronic documentation.

10. Measure revenue improvement.

Brooker: Once you have installed your software, do you find that your collections period has shortened, bringing funds more immediately to your back account? Are you billing electronically for as much as allowable by your carriers? We are finding that electronic billing can shorten collections to as short as 4 days, though the average across all carriers seems to be in the 15- to 25-day range. Have claims denials declined? Your software should warn you before making costly mistakes, such as billing beyond the patient's reimbursement cap without the appropriate modifier, or billing beyond the patient's authorized visits.

11. Create a management dashboard.

Brooker: What are the key metrics you should be looking at to optimize the performance of your practice? Practice-management software systems have varying degrees of management reports, but the biggest problem is that users don't know how to best take advantage of them. If you don't have the knowledge or experience to do this, see if your vendor can provide training or whether there are independent consultants in your area who can help you. It is a small investment that pays for itself many times over.

12. Less is more.

Plymale: Do not inundate everyone with a pile of reports. This is a mistake, and will likely decrease productivity among your staff. Information is really only valuable if it supports making decisions and taking action. Make sure your system tracks the important numbers: Patient Attendance, Days A/R, Unbilled Visits, Referrals by Source, Units Per Visit, Revenue Per Visit, Collections Per Visit, Denials by Payor or Clinic, % Recovery by Payor. More importantly, make sure the system lets you "drill down" and analyze the details behind the numbers. For example, which payors, programs, referrers, therapists, facilities, and modalities are driving the results up or down? Armed with data, you're ready to drive specific action in your organization that will improve business results.

13. Go with what you know.

Plymale: Consider outsourcing your software system needs. Depending upon the size of your business, it may make more sense. Ask yourself: Is it the best use of your resources and time to maintain a server with all the required IT support, security, backups and redundancy? If not, Software as a Service (SaaS) provides you a new option. Even a smaller organization can have access to state of the art, robust information systems previously available only to large organizations. Other functions may have both a cost and performance factors to consider when outsourcing. Billing and collections is an example of a function you may choose to outsource to a company with more expertise. If outsourcing your billing and collections improves your collections per visit by a small amount, it will prove a worthwhile investment.

14. Consider the bigger picture.

Are you up to date on the latest software lingo? See our November 2006 article, "Software Roundtable," for the must-know technology terminology.

Schweitzer: The most important factor for an existing or new practice when considering practice management is efficiency, efficiency, efficiency. Your entire practice needs to be integrated from scheduling to documentation and all the way through to billing. If any of these areas are lacking, it can evolve into loss of revenue and more importantly decreased patient satisfaction and confidence. When searching for a practice-management solution, the best candidate will not only handle your current needs but will grow with the practice. Every aspect of the practice has its own unique requirements. Scheduling, for example, is much more than just putting a name in a time slot. A good scheduling system will allow you to book multiple appointments quickly, search for next available appointments, and have multiple views of the schedule for the day, week, and month. The ability to confirm the appointments with automated reminders will greatly increase your appointment show rates. With an efficient practice you can spend more time with the patient, have better follow-up, get higher reimbursement on claims with less rejections, and instill confidence in your patient that establishes future visits and ongoing referrals.