What specific business areas should PTs evaluate when deciding on what software will help them the most in managing their practice?

Brooker: The key factors that PTs should consider when looking at a software system are its impact on: (1) profitability, (2) quality of patient care, (3) compliance (i.e. reduction of adverse audits), and (4) the job satisfaction of owners, therapists, and other staff. Regarding the interplay between billing, documentation, and scheduling modules, my advice would be to plan to use all three. If your practice wants to go slowly, I recommend starting with billing module (it will have the most impact on your profitability), then add scheduling, then documentation, at your own pace.

Gomez: Productivity and time-management. Software should make the therapist and support staff more efficient and productive, not less. A telltale sign of complicated software is the amount of time it takes to train users. The longer it takes to train on using the software, generally, the software will be more complicated to use. Technical support is another consideration. When a user needs support, what are their options? Does support cost extra?

Hammer: A system investment will yield the highest return when it is a full workflow management system. A high administrative return on investment comes through scheduling, appointment reminders, and referral/authorization management. A high financial return on investment comes through payor-compliant documentation and denial management tools. A high clinical return on investment comes through a standardized documentation module that is deep and rich with relevant content.

Lee: A clinic's software management program should have strong practice analysis reporting capabilities. Every aspect of a practice should be able to be analyzed—from employee productivity to detailed referral analysis, to charting compliance of providers, to providing data for effective marketing campaigns. Clinic owners should seek practice software that can automate some office staff tasks such as insurance eligibility checking and appointment reminder calls. These capabilities can save thousands per year in staffing costs. Finally, a clinic owner can greatly benefit by finding a software product that can be configured to match the workflow in their clinic. Too often, practices need to adjust their operation to match the dictates of the software program—rather than the other way around.

McMullen: The specific business areas that PTs should evaluate when deciding or determining what software will help them most in managing their practice should come from an analysis of their own practices key deficiencies or defects. These could be anything from claim denials due to improper coding edits or missing documentation; or decreased visits per referral due to increased patient self-discharge rates or poor overall referral management. Each PT owned practice should have established operational benchmarks that are measured and reviewed on a weekly if not daily basis. Any critical shortfalls or deficiencies over a period of time should reveal business areas that are candidates for benefit from practice-management software.

Morrill: Rehabilitation practices should start with defining the goals of their organization and how they are progressing. To figure out where investment dollars should be spent, a good process is to split the clinic into three sections; clinical, font office, and back office. Next, identify the activities that occur at each section, and determine if they can be made more effective by specific features of the software you are looking at.

Palumbo: While the quick solution may be to consider billing, you would be doing yourself a disservice looking at billing only for practice-management software. Since the collection of data necessary for proper billing occurs in several areas and by different personnel of the practice—front desk, therapist, and biller—the software you choose should have the ability to collect data from all by improving the current workflow and data-gathering process. In terms of impact, you will see the most immediate changes in efficiency with scheduling. Billing would have the biggest impact on the bottom line, of course. And having an electronic medical record ties those two areas together and will provide the biggest effect on personnel and patients.

Petrie: Some of the key business areas any practice must evaluate include: (1) growing your practice by getting new patients, (2) delivering quality care that makes that growth possible, and (3) maximizing revenue from services rendered through billing and collections. To manage any of these business areas effectively, you need to pull together data siloed throughout your practice. For instance, getting new patients will require analyzing the sources of your referrals (data in your scheduling software) combined with the value of those referrals (data from your billing function). So when deciding where to invest, strive for best-of-breed functionality across the board—scheduling, documentation, and billing—because all of these functions play a role in all of your key business areas.

Stone: Documentation software that contains coding and billing alerts for the point-of-care therapist will go a long way in improving the management of any rehab clinic's practice. Documentation that clearly identifies "medical necessity" on all patients will streamline the processes and minimize the negative consequences of future audits. There are many billing and scheduling programs that sufficiently do their job, but the documentation application is the key to enhancing efficient workflow processes throughout the clinic.

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Arati Murti is the editor of Physical Therapy Products. For more information, contact .

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Consider two types of physical therapy practices in terms of implementation and adoption of practice-management software—"beginners" and "advanced." What are three characteristics that describe each of these types of practices? What would they each be considering in terms of practice-management software?

Gomez: Beginners are usually enthusiastic, trusting, and flexible but at times can feel intimidated and/or overwhelmed. Advanced users are usually comfortable, confident, and determined but can be skeptical. Beginners should look at ease of use. Advanced users should focus on ease of integration within the current workflow.

McMullen: Beginners: (1) Little or no experience with software technology, (2) Key selection criteria based on cost or price, and (3) Unrealistic expectations. The "Beginners" typically take a short-term approach and don't look at the lon-term impacts. Frequently the "beginner" does not take the time to clearly define the critical business needs up front, which results in a mismatch between the needs and strength of functionality that exists in the practice management system. Advanced: (1) Previous experience with practice management software technology; (2) Key selection criteria based on critical business processes; and (3) Realistic and defined expectations. The "Advanced" are considering a return on investment in their practice management system based on that system's ability to meet their core business requirements. They typically pay significantly more attention to the depth of functionality of the practice management system to address their established business requirements versus the visual presentation of the software itself.

Palumbo: Let's start by defining "beginners" as either new practices or practices new to using software. Beginners may not have as complete an understanding of how software can positively impact their practice. As a result, they may have problems quantifying all the areas that impact their return on investment in software.

Conversely, "advanced" would be an established practice with some exposure to software. These clinics will consider all options: ownership versus hosting, staged implementations versus complete and immediate usage, expectations versus actual functionality. Lastly, having been down the road before, they better understand the roles each department and individuals have to take in order to ensure a successful migration to new software.

Petrie: Beginning practices generally (1) have fewer financial resources; (2) have each member of the team wearing many hats; and (3) are establishing workflow habits that will affect the growth of the practice for years to come. They should consider these goals when choosing practice management software: Establish best practices; Focus on your core competencies; Spend your limited resources on what you do best, and automate or outsource the rest; and Build credibility in the community. A smart investment in software can make a beginning business look professional and established. An advanced practice (1) tends to have more people, locations, and functions to manage; (2) finds that communication and teamwork become harder to achieve; and (3) finds difficulty with maintaining the "personal touch" with patients and referrers that made the practice so successful to begin with. It should consider these goals when choosing practice-management software: Identify problems quickly; Boost teamwork, communication, and efficiency; and Stay personal. A number of technologies can make your office more personal: You can reduce patient wait times with automated therapist alerts, personalize patient service at the front desk with pop-up messages initiated by the therapist or the billing department, and simplify the patient's day with detailed reminder letters containing all of a patient's scheduled appointments on a single sheet.

Plymale: Beginners: (1) They believe that right software will solve their problems in running a practice efficiently; (2) They are usually looking for the lowest cost solution; and (3) They are more open to different options (for example, they don't have a defined infrastructure in place that they are trying to leverage, or established processes that they would like the software to support). Advanced: (1) They have learned that software will not solve their problems, and have a better understanding that the underlying processes in their clinic are critical, and that software should support and uphold these; (2) They have experienced the burden and expense of hosting, maintaining and supporting software in house, and are looking for alternative solutions that eliminate these hassles, yet still give them control and visibility into every aspect of their business; and (3) They have tried to navigate their way through constantly changing payer rules and experienced continually decreasing reimbursement rates and are frustrated they are working harder and getting paid less.

Stone: "beginners" are usually brand-new clinics. Most established rehab clinics are already using billing software and have some hardware (computers, laptops, server, etc). However, they may still be in the "beginners" group because the therapists are still doing manual documentation. This group needs to find the best clinical documentation program that has a long, successful track record of interfacing with their current billing system or "best of breed" billing and scheduling programs.

There are not many "advanced" clinics out there. Still, over 80% of rehab professionals are doing manual documentation (handwritten forms and/or dictation). The ones that are "advanced" are the true pioneers, leaders, and entrepreneurs who have a strong drive to be most efficient and profitable.

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What are the biggest mistakes PTs should avoid in terms of practice-management software?

Brooker: The biggest mistake is to start out with a low-end system, hoping to upgrade to another product later on. It's much better to start with the system that will accommodate your evolution over time. [Another mistake is that] many practices don't "kick the tires" on the software vendor's customer support function and later regret it. Before you choose your software, ask how many people are on the support team and what their backgrounds are, and ask about the systems behind the support function. If possible, speak with users you contact on your own, in addition to references provided by the vendor.

Gomez: Mistake (1) When purchasing practice management software, PTs should be careful of overbuying. Many times PTs will be convinced to purchase unnecessary hardware and/or software add-ons. Mistake (2) Dealing with a software provider that has converted the software designed for a different market (ie, physicians, dentists). Mistake (3) The idea that data must be able to be transferred from old software to new software. At first, this seems like a necessity, but sometimes it can transfer problems or legacy errors. More times than not, it is easier and more productive to enter the existing patients by hand than having the data imported. A good software vendor will advise their clients as to the best course of action.

Hammer: In the purchasing phase, the biggest mistake is not conducting the proper due diligence in evaluating systems and vendors. In the implementation phase, the biggest mistake is skimping on implementation services, especially contracting with a vendor that does not provide professional project-management and/or one-on-one training during implementation. In the support phase, the biggest mistake is partnering with a start-up or inexperienced vendor that does not have the resources to support and maintain the software long-term.

Lee: The biggest mistake PTs make is selecting a solution that can't be adequately "scaled" to meet the needs of their clinic as it grows (and additional locations are added). New clinic owners are often tempted to save some money by purchasing a generic lower-priced "out of the box" solution. While this might save money in the short term, in the long run it costs, because invariably, they need to purchase a new system in a few years. Furthermore, less robust programs don't have the features built-in that can dramatically improve staff productivity.

Morrill: Practices should avoid not deciding on a budget in place before they start looking at software. It can be quite frustrating to find the perfect software for a practice and find out that it is too expensive to purchase. Another mistake to avoid is to not include key staff members in the decision making process to select a software system. Avoiding this mistake will also prove to be beneficial during the implementation phase of the software because others will see this as a collective change for the betterment of the whole practice.

Palumbo: (1) Tunnel vision: Many buyers get locked into certain ideas during the purchasing stage. For example, feeling that they must own the program instead of considering the benefits of a hosted (ASP) solution or that they must adhere to what previous software offered because that is what they were accustomed to. (2) Failing to negotiate: Don't be afraid to ask for terms for your purchase, training, and a host of other services. (3) Underestimating implementation: There is a difference between buying your software and owning it. Once you get the software, there is work that you as the software buyer must undertake to make the software your own. Your database must reflect the uniqueness of your practice, its therapists, and their techniques, but balance it with the high standards demanded by your profession.

Petrie: Mistake (1): Focus only on the immediate need. Your software is an investment you will profit from for years, so choose a system that can grow with your practice. Just because you don't need certain features today doesn't mean you won't be glad you have them in the future. Mistake (2): Rely on manuals and videos for training. A live trainer—experienced in the needs of rehab practices—can customize your staff experience to meet the specific challenges of your practice. Your people will gain a tremendous education not only in how to use the software, but in best practices for running your business. Mistake (3): Save money on support. Your software system will be the lifeblood of your practice, so if it's not running properly, neither is your business. Whether you pay separately for support or it's built into your monthly software-as-a-service fee, take advantage of it! Make sure you are getting the best possible performance from your system.

Stone: The first mistake is not doing your homework on the software company itself. You will be entering a long-term relationship where clinical and technical support and upgrades will become vital to your daily business operations. Ask meaningful questions about the company and get references. The second mistake is the clinic's manager/owner does not fully analyze the clinic's current clerical and clinical workflow processes. To fully understand where the clinic wants to be with information technology, and how to get there, starts with knowing exactly how every bit of the current operation will be affected. The third mistake is not understanding that there will be a reduction in productivity in the first 6 to 8 weeks of implementation, no matter which system is chosen. Expect to give the therapists and clerical personnel paid training time. This is a major transition that requires time and patience; however, the rewards will be enormous.