Tech-savvy schools reclaim millions
By Corey Murray, Assistant Editor, eSchool News
November 10, 2004

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When officials at the San Diego City Schools decided to convert the district's special-education system to a new computerized tracking database, it marked the beginning of the end to a long-running bureaucratic nightmare for special-education director Carolyn Nunes.

After spending her entire career struggling to keep pace with the unending barrage of paperwork that followed every one of the district's approximately 17,000 special-needs students through the school system--the second largest in California--Nunes was convinced the district needed a more efficient means of ensuring that eligible students were receiving the care they so desperately needed ... and deserved.

"We were looking for something that could capture everything we needed into one system. In addition to tracking student timelines, we wanted a system that had the ability to keep us in compliance and potentially help us increase our revenue recovery through MediCal," California's version of Medicaid, Nunes said.

San Diego is one of dozens of school systems nationwide reportedly benefiting from the use of new technology designed to track, monitor, record, and report the delivery of special-education services.

Not only do these electronic tools promise to reduce dramatically the amount of paper pushed across administrators' desks on a daily basis, but some say the technology is helping foot the bill for special-needs children--giving schools a much more efficient means of applying for and collecting millions in state-provided Medicaid reimbursements.

In St. Paul, Minn., special-ed coordinator Janet Lowe estimates the district increased its recovery of Medicaid funds by more than $1 million--and as much as 90 percent--per year after moving to an automated tracking program furnished by Boston-based Public Consulting Group Inc. (PCG). And in Baltimore City, Md., officials realized a tenfold increase in Medicaid recovery--to $25 million--within three years of upgrading to a software program from Baltimore-based 4GL School Solutions.

Though the St. Paul school district was entitled to reimbursements from the state for a variety of services, Lowe said, the sheer volume of paperwork and the complexity of the reporting requirements often precluded busy administrators from applying for anything more than standard nursing services.

Using the automated filing system, she said, district officials now can apply for state money to fund everything from physical and occupational therapy sessions to speech and audiological services, as well as necessary social work and additional paraprofessional support.

Accountability is another benefit. Instead of digging through rooms full of file cabinets to account for services provided to students, Lowe said, special-education teachers and district and state auditors now can see those services reflected almost instantly by logging onto the system, which even allows service providers to fill out the necessary paperwork from their Palm Pilots almost immediately after meeting with students.

Clark Easter, chairman of 4GL, which also worked on the San Diego project, first envisioned the benefits of an automated special-education system in 1996.

Charged with helping the beleaguered Baltimore City School System meet its timelines for special-education children, Easter began searching for ways to expedite a process that, at the time, was failing to adequately account for 30 percent of the district's special-needs students. The situation was so bad, in fact, that the district was under a judicial decree to get its house in order, Easter said.

The problem with a paper-based system is that it's not very efficient, Easter noted. When a special-education service provider--whether a student psychologist or a physical therapist--comes to the school to meet with a child, the provider's top concern is to provide assistance to the student. And that's a good thing. But it also means the paperwork is likely to get put off until the service provider returns to his or her office. For most schools, Easter said, that's where the trouble starts.

Without the proper paperwork in hand, administrators have a difficult time keeping track of which students are receiving adequate care and which are being forced to go without. In the public school system, every special-needs child is required to have an individualized education plan, or IEP, that charts a course for success from kindergarten through high school graduation. Failing to provide services prescribed in an IEP is a violation of federal law and opens the school up to potential lawsuits filed on behalf of frustrated parents.

For schools, finding the money to pay for such services--from psychoanalysis to physical and occupational therapy--isn't easy. Though special-education students typically account for less than 20 percent of a school system's total enrollment, Easter said, districts can spend as much as 50 percent of their full education budgets on special-needs programs.

Fortunately, schools can use state Medicaid dollars to pay for these services, assuming that that the paperwork is done correctly and handed in on time. But that alone can be an onerous task. To receive payment for special-needs services, administrators first must navigate a complex web of forms and procedures, which makes meeting deadlines for claims virtually impossible in most cases, Easter said. As a result, it isn't uncommon for school districts to get less than 50 cents on the dollar for treatment rendered, leaving them to pay for the remainder of the services out of pocket.

Easter blames the bureaucratic headaches on faulty logic.

Most administrators, he said, make the mistake of approaching Medicaid and special education as two separate bureaucracies within the school system. "This is one of the key reasons why districts don't get the Medicaid [reimbursements] they should," Easter said.

When he arrived in Baltimore City eight years ago, the district was reportedly receiving $2.5 million a year in Medicaid funds from the state. Three years later, after upgrading their records-keeping process and eventually switching to an automated system, officials reportedly reaped more than $25 million in claims reimbursements.

"People were incredulous that there was that much money there," he said. "What they failed to realize is that Medicaid and special education are two halves of the same coin."

Convinced most school systems don't do a good job of teaching staff about Medicaid-eligible programs, Easter set out to design a set of tools that would help other districts achieve similar benefits.

Though the list of eligible services is different in every state, "many of the services kids need are reimbursable," Easter said.

Today, a number of companies--including 4GL, PCG, and Mobile, Ala.-based Software Technology Inc. (STI)--market web-based software solutions designed to simplify the administrative burdens inherent in special-education record-keeping, while optimizing the financial opportunities available to schools.

4GL's product, called ENCORE!, has a number of components that can be bought and deployed separately based on a school system's needs. Among these are Timeline Tracker, which aims to manage all phases of the IEP process for students, and Forms Tracker, designed to streamline data entry with electronic versions of district-specific forms used by special-education teams.

The ENCORE! suite also includes a number of optional modules, including Claims Tracker, an automated billing application that allows districts to file claims for reimbursable services; and Encounter Tracker, which documents the delivery of direct and administrative services, among other features.


PCG, which claims to have helped save U.S. school districts more than $750 million in special-education services, markets a web-based program, called EasyTRAC, for clinicians and service providers that lets them fill out required paperwork for individual students on site using a Palm Pilot or other handheld device. A similar service, called EasyAOC, is available to help district staff coordinate the delivery of health-related services to students.

"With paper, there is a long lag time" between when the analysis is done and when administrators actually see the claims reflected in the system, said Dan Wistman, associate manager for PCG. Conversely, the web-based model allows customers to track in real time which services are being delivered to students.

Working with more than 1,000 school districts across 17 states and the District of Columbia, PCG also provides tools for creating and tracking IEPs, including a Process Wizard feature, which helps guide special-education teachers step by step through the rigorous filing procedure, cutting the amount of time spent on paperwork by as much as 30 percent in the first year of implementation, Wistman said.

Using the tracking tools not only enables special-ed teachers to become more efficient, Wistman said; it also helps administrators track how special-education dollars are being spent within the system--an important attribute, especially where critics have questioned the rising costs of special education, "so that they know the money is being spent wisely," he explained.

STI offers similar features through its Special Education Tracking System (SETS). Besides automating and monitoring the IEP process, SETS lets teachers and administrators access students' guardian information, schedules, attendance, disciplinary records, and teacher demographics.

Karen Snelling, special-education director for the Boone County Schools in Kentucky, said SETS has done wonders for the district's special-needs programs.

"I can pull up any student's information in any school at any time," Snelling said. Before SETS, it wasn't uncommon to sit through six hours of meetings and hours of documentation in order to complete a single IEP." It was an astronomical task," she said.

What's more, SETS is deployed statewide in Kentucky, meaning special-ed administrators in Boone County can import and export IEPs to and from other districts, allowing Snelling and other district leaders to share important information and keep better track of students as they progress through the system.

Though Medicaid savings are just beginning to become a reality for most schools, proponents of automated special-education systems contend the cost savings on administrative processes alone is enough to justify a switchover.

"The burden of compliance is grueling in special education," said Sam Dempsey, director of exceptional children's programs for the Winston-Salem Forsyth County Schools in North Carolina. This large urban district employs more than 1,000 special-education staff members across more than 70 buildings.

According to Dempsey, paperwork is the No. 1 reason teachers leave the profession.

In the eyes of the nation's special-education teachers, the very word "paperwork" is enough to invoke images of an endless bureaucratic morass, the likes of which would discourage even the busiest accountants at tax time.

By increasing the efficiency with which paperwork can be done, Dempsey said, special-ed teachers can spend more time in the classroom working with students to achieve higher gains.

Before going high-tech, Dempsey said, teachers and administrators in Winston-Salem were required to fill out forms with more than 370 different regulations--by hand. The process took hours, he said. Worse still, if someone happened to make a mistake, the form would likely be deemed ineligible, meaning the school could forget about Medicaid dollars.

But the electronic system guides educators through the process, ensuring that each form is filled in completely, thus eliminating a vast majority of the clerical errors that for years marred the district's clumsy, paper-based system. If educators try to enter data into the wrong box on an IEP form, the program stops them. Likewise, if they neglect to complete any portion of the form, it reminds them to do so.

That doesn't mean mistakes have been eliminated entirely. "There is no such thing as a foolproof system," Dempsey acknowledged." But it helps."

Administrators still must convince their staff the system is worth it. Teacher buy-in is critical to an effective implementation, Dempsey said. In Winston-Salem, the philosophy is simple: Train the willing, and the rest will follow--eventually. Once the district has the support of the majority of its educators, it can then mandate use of the technology, forcing the holdouts to come around, he said.

Before the school system's deal with 4GL, Dempsey said, its special-education teachers were spending an average of two hours apiece on the individualized learning plans.

Now, he said, teachers can prepare a draft in as little as 15 minutes. What's more, the electronic forms can be updated and replaced automatically across the entire school system. In a paper-based environment, he said, it was difficult to ensure that teachers and administrators were receiving the most up-to-date forms. Now, whenever educators sit down at their computers to access the system, they can expect to have the most recent forms at their disposal.

The system also can be configured to notify administrators when an update is required, Dempsey said. For instance, when a special-ed child moves from elementary school to middle school or makes the jump from middle school to high school, administrators are required to update the student's IEP folder with a transitional plan. If the plan is not turned in on time, the student's folder runs the risk of being deemed non-compliant. The electronic alert system helps ensure deadlines are met and keeps updates from falling through the cracks.

The technology reportedly has enabled teachers to communicate more effectively with parents, too, Dempsey said. Instead of spending the majority of parent-teacher conferences dwelling on logistics and paperwork, "you can talk more to the parent about the child," he pointed out.

And it isn't just the allure of efficiency that has schools in Winston-Salem scrapping their paper-based systems in favor of computerized databases. According to Dempsey, the technology is proving to be a money-saver as well.

In the two years since Winston-Salem began using 4GL's technology, Dempsey estimates, the district has saved upwards of $2 million in administrative costs. That includes a 90-percent reduction in printing costs alone. Dempsey said central office administrators emptied 70 four-drawer file cabinets, which were redeployed within the school system to provide much-needed storage space for teachers. "Everything gets redirected back into the program," he said.

Back in San Diego, Nunes said that while she couldn't imagine life without the technology, it's not a panacea.

"You cannot separate training from the law," she cautioned. Even if technology makes the job easier, it's still up to educators to file the necessary paperwork and prescribe appropriate services for students. And getting it right takes time.

"A large, painful challenge for us is teaching people to do things the right way," she added. "But I'm a visionary. I know that two years down the road, it will be a beautiful thing."

Links:

4GL School Solutions

Public Consulting Group Inc.

Software Technology Inc.