Three Reasons for Social Robots: Mobility, Humanity’s construct and Anthropomorphism

I am constantly asked why does anyone need a robot of the social, companion class or type? It is the most frequently asked question that I encounter when demonstrating collaborative style robots. This question spans all age demographics and is often the opening query of knowledgeable analysts and investors. It is offered as question in search of an answer to what remains to be somewhat of a mystery. For the young – it is phrased as “what can this robot do?” but sounds more like “impress me”. For the more senior it is “why would I want this?” OK. Fair questions. When first encountered most social robots seem to be just computer tablets on wheels. And, sadly, most early social robot demonstrations seem to reinforce that view. They are made to dance or play a song to demonstrate their hardware construct, range of freedoms and gyroscopic features. Cool, it can dance and broadcast an MP4 file so, what’s next? Where is the utility?

This current stage of development of social robots seems however to be tracking to a positive set of attributes that better demonstrate current or potential utility. First, the overarching paradigm is that social robots represent a new style of interfaces to the world of knowledge and interactions with the world around us and thus the world around the robot. Out of these interactions will emerge ever more expansive human- robot interfaces. But here again the vector seems to be a deep reliance on A.I. to detect the state of mind, emotion, discussion or inquiry path the interacting human is on or facing. You don’t need a robot just to deliver the vast amount of the benefits of A.I. When that robotic based A.I. interaction is directed at a purposeful use case like helping a child understand a medical procedure or an autistic child develop a positive response to social cues it makes more sense.

Fundamentally, it seems to me that the initial support case for the utility of social robots points to the mobility of the robot. One you experience a robot coming to your location, especially if you yourself can’t easily move around, by simply calling for it or by driving it to you from a smartphone interface or planning it to show up at certain spot at a specific time you begin to sense “hey, this is better than my laptop”. I can even get it to follow me around. And the first time a robot motors around the house and seeks you out and determines whether you are sleeping or passed out- you will get it. Or, when the robot meanders into your meeting to get you on conference call you will discover the assistive features.

The next aspect I support of social robots one needs to consider that the world that has been created around us has been formulated and driven by our own ‘humanoid form’ construct. Chairs are designed for humans. Door knobs and handles are waist high. And when we encounter things in our life that are distinctly human such as a knee joint replacement surgery we see how a social humanoid robot can perform as guidance system to lead (and encourage) surgery recovery exercises. And with the growing lack of therapists and health aides – a humanoid robot is a prime ‘mirror like’ solution to lead these exercises – while the human caregivers can attend to things only humans can. So, a social, humanoid style robot seems to fill that gap and shortage nicely. Even more so, the session leading robot never tires or needs time off or a break.

Another aspect that has clinical cache supporting the case for robots is anthropomorphism. Fundamentally, people may not always believe what a computer system screen presents but they seemingly do trust a robot. Children have little trust in a doctor or a nurse but they do trust a robot when they are told by the robot that they will be OK when facing a medical or dental procedure. Placing faith in inanimate objects is a cultural attribute of humans and is easily subscribe to. Hence that ‘rabbits foot’ in your pocket or that ‘lucky shirt’ you wear on game day – anthropomorphism. Robots are loaded with it and thus can be put to purposeful missions like treating autism, giving instructions and sounding alerts that other devices cannot deliver as well or at all.

While there is a lot more to present and discuss as we experience the rise of the robots, mobility, human construct and anthropomorphism are my suggestions for beginning to answer the question – “why would I want a robot?” Next time, we will discuss the fact that they are engaging and fun!

Mike Radice is Chairman of the Technology Advisory at ChartaCloud Technologies and ROBOTTECA.com

ChartaCloud's ROBOTTECA Launches QIHAN's Sanbot Robot in U.S

ChartaCloud's ROBOTTECA Launches QIHAN's Sanbot Robot in U.S

A dispatch from the frontlines of social and service robots

The time has come to recognize that the use of social and service robots:

·         Reduces pain and stress in children facing medical procedures

·         Lessens the impact of autism

·         Brings affordable health care to rural communities

·         Reduces hospital re-admissions

·         Reduces the debilitating impact of loneliness and isolation on seniors

·         Helps student learn more and faster

·         Increases retail store sales

No need to ponder further whether social and service robots will find a role in the business models of hospitals, retail stores, retirement communities, skilled nursing facilities, schools, libraries and in the homes of those seeking to age-at-home. The reality is that they are already advancing these business models, being driven by ever more sophisticated hardware constructs and by the software that defines and manages a robot’s behavior.

Our social and service robots are at work today:

·         Serving as remote tele-medicine health examination and health care services platform

·         Enhancing autism engagement therapies and delivering lasting positive change

·         Serving as an assistant in pediatric medical procedures reducing pain and stress in children by as much as 50%

·         Leading group exercise sessions in retirement communities and skilled nursing facilities

·         Working in retail stores to enhance the customer experience and satisfaction

·         Models for teaching students about science, technology, engineering and math -STEM

·         Serving as concierge/hospitality helpers in hotels and at major conferences and trade shows

·         Enhancing the lives of seniors via tele-presence – reducing the debilitating impact of isolation and loneliness

In the earlier days of robotics, the question was: “What can they do?” The question now is: “How and when will I start to (read: need to) use this technology”.

Mike Radice is Chairman of the Technology Advisory for ChartaCloud’s ROBOTTECA www.robotteca.com

An Update from ROBOTTECA.COM on Humanoid Robot Being Used for Assisted Pediatric Medical Care

Technological advancements, clinical research and hospital adoptions surrounding and supporting the humanoid robot called NAO from Softbank Robotics, being used in pediatric medical care continues to grow and expand. The use of the NAO humanoid robot in assisted pediatric medical care when used with specialized behavior software continues to prove itself effective in reducing pain and stress in children facing medical procedures. Adoption of the robot is now expanding into pediatric dental practices.

A few of the more common questions follow:

How does a robot reduce children's pain?

The robot is programmed to use a variety of child friendly cognitive-behavioral strategies that are known to work. When we teach these to children, they tend to forget to use them, and when we teach them to parents, they tend to use them in an ineffective way. The robot delivers the intervention in exactly the way we program it to.

Why are hospitals using the robot to interact with children while they are having non-painful medical procedures like x-ray and EEG tests?
Many children experience extreme distress during procedures because they don’t know if it will hurt. They may expect the worst. The robot helps children manage their fear of pain.

Does the robot reduce pain simply because it's novel? Would repeated use of the robot with the same children still have an effect?
Since the robot has numerous capabilities, it can do something different every time it visits with a child. Each interaction with a child can be unique.

Are any children afraid of the robot?

When children meet the robot, they typically look to the adults to see if they are allowed to touch its body. Most children give the robot a ‘high five’ when invited to do so.

See www.robotteca.com  for additional information or call ROBOTTECA at 603-580-5497

My Experienced-based Cultural Truths About Robots

 When I demonstrate robots the most frequent question I am asked is: “What does it do?”

My – admittedly, my somewhat flippant answer is: “What would you like it to do?”

The time has come to recognize that the advance of humanoid robots while presently still only at a nascent stage, has already achieved amazingly great things. Clearly though, people are trying to understand and grapple with the very idea of robots as a reality. Not just where do they fit in society? But where will they fit in my life? How will I end up interacting with them? Will I be forced to interact with them? Are they nice to be around? What role will they play in my life?  Will they take my job? What does it mean to own and use one? 

Most of the questions I get quickly arrive at the same personal level that I remember surrounded the reactions and responses to the advent of personal computers. But this go around with robots as the next new interface to knowledge, information and services has a different edge to it.

It seems that with robots we tend to want to test and probe more about the humanized traits they display. We didn’t do this so much with personal computers. They were quickly seen as friendly and as an ally and in the end a machine. And, they were deemed controllable. Robots stir up a different reaction. Does it think by itself? Does it feel the emotion it senses? Can it run off and do its own thing? Does it know what I am thinking? I was once even asked if one felt sad being left alone?

The reasons these reactions are different from the initial personal computer experience is driven by the fact that robots are intentionally designed to evoke a human-like quality. And yes, they can become engaging, empathetic and endearing. But perhaps most unsettling to some, is that robots have mobility and a certain display of autonomy. They can move about and navigate their surroundings. They turn their heads and look at you when you speak, and move their arms and hands and fingers. Some individuals I have met feel that maybe this ‘thing’ can and might ‘chase them down’. “Can I hide from it?” they ask. At the core of most of this cultural and social formulation attitudes about robots is the sense of the foreboding by many that surrounds robots in that they will be replacing people in many roles and jobs.

A lot of this emotive reaction has already given rise in Europe with the Economic Union (EU) developing ‘civil law rules for robotics’. This is of course in anticipation of the impact of and the quantity of robots we will encounter in our future society. While in and of itself a good idea to think about and consider such policies, it tends to contribute to the general uneasiness about robots in that they seemingly have already achieved a ‘lobbying status’ in governmental bodies.

In debates and discussions about these issues I inevitably return to my actual experience. When you see a child suffer less pain and stress when facing medical procedures because they are accompanied by a medical assistant robot that they trust; when you see seniors becoming actively engaged via a tele-presence robot reducing the life-threatening impact of loneliness and isolation; when you see young students in a classroom becoming excited and engaged with learning new math and science concepts and skills; when you see the elderly in a skilled nursing facility become animated over attending an exercise session led by a robot; when you see a robot contribute to enhanced care decisions and performance results in a hospital labor ward; when you see an autistic child achieve lasting social improvement progress you begin to sense the true cultural and social impact of robots…and it is good.

MACs, RACs, ZPICs and Home Care Services

Navigating the audit gauntlet in CMS billing is getting more challenging by the week and recently, it seems, by the day. Two things are becoming abundantly clear. First, and no matter how well intentioned and honest, the old methods of claims preparation and submissions no longer work. Second, and more than ever, you must avoid submitting what you can’t defend.

The first line of the gauntlet is firmly in place.

MACs – Medicaid Administrative Contractors

RACs –  Recovery Audit Contractors

ZPICs - Zone Program Integrity Contractors

Each of the above hired, licensed, paid and deployed throughout the country to oversee, review, process and question each and every claim you submit.

As challenging as understanding, complying and staying current with the medical and health care aspects of providing home care is and the proper ‘care coding’ and claims submission documentation is, the challenge of navigating and avoiding the deepening scrutiny of these multiple audit weapons that CMS has operational to oversee fraud, waste and abuse (FWA) is equally challenging. The ROI for CMS is provably simple. CMS spent $450 million on FWA programs and re-gained $42 billion. Without a blink they just announced a $11 billion charge back to hospitals for past over payments. So don’t expect the pressure to lessen any time soon. The authorities granted these contractors extends to being able to refer home care agencies to the DOJ or OIG for investigation and potential prosecution.

Quality assessment and control (QA) over claims documentation has now become a mandatory staffing and skill set requirement for home care services.

As Michael McGowan an experienced auditor now leading OPERACARE stated, “Poor documentation that doesn't show necessity, skill, or documentation to standards of CoP can all down grade a visit.  Or, visits are easily deemed non billable due to no orders to support the claim or even improper supervision.   So it is no longer a matter of RAP vs reality of how many, but so many other factors can down grade your therapy counts.  Even a whole chart with MUE can negate all therapy visits before they occur.  Only proper OASIS scrutiny in real time at SOC to plan for necessity and efficient treatment followed up by rock solid documentation can help you get the payment you think you are going to get.”

With the new pre authorization claim review, and with MACs, RACs and ZPICs and all the other audit teams out there, it is best to be sure of what you are doing and why, and make sure it all follows through.

So what can be done to lessen audit risk? To prevent being audited into bankruptcy? Use software that lets you see what CMS sees before they see it and don’t submit what you can’t defend.

The best I have seen is OPERACARE. But don’t only take my word for it.

Ben Galin of Galin Consulting after reviewing OPERACARE said “It is the only tool I have seen that automates some of these first steps to let you see your chart from a macro and micro and agency macro view simultaneously, in seconds, where it can take an entire QA team to do this in hours.”

The true bottom line is this: It is a new world, a new age and a new era for home care, one where your bank accounts now have large exit doors. It is time to step up to these new challenges with advanced weaponry of your own, show your worth and lessen your worries about MACs, RACs and ZPICs knocking at your door. OPERACARE can help you do that.

10 Strategic Imperatives for Home Care Services In The New Era

The avalanche of changes impacting home care services can only be described as dramatic. Home care leaders are now pressingly faced with addressing an entirely new era. A new landscape has been created that demands a new approach to protecting revenues, ensuring business sustainability, thus survivability, and the recasting of operational methods and processes that meet the needs of patients…and the business.

What defines this new era?

CMS: $42 billion dollars saved via its fraud prevention programs

The primary impetus is of course CMS. New regulations, reporting, coding, quality benchmarks, bundled payments are just a few to be highlighted. The heightened attention and regulatory oversight given to payment penalties, re-admissions, claims reviews and audits are CMS policies that stimulate the establishment of the new culture. One can only assume that this regulatory and heightened audit cultural impact will continue.

Underlying all of these actions and more is of course, the implied belief by CMS derived from the state of the industry, that there are too many home care services, serving too small a client base, that are under performing and are operationally, poorly managed. CMS wants fewer home care agencies serving larger client bases having financial stability. In addition is the ever deepening CMS/MAC oversight that seeks to ferret out fraud, waste and abuse. The consensus is that the number of home care agencies while having increased dramatically will enter a period of CMS motivated decline with 12,000+ agencies today becoming ~ 8,000 in just a few years.

Bottom line: all major categories of financial performance are under pressure. According to one recent industry survey source, “cash on hand” to operate has dropped to 33 days; median revenues have fallen; accounts receivable has slowed from 44 days to 68 days. Current asset to current liability ratio is worsening making borrowing problematic. Unless cash flow cycles can be improved the outlook can only get dimmer.

Everything taken together it is indeed, a new era.

The home care industry has been slow to recognize and follow the lead of hospitals and SNFs for example in successfully making operational quality and efficiency gains through automation. Hospitals and SNFs understood that outdated polices and paper based processes were not going to enable them to produce the efficiency gains and achieve the quality objectives that their new environment (and CMS) demanded. Being slow to adopt automation methods designed for the new era in home care is no longer an option given that surviving in the new era is important.

The issue is not just about running a home care business more efficiently and effectively. While adopting to the new era process may seem like added costs, industry research indicates that agencies with higher visit costs were also more likely to have high quality and satisfaction scores and be among the top performers. The new processes done correctly points to actually freeing capacity to serve more clients.

Payment Error rates (PERM) are the highest since CMS tracking began

New on-boarding methods utilizing automation can actually contribute to increased revenues. Using automated home care QA and UR pre-claims automated methods can deliver up to 50% better profit margins in many cases and actually increase the capacity of the business to serve more clients with the same staff levels.

Dealing with compliance audits and ADR requests is simply a very expensive waste of time and staff resources. Technology should be and can be the targeted solution strategy.

  

Let’s look at the new paradigm with Ten Strategic Imperatives as Guideposts:

#1 STAR Ratings are the new driver. Bench-marking outcomes are now less relevant. STARS outcomes need to be managed in real time prior to their submission to CMS.

#2 OASIS care plans have typically been written up hours or days post visit.  All care plans and service utilization decisions need to be done on site during the OASIS visits. RAP submissions should be made within 2 -3 hours of the OASIS visit.

#3 Over Utilization visits from one episode to the next need to be reduced. OASIS based data needs to drive staffing. Home care needs to use OASIS data the same way hospitals use DRG data.

#4 Outcomes data needs to be distributed to field clinicians via tools that make each field clinician accountable for the results (data) they produce.

#5 Claims submission error rate of + 40% (current average) needs to be sub 15%

#6 Hospital Re-admission rates at +27% (current average) needs to be sub 10%

What is clear from the above is that a new approach for the new era is not just needed, it is demanded. This means that new processes supported with new supportive automation methods is required.

Legacy systems built for the old era requirements of PPS will no longer meet future needs.

#7 Avoid Being Audited into Bankruptcy

If you see what MAC sees what would you do differently?

First and most essential is the ability to avoid costly and time consuming audits. It is far too easy to be ‘audited into bankruptcy’ resulting from inaccurate, or clinically inconsistent claims. Do this enough and you are on the MAC radar screen. Having software that uses the audit analytics that MAC uses aids you in not submitting what you can’t defend.

#8 Don’t Miss Securing Additional Justifiable Revenues

Missed revenues is significantly more prevalent than most home care service providers realize. Having software that can align claims with additional, justifiable revenues is critical to survival and stability.

#9 Transition to a New Era Repeatable Process

Getting ‘real time’ claims feedback enables improved, speedier claims filing without a seeming unending cycle of ADRs. Cash flow cycles improve.

Establishing new process methods that binds field clinicians with QA staff lessens inaccuracies, speeds accurate claims and will in the end lessen staff requirements and improve capacity to handle more clients. This is a key factor as having definable repeatable on-boarding processes if the foundation that underlies stability.

#10 Win New Business Based on Facts and Data – Win with Strong ‘Value-based Purchasing’

Being able to generate outcome analytics that supports quality claims becomes the basis for new business marketing that differentiates your service and attracts new business.

The re-design of home care delivery is real. The numbers of the growing elderly population with expanding care needs is real. CMS’ new regulations and ‘submission demonstrations’ are real. Increased MAC audit pressures are real. True home care service leaders will advance to meet these realities -- the opportunity to survive and excel is real.

Michael McGowan is President of OperaCare Inc. | Michael Radice is Chairman, Technology Advisory Board, ChartaCloud Technologies LLC | PHOTO Credit: lehrmach2.blogspot.com

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