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Integrating Care Coordination in the Revenue Cycle
- 1. TraceCommunication.com “Integrating Care Coordination in the Revenue Cycle” May 6, 2014 | 1pm ET, 10 am PT Thank you for joining today’s webinar. The presentation will begin at 1pm EST.
- 2. TraceCommunication.com “Integrating Care Coordination in the Revenue Cycle” May 6, 2014 | 1pm ET, 10 am PT
- 3. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Today’s Webinar Agenda • Housekeeping Items • Introduction of Speakers and Presentation • Q&A Session
- 4. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Housekeeping Items • Welcome to Today’s Webinar! – Phone lines will be muted – For technical support, please contact: WebEx Technical Support 866-229-3239 or support@webex.com
- 5. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Webinar Playback • Today’s presentation will be recorded. • View past recordings on our website: TraceCommunication.com/Webinars
- 6. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Asking Questions • Submit questions at any time using Q&A box in the bottom right hand panel • Questions will be addressed at the end of the presentation
- 7. TraceCommunication.com “Integrating Care Coordination in the Revenue Cycle” Darlene Gondrella VP of Care Coordination West Jefferson Medical Center
- 8. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Today’s Presenter Darlene Gondrella, RN, BSN, CCM Vice President, Care Coordination West Jefferson Medical Center
- 9. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Today’s Agenda Engaging care coordination in the revenue cycle Integrating clinical & revenue cycle teams Bridging communication gaps Reducing admissions
- 10. TraceCommunication.com Care Coordination Strategies for Improved Performance Care Coordination at WJMC Integration with the Revenue Cycle Processes to Improve Rev Cycle Performance Darlene Gondrella
- 11. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. West Jefferson Medical Center 427-bed, not-for-profit community hospital in Marrero, LA, close to New Orleans Medical staff of more than 400 and employee/volunteer base of 1900 National awards for clinical excellence across many of our subspecialties
- 12. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Care Coordination at WJMC • Case managers • Social workers • Discharge planners • Discharge expeditor Inpatient • Case managersOutpatient
- 13. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Care Coordination in the Revenue Cycle Chief Administrative Officer • Patient Access • Case Management (Inpatient and Outpatient) • Patient Business Services • Health Information Management • Physician Clinics • Hospitalists • Cardiac/Neuro/Oncology /Palliative Care Service Lines • Marketing • Retail
- 14. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Integration with Care Coordination Bridging communication gaps Decrease unnecessary denials Reduce readmissions to prevent reduction in pay penalties
- 15. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Revenue Cycle Team •Patient Access Services •Case Management •Patient Business Services •Health Information Management •Service Line Development Meets monthly with CAO
- 16. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Revenue Cycle Team Coding Denials Trends RAC audits Training needs New CMS rules and regs
- 17. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Bridging Communication Gaps Monthly meetings Education, Education, Education Access to transparent, timely patient information and data
- 18. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Education Physician office lunch & learn sessions Monthly hospitalist meetings Articles in physician newsletters re: upcoming regs/changes that affect the Medical Staff Interdisciplinary team meetings for new service line development
- 19. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. CM in Relation to the Revenue Cycle
- 20. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. CM Challenges •Number of days approved, level of care •Lack of clinical Medical Necessity Denials •Inaccurate or incomplete documentation •Missing information Documentation Failures •Rework, inefficiency •Payment delays, underpayment Time Constraints •Duplication •Manual, paper-based process Medicaid Notification •Time intensive •Back and forth Discharge Planning
- 21. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Technology Implementation Real-time recording of all conversations Ability to send transcripts of recordings to insurance companies Reduced denials, less time spent preparing appeals Complete record of information coming in and going out Improved workflow and time savings Savings in paper record storage Capture and save information in a single click Less time spent printing, scanning and filing Reduced medical necessity denials
- 22. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Patient View
- 23. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Coordinate daily CM activities
- 24. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. CM in Relation to the Revenue Cycle
- 25. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Pre-Admission Patient class for ED Admissions Inpatient only procedures
- 26. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Admission Document clinical reviews for urgent/emergent admissions Record precert and eligibility calls Record admission notification
- 27. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Concurrent Record concurrent review calls with payers Capture clinical information and fax electronically
- 28. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Discharge Blast fax discharge placement Fax orders/discharge summaries to HH agencies
- 29. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Post-Discharge Insurance logs/denial letters Denial Appeals Process Patient Follow-up
- 30. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Denial Appeals Follow-up More efficient use of time • Proof of authorization • Proof of notification • Proof of clinical info sent Proof of authorization lead to decreased denials
- 31. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Initial Outcomes Avoided initial denials from payers by showing documented proof of calls Improved turnaround time on claims payments by 30 – 60 days Increased percentage of medical necessity denials overturned from 56 percent to nearly 83 percent Reduced number of medical necessity denials Allowed case manager previously handling appeals to take on full case load
- 32. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Patient Follow-up Outpatient Care Coordination • Phone calls post discharge – recorded • Early identification of symptoms – early intervention • Review calls for quality • Teachback • Customer service • Complaints • OP can resend information that was previously sent to HH agency with click of a button
- 33. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc.
- 34. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Reduce Readmissions CTC Clinic • Free service – appt in 24-48hrs. • Assists PCP when they do their follow up visit in 3-5 days Dispo codes for planned readmits – CM working with HIM to ensure correct coding Dispo codes for AMA
- 35. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc.
- 36. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc.
- 37. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Conclusion Important to involve patients and caregivers in Plan of Care Will lead to: Better outcomes Reduced denials Reduced penalties Improved transitions of care Integration of Care Coordination in the Revenue Cycle is essential to hospital success.
- 38. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Questions? Please submit questions using the Q&A section in the participant panel.
- 39. TraceCommunication.comProprietary and Confidential ©2014 The White Stone Group, Inc. Thank you! Blair Wright The White Stone Group, Inc. blair.wright@twsg.com Darlene Gondrella West Jefferson Medical Center darlene.gondrella@wjmc.org
Editor's Notes
- Great Intro Blair.And Welcome to everyone listening today from all across the great USA! Now, let me tell you a little about myself. I have been at WJMC for the last 16 years. As the VP of Care Coordination, my areas of responsibility include IP Case Management (which includes Case Managers, Social Workers, Discharge Planners, Discharge Expeditor and clerical staff), OP Care Coordination (which we will spend a little bit of time on here today) and PAS. As Blair mentioned Current Healthcare Challenges span the entire spectrum from clinical to financial and Care Coordination is the bridge that connects the 2. So, hopefully today I will be able to share with you some ideas and processes that we have implemented here for Care Coordination enhancement to improve the revenue cycle process. I will do my best to leave time for Q&A at the end of our time, but if time runs out, I will be happy to take calls/emails from you and my contact information will be listed at the end of the presentation.
- Of course, I must take a moment to highlight West Jefferson by telling you just a few of our proudest accomplishments. West Jefferson Medical Center is a 427-bed not-for-profit hospital and health system located in Marrero, Louisiana, just outside of New Orleans. We have provided more than four decades of service to the West Bank of Jefferson Parish and the surrounding area. We are one of only three area hospitals that kept its doors open in the onset and aftermath of Hurricane Katrina’s arrival on the shore of New Orleans in August 2005. And I was there through it all, but that’s a story for another day!We have over 400 physicians on our Medical Staff, over 1900 employees, 67 volunteers, 23 Nurse Practitioners and over 350 contracted employees.Just to name a few of our most recent awards:-Top 100 Hospitals with Great Heart Programs (Becker’s Hospital Review)-Get with the Guidelines Stroke Gold Plus Achievement (AHA, Am. Stroke Assoc)-Mission Lifeline STEMI Gold Recognition (AHA)
- Case Managers – 12Social Workers – 14Expeditor – 1D/C Planners – 3Clerical – 3Managers – 2Weekend coverage on site by both a Case Manager and a Social WorkerStaggered hours to allow coverage on site until 7:30 M-F and until 5:30 Sat and SunOn call coverage for all remaining hoursOP – 6 but in process of hiring a 7th and expect to continue to expand in this arena.
- Many CM depts fall under the Nursing Division, which is outside of the Revenue Cycle areas. Here at WJMC, we have always been under the same umbrella with the rest of the Revenue Cycle Team.So, as you can see, we report to the CAO, and I’ve listed all the depts that fall under the same division. PAS, HIM, CM, PBS, (which are the typical revenue cycle depts) along with a few others.
- So, what are our goals for Revenue Cycle Integration with Care Coordination?Well, at this point we have 3 main areas of focus:Bridging Communication GapsDecrease unnecessary denialsReduce readmission penaltiesAnd I’ll go into a little more detail for each of these as we continue through the presentation.
- I’m sure many of you have this already in place, so like you, we have a Monthly Revenue Cycle Team Meeting. This is not a meeting with just the Directors and Managers of the dept, but it also includes the Respective Vice Presidents of the area, and the CAO. In order to really be productive and identify and strategize on our opportunities, we feel it is important to have Top Leadership in the meetings as well as some of the front line supervisors, managers in each area.
- Some of the issues/topics we discuss, include coding, denials, trends, RAC audits, training needs (whether it be for staff, physicians, physician office staff, etc), And of course new rules and regs from CMS (as we all know that these change quite often and keeping up to date with them can sometimes be a challenge).
- As I mentioned, the goals of Integration of Care Coordination in the Revenue Cycle, include Bridging Communication Gaps, Decreasing denials and reducing readmissions, So, how do we do this?For Bridging Communication Gaps:As I previously stated, we have monthly team meetings. And then depending on an issue that might come up, we may need to have additional subcommittee meetings.This also includes meetings to discuss new service lines being implemented like Palliative Care or Heart Failure Resource Center. Too many times, a dept begins implementation of a project only to find out at the last minute that Go Live has to be delayed because they forgot to get the input from PBS on how they were going to bill or what codes were to be used and what the charges were going to be. Or, they forgot to include registration to see what accomodation code is to be used and how the pt will be registered and if a registrar would be needed in that area vs. presenting to central registration. Involving all the players is essential to the success of a roll out of a new service. For example, the ortho service wanted to implement a new product that was to replace our standard SCD pumps in house, which included a portion of pump use at home. No-one included CM and we were the ones who knew if the payors would authorize such a new product.
- Another way to bridge the Communication Gap is Education! We all know that consistency and accuracy in our workflow prevent errors which could lead to unnecessary denials. In addition, staff turnover can also lead to increase in errors due to learning curves of new staff. So, the #1 thing we can do is to constantly Educate. We educate each other between the various depts (for ex: contract changes, coding changes, denial reasons, trends, etc). We do quarterly Physician Lunch and Learn sessions, attend monthly Hospitalist meetings and submit articles for inclusion in the Physician newsletters. -In addition, we will go as a team to physicians offices to educate them on processes relating to prior auth requirements from payors, etc. We recently met with a Neurological group regarding differences in levels of care for elective surgeries and what this means to us and to the payors and why the communication between the physician offices, the payors and Case Management is essential to ensure accurate and appropriate billing.We also have Interdisciplinary meeting for service line development: For example…-CTC development (Care Transition Clinic)-Heart Failure Resource Center development-Cancer Center-Palliative Care-urgent care clinicWe make sure all depts affected in any way, sit around the table together to discuss before the roll out of any new service. As a nurse myself, we know that clinicians think about what they can do clinically to help our patients, but someone has to think about the charging, coding and billing process in order to ensure payment for the great services we decide to implement.
- We thought this slide would be a good way to show all the phases where CM and Revenue Cycle integration is crucial to cash flow.Admission PhaseProviding clinical reviews to payors for urgent/emergent admissions. Admission review of elective admissions.Early identification of discharge needs. Concurrent PhaseApplication of utilization management criteria such as Interqual or Milliman Care Guidelines to all inpatientsProvide timely concurrent continued stay reviews for payers and take appropriate action when criteria are not met.Discharge PhaseFinal review of authorized daysExecute the discharge planPost-discharge PhaseActive denials management and timely response to post-billing denials and outstanding reviewsClearly identify how denials management responsibilities and accountabilities are divided between finance and case management (medical necessity, appeals process)Follow-up with patients with discharge plans including home care and durable medical equipment
- Let me reflect back on some of our challenges in CM before reviewing our 3rd way to Bridge Communication Gaps……-Some of our challenges included:1- Medical necessity denials (2000 - medical necessity denials were more than $700,000)He-said, she-said challenges Discrepancies over number of days approved, appropriate level of careDisputes over payment when case manager gave clinical but payer had no record of call2-Documentation FailuresInability to document routine communication, other than manuallyDifficult to remember to document in the financial system post discharge, which still sometimes happens today (however we ask the business office to check TRACKER before calling CM to research)Inaccurate or incomplete documentationPatient account numbers transposed, putting the information on the wrong account, preventing retrieval later on. (HL7 interface in TRACKER so it is much less likely to have errors like this)3-Time Constraints: Inefficiencies, Delays, UnderpaymentConstant rework in collections (back and forth between business office, case management and payer)Payment delayed an additional 30 to 60 daysIncreased medical necessity denialsUnderpayment for services rendered-So, as you can see…..from eligibility and benefits, to precert to authorized days to physician communication and discharge placement, COMMUNICATION is complex!-and our communication activities are: -numerous -daily -across multiple venues -many times seem insignificant – and often overlooked -and they have VALUE!-so, we implemented a tool that allowed access to transparent, timely, patient information and data which is another way that we bridge the communicate gap and integrate CM into the Revenue Cycle.Next Slide please
- So, Technology Implementation…..-we implemented TRACE Tracker. This gives everyone access to the same information and it is time stamped. This tool allows depts like PAS and CM to record calls (both incoming and outgoing) or to keep track of authorization logs, denial letters, etc from the payors so that if there are any discrepancies on the payment on the back end, the Business office can just look in TRACKER and pull up the information. Once retreived, they can share that information with the payors claims dept to resolve any issues we have with underpayment of claims or false denials. -Again, as I said, all depts can access information entered into the system by the other depts. It allows for more efficient use of time and proof of the authorization which leads to a decrease in denials. It saves paper and toner and eliminates filing cabinets.Another way that this tool helps is on the Discharge Planning piece in the hospital which allows for blast faxing to multiple post acute care providers and it helps in the OP setting which I will go into a little later.
- So, looking back at this slide that I showed you a little earlier, lets walk through each step in the process to show CM’s role in the Revenue Cycle process and why this is so important to your bottom line.
- Pre-Admit Phase:-CM reviews cases for appropriate level of care based on Medical Necessity criteria (or the 2MN ruling) and informs patients of their level of care and what it means to them.-We also review all elective surgeries for appropriate level of care as well as for IP only procedures to ensure orders are correct at time of admission to ensure accurate auth is obtained if needed by the payor and to ensure appropriate billing/payment.-and we all know the payment could be vastly different for OBV for IP so it is essential to ensure we get the level of care correct to ensure we get the right payment for the services we provide.
- Admission Phase:-Admission notification is required by the payors or they are quick to issue an administrative denial. So, we record all admission notifications to prevent any denials, as we will be able to prove to the payor that the notification was indeed done.-Eligibility and Precert calls are also recorded so that not only do we have proof of authorization but prook of what level of care the auth was called in for. We then can listen to these calls for quality assurance, which helps us to identify opportunities, which if found, we can then re-educate the appropriate staff. For ex: Perhaps the registrar called it in for an admission but it wasn’t clear if it was for OBV or IP and later there is a dispute about it. Listening to the calls allows you to identify your opportunities and correct the issue.-Documentation of clinical reviews. We do this through calls and/or faxes depending on the payor. Both methods are done using the tool so that we have documented proof that it was done. Again, listening to these calls allows you to hear the details of the clinical review, hear the approval decisions and if opportunities were identified, we can correct the issue. For example, we had identified that when the CM’s were recording the calls, they may forget to initiate the recording at the beginning of the call when the patients name was mentioned, and they hit the record button just for the approval part. The problem was that on the back end, even though we had a recording, there was no proof of what patient it belonged to therefore it did nothing for us. Re-educating the staff and letting them hear the call and how it was not going to help us make a case on the back end, made them realize the opportunity and change their process.
- Concurrent Phase:-Pretty much the same process as admission with utilizing faxes and recorded calls to ensure proof of clinicals being sent to the payors was captured.-this is a huge time saver and we have eliminated fax machines as these faxes are able to be sent through the computer workstation without ever having to stand at a fax machine.
- Discharge Phase:-At our facility, social workers are responsible for securing placement for patients in need of additional care upon discharge. Prior to TRACE, social workers used the following process for discharge planning:-Compiled hard copies of documents such as patient’s medical record, history and physical, x-rays, medication list and progress notes-Manually faxed the 30-page document to nursing homes and long-term care facilities-Continued sending faxes until placement was secured, often having to update the information or feed the fax one page at a time-Spent minimum of 5 hours per week on discharge planning as a department-This process took time away from the patient at the bedside as they were busy standing by a faxNow that we’ve changed our process, clerical staff can assist in discharge planning. -Clerical staff use FaxCert to send discharge placement forms to multiple facilities at one time. Allowing my Social Workers to spend more time at the bedside with the pt instead of doing clerical type tasks.-they can PixCert orders out of system and fax directly to LTAC’s and NH’s, and sometimes home health agencies without having to print a single piece of paper from the EMR.-Blast faxing function allows staff to fax the forms to pre-determined distribution lists through DCR Tracker. And we can later expand the search for difficult placements by just selecting the original transaction in Tracker and resending to a new group of facilities.-If placement is not secured after the first distribution, the fax can be resent to a new distribution list with an expanded search area (no need to redo paperwork)-If the patient’s status changes, staff can add an addendum to the fax with new progress notes instead of re-doing the paperwork.Of course, the EMR that we use is Cerner and we have been very successful with capturing this information using the tool without ever having to print 1 single piece of paper. This tool quickly became the staff’s best friend, but there was lots of resistant to the process initially (as we all know how resistant people can be to change).Next Slide please
- Post Discharge Phase:-As I’m sure many of you face the same challenges with claims payment as we do, and often times a claim gets rejected/denied the first time out the door.-this is why bridging that communication gap and having a tool that can be used by the Business office to help get these claims paid timely is so important.-CM used to be very involved on the back end when claims were denied and many hours had to be spent researching cases and even calling back the payor review nurse back weeks after discharge to fight a claim dispute. Now, we are rarely involved as the Business Office does the research in TRACE themselves to get the proof they need to send to the payor to get the claim paid. The only time we really need to get involved is when TRACE was not used, which then leads to staff re-education!-Another part of the Post Discharge Phase is patient follow up which we’ll talk in further detail in just a few minutes.
- So, I know we’ve talked about a lot, so I just want to remind you of our 3 goals of CM integration into the revenue cycle: Bridging the communication gaps, Decrease denials and reduce readmissions. We’ve talked a lot about the 1st one and have touched some on the 2nd one with decreased denials but here I’m going to touch a little but more on Goal #2 of why integration of Care Coordination into the Revenue Cycle is important….which is denials-so, we know that Proof of authorization lead to decreased denials-Our process now allows for more efficient use of time – PBS can search TRACKER for authorizations, proof of notification, proof of clinicals being sent in, etc and provide that to the payor either through email or they can even play the recording back over the phone to the payor to expedite claims reprocessing.I want to give you a recent example, we had a payor in the last 6 months who sent letters to PBS regarding payment recoupments on several patients resulting in upwards of 50K dollars. Lucky for us, the Business office keeps CM “in the know” when things like this happen. We have a financial system where CM puts notes to indicate authorization and these were clearly documented as approved by the payor. But of course, with just that, it was my word against theirs. So, we looked up all those accounts in TRACKER and sure enough we had logs from the payor with the actual approval from them on their template form. We called a meeting with the CAO, VP of Revenue Cycle, myself (VP, Care Coordination) and the payor which included their Executive Director, their UM Manager and their Medical Director. We laid out on the table all the approval logs from them on these patients they were trying to recoup on. Needless to say, we won on all cases AND in the process, the payor realized they had holes in their process that they needed to correct, which took them several months to do. It was agree that no further recoupments would take place after a secondary review on their claims unless and until they had a clear process in place.
- Our initial outcomes:-Avoided initial denials from payors by showing documented proof of calls.-improved turn around time on claims payments by 30-60 days.-Increased percentage of medical necessity denials overtuned by providing proof of clinicals or insurance logs with days certed and level of care-reduced number of medical necessity denials-allowed case manager previously handling appeals to take on a full case load and handed off the appeals process to PBS.
- Goal #3 of Integrating Care Coordination and Revenue Cycle…Reducing Readmissions. We all know that the penalties for readmissions keep increasing in percentage and the DRG’s that are looked at keep increasing so minimizing readmissions is essential to the bottom line and CM plays an integral part in that.This is one of my favorite topics….OPCC and the CTC (which is our Care Transition Clinic or “Discharge Clinic”) was created and implemented mid 2012.For OPCC:-We created a home grown registry to capture discharges from our BOOST units, as well as anyone assigned to a Hospitalist-Later, we further expanded the program to include all patients who had a cardiologists on their case while they were IP-These patients get called at 48-72 hrs post discharge to review meds (if not already done by the NP during the CTC visit), follow up appointments, disease process education, signs and symptoms to look for , telephonic assessment of pt (wt gain, diet, BP, Bld sugar readings, leg swelling, etc). These calls are then done weekly or more often depending on the pts needs up until 31 days post discharge.Calls are recorded for quality purposes to ensure quality of calls, ensure teachback is done, review for complaints rec’d and to go back and review on a readmission to see if we missed picking up something in the phone call that could have prevented the readmit. -When opportunities are identified, the employees are called in to listen to their calls to see where the opportunity lies and it has proved to be a good learning tool for the staff. -When the program was first rolled out, we weren’t recording the calls and I suspected that teachback was not being utilized. So, we started recording and sure enough, we had gaps where teachback was NOT being done. Once the staff were re-educated on the importance of the teachback method, and they knew we were listening to calls, their practice of using teachback improved. -We have made it one of our PI projects for the dept and track by individual and have reached our benchmark of 90% for the 1st quarter this year.Another thing they do is follow up with the HH agencies/DME companies to ensure everything is in place. Often times the HH may say that they haven’t received the discharge information. Although this is sent by the discharge planners at the time arrangements are made, it gets overlooked or not into the right hands. -The OPCC have the ability to go into the system we use and just hit resend instead of pulling up the medical record, printing it all out and faxing it to the number. No paper is required. If they need additional information, they can capture the information in the EMR through TRACE and fax it over through the system without ever having to print anything out. -This reduces time, saves paper and toner for fax machines and printers.
- Of course Hospital Compare data is always a few years behind, I just wanted to show you where we were initially.For MI, we went from 20.1% to 18.4% and continue to see downward trends concurrently.For CHF, we’ve gone from 27.7% to 22.5% and this is before implementation of our Heart Failure Resource Center which we believe to be attributing to further reductions concurrently. For the data we capture internally more concurrently, our CHF has dropped again in 2013 to 20.67% and ytd for 2014 is 16.25%. -We are so excited about our Care Transitions Program with our OP Care Coordinators telephonic follow up, the CTC and the HRFC and we are confident that we will continue to expand upon our programs and see continued reductions in readmissions
- Goal #3 of Integrating Care Coordination and Revenue CycleFor CTC:We have a NP that runs a discharge clinic and sees patients discharged from the hospital within 24-48hrs. The purpose of this visit is to review their medications and ensure accuracy of med rec, review signs and symptoms of their disease process and to ensure all appropriate follow up has been scheduled. The NP basically does the transition of care and hands everything in a nicely tied package with a bow to the PCP prior to their follow up visit with the PCP (which is usually 5-7 days post discharge). This is a FREE visit. Appointments for the CTC are made prior to the patient leaving the hospital. The clinic is located on the main hospital campus with a separate ground level parking lot for easy access. We have now created within that same building a Heart Failure Resource Center to assist with management of our chronic CHF pts to help further reduce readmissions. This was a soft go live in last qtr 2013 and continues to grow.In addition CM works closely with HIM on AMA’s and planned readmits alerting them up front to ensure the disposition codes are accurate, not only for billing purposes but to help identify opportunities with readmissions if indeed it is an exclusion criteria for the readmit. For ex; AMI pt who returns for a CABG is an exclusion for a readmit. Although CMS is not looking at these in relation to the Readmission Reduction program at this time, it allows us to track and pull reports when looking for opportunities to prevent readmits. AMA’s however are always excluded and was already an existing code so we want to make sure those are coded correctly to prevent unnecessary penalties.Another project we are working on and hope to implement by June 1st is for our EMS dept. to check in on chronic patients as needed. This would be a referral from the NP at the CTC or an OP Care Coordinator who has concerns about the pt. We are hoping that early intervention in these cases will further reduce readmissions.
- Here is another slide that shows all DRG’s and is more current data than Hospital Compare.-We track Hospitalists vs. Non Hospitalists because only our Hospitalists patients go to the CTC clinic visit (and this is at the request of the Non Hospitalist physicians). We of course are continuing to track this data and have discussions with the Non-Hospitalists to show the impact in hopes that we can get their approval for their patients to come to the CTC.-Our own Primary Care Physcians were initially hesitant to the CTC and the OP Care Coordination follow up as they felt burdened by some of the calls that took place after discharge to the PCP to clarify certain things like meds, diet, HH orders, etc, HOWEVER they soon realized the benefits to them and now get upset if one of their patients doesn’t go to the CTC post discharge (as the transition to the PCP for their first follow up visit with the patient is not as smooth and often time consuming).As you can see the hospital overrall went from 12.93% in 2012 to 10.44% ytd in 2014 which is a decrease of 19%.
- 28% reduction in readmits since implementation.
- Integration of Care Coordination and Revenue Cycle are integral to the success of hospitals today. With the ever changing rules and regulations from CMS as well as continued Medicare cuts to both Hospitals and Physicians, it is essential you have a Revenue Cycle team in place that includes Care Coordination. This will lead to better outcomes, decreased denials and penalties and improved transitions of care through improved communications. Involving the patient and caregiver in the Plan of Care is key to success in maintaining our patients quality of life and keeping them healthy and active outside of the hospital setting.