Patient Resource Management
Mary O’Brien Barrington, MBA
Duke University Hospital
July 6, 2004
Who Are We?
• Physician/Service based department
• Responsible for all inpatient services at
DUH Staff comprised of clinic...
Mission
• To bring together the right people with the
right resources at the right time to ensure
quality, safety and effi...
Scope of Practice
• Management of the patient care continuum
from admission to discharge including:
– Initial assessment o...
Scope of Practice, cont.
• Provide consistency to patients and clinical
team
• Ensure customer satisfaction
– Patient
– Ph...
Scope of Practice, cont.
• Work directly with clinical team to ensure
compliance with regulatory and billing
requirements
...
Scope of Practice, cont.
• Responsible for data analysis of quality
indicators for DUH/PRM scorecard:
– 31 day readmission...
Scope of Practice, cont.
• Management and reduction of Length of
Stay at Duke Hospital
• Review of all Accounts >100K
– id...
How does it all tie together?
PRM Balanced Scorecard
• CUSTOMER PERSPECTIVE
– Patient Satisfaction (Press Gainey)
• Overall Discharge Satisfaction
• Ext...
PRM Balanced Scorecard
• INTERNAL BUSINESS PERSPECTIVE
– Patient Flow (pending discharge)
– LOS (analysis of top 5 DRGs by...
PRM Balanced Scorecard
• FINANCIAL PERSPECTIVE
– Patient Status - verification of correct orders in
medical record to supp...
PRM Balanced Scorecard
• INTERNAL GROWTH AND
LEARNING
– Attendance at Staff/Educational/CSU Meetings
– Compliance with man...
Summary
• PATIENT
• The patient always comes first
• RESOURCE
• PRMs are a resource at DUH
• We strive to always have the ...
Administrative Offices
• PRM administrative office: 668-2483
• PRM fax: 668-0251
• PRM administrative pager: 970-2473
• Do...
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Patient Resource Management Mary O'Brien Barrington, MBA

  1. 1. Patient Resource Management Mary O’Brien Barrington, MBA Duke University Hospital July 6, 2004
  2. 2. Who Are We? • Physician/Service based department • Responsible for all inpatient services at DUH Staff comprised of clinically licensed professionals (minimum bachelors degree) • 85% BSN • 10% CCSW • 5% Other ancillary healthcare professionals
  3. 3. Mission • To bring together the right people with the right resources at the right time to ensure quality, safety and efficiency in the management of the patient care continuum
  4. 4. Scope of Practice • Management of the patient care continuum from admission to discharge including: – Initial assessment of the patient within 72 hours of admission to identify potential needs at the time of discharge – Liaison with third party payors to ensure concurrent authorization for the hospitalization – Coordinate the needs of a multidisciplinary care team to ensure that the plan of care is moving forward safely, effectively and efficiently
  5. 5. Scope of Practice, cont. • Provide consistency to patients and clinical team • Ensure customer satisfaction – Patient – Physician – Community Resources
  6. 6. Scope of Practice, cont. • Work directly with clinical team to ensure compliance with regulatory and billing requirements – accuracy of physician orders in the medical record – education of all physician staff as to changes in payor patterns and Medicare requirements for medical necessity
  7. 7. Scope of Practice, cont. • Responsible for data analysis of quality indicators for DUH/PRM scorecard: – 31 day readmissions to DUH • Medicare regulations for combined billing • Quality of care – Review of all One Day Stays at DUH – Review of all Observation patient housed outside of the CEU – Review of all Outpatient status patient housed in Duke North Hospital
  8. 8. Scope of Practice, cont. • Management and reduction of Length of Stay at Duke Hospital • Review of all Accounts >100K – identification of potential barriers to discharge – identification of nonfunded or underfunded patients – identification of patients that may require input from senior hospital leadership to achieve appropriate discharge disposition
  9. 9. How does it all tie together?
  10. 10. PRM Balanced Scorecard • CUSTOMER PERSPECTIVE – Patient Satisfaction (Press Gainey) • Overall Discharge Satisfaction • Extent Ready for Discharge • Help arranging home care services • Informed of discharge date and time – Physician Satisfaction – Customer/Resource Satisfaction
  11. 11. PRM Balanced Scorecard • INTERNAL BUSINESS PERSPECTIVE – Patient Flow (pending discharge) – LOS (analysis of top 5 DRGs by volume for each service at DUH) – 31 Day readmission - quality of care
  12. 12. PRM Balanced Scorecard • FINANCIAL PERSPECTIVE – Patient Status - verification of correct orders in medical record to support billing to third party payors – Accounts > 100K – 31 Day Readmission - Combined Billing
  13. 13. PRM Balanced Scorecard • INTERNAL GROWTH AND LEARNING – Attendance at Staff/Educational/CSU Meetings – Compliance with mandatory training – Submission of Quarterly Report – Participation in CSU activities/initiatives – Participation in PRM activities/initiatives
  14. 14. Summary • PATIENT • The patient always comes first • RESOURCE • PRMs are a resource at DUH • We strive to always have the “big picture” • MANAGER • Management of the patient care continuum
  15. 15. Administrative Offices • PRM administrative office: 668-2483 • PRM fax: 668-0251 • PRM administrative pager: 970-2473 • Donna Peter, MSN - Director • Mary Barrington, MBA - Asst. Director • Jill Duvall, CCSW - Asst. Director

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