|
||||||
|
|
Care Coordination Center Streamlines Admissions When Marilyn Hendrix of Jackson, Tenn., suffered a heart attack while visiting her daughter, she had to endure a two-hour ambulance ride while being transferred from Quincy, Ill., to Columbia. However, once at University Hospital, Marilyn's wait was over. She was moved from the ambulance directly to a patient bed in the Medicine Intensive Care Unit without stopping at the emergency room. While Marilyn's only other hospital experiences occurred when she gave birth to her three children, she remembers having to stop at admissions to present insurance information. However, with her heart attack, Marilyn says there were no delays. "Everything went very smooth," Marilyn says. "The medical staff didn't hesitate for a moment." A patient account representative met her in the MICU to gather information, obtain her signature and deliver a packet containing valuable information regarding University Hospital. This new admission process that Marilyn experienced is the result of the creation of the Care Coordination Center (CCC), which brings a comprehensive 24-hour admission service to University Hospital and Children's Hospital. The center, which began operation this fall, was created after two departments - Admissions and Utilization Management - joined forces to improve the admission process and enhance guest and physician relations. The center not only provides timely delivery of service prior to and at the time of admission, but it also ensures appropriate utilization of resources, optimizes reimbursement and develops plans for continuing care and follow-up treatment. With the help of the Triage Center - which takes calls on weekends and after 8 p.m. on weekdays - the service can be reached 24 hours a day, seven days a week at 882-6985. Helen Kelly, CCC coordinator, says the center will greatly reduce unnecessary denials of coverage, such as those caused by failure to secure precertification or verification within a 24-hour time limit, and improve patient services at the same time. 
"This new process allows nurses to gather clinical data necessary to precertify patients with their insurance company before they come through the door," she says. "This enables patients to bypass admissions and go directly to the appropriate area for care." Helen adds that the changes made in the admissions process were mandated by the fact that managed care is more prominent and more insurance companies are requiring preauthorization for their policyholders, often within 24 hours of hospitalization. Failure to call the insurance company within that time frame results in the company's refusal to pay for the patient's entire stay. With the new system, utilization-management nurses have become more active with the multidisciplinary care team. They still review clinical charts and call insurance companies to precertify hospital stays, but they also are more involved in multidisciplinary conferences and care plan issues. This allows them to focus on educating residents and the medical staff about necessary documentation, appropriate length of stay and InterQual criteria. Admission adviser nurses have taken the place of precertification nurses. These nurses are available 24 hours a day to make recommendations based on InterQual criteria for appropriate utilization of health-care resources. For example, the advisers may recommend that a patient be seen on an inpatient basis rather than through 24-hour observation. "We know we are doing a better job," Helen says. "Our patients are being taken care of from the moment they walk in, and our physicians can call one number for their admissions and know upfront whether that patient meets the criteria for the care plan they've recommended. We have already seen a reduction in our denials from third-party payers and improved patient satisfaction as a result." |
|||||
|
||||||
