Expedited discharge fund helps uninsured patients
Plan frees up beds for patients who can pay
When patients are medically ready to leave the acute care hospital and have no coverage for post-acute care, it's a "no-brainer" for the hospital to pay to move the patient to a lower level of care, says Jay Cayner, director of social patient and family services at the University of Iowa Hospitals and Clinics.
"At minimum, providing care in an alternate setting won't cost more than taking care of the patient in our hospital. In addition, this gives us an opportunity to fill the bed with someone who needs tertiary care and who does not have a payer. With a hospital census that hovers around 80% occupancy, it makes all the sense in the world," Cayner adds.
Located in Iowa City, University of Iowa Hospital is a tertiary care teaching hospital with about 700 beds. It's a regional hospital that provides specialty care for highly complex patients from all over Iowa and surrounding states.
The hospital has created an expedited discharge fund to pay for medical equipment, courses of IV antibiotics, special transportation, and other goods and services that are holding up a patient's discharge. The fund may be used for pharmaceuticals, including providing medications for patients with Medicare drug coverage "donut holes," physical therapy, occupational therapy, intravenous therapies, wound vacs, and other equipment.
If a patient's Medicaid coverage is pending, the hospital may work out an arrangement with a post-acute facility to take the patient and will guarantee payment at 95% of the Medicaid rate for 90 days, until Medicaid kicks in.
Patients must meet strict requirements to qualify for the expedited discharge funds. They must be medically ready to go, have medical needs for which they would otherwise have to stay in the hospital, and have no payer, Cayner says.
The fund helps the hospital's social workers and case managers find a safe discharge for a patient who otherwise would have to stay in the hospital, says Jill Carroll, MSW, LISW, a social worker at the hospital.
"Many highly complex patients are transferred to us because local hospitals are not able to provide specialty care. Creating a safe discharge for these patients who have no insurance and who need a lot of post-acute service is a huge challenge," Carroll adds.
The hospital employs a full-time bachelor's-level social worker who helps patients with applications for Social Security disability payments and other funding.
Master's-level social workers assigned to each inpatient unit coordinate the discharge plan and start looking at patient resources early in the stay.
"We check to make sure the patients without insurance don't have any other resources forthcoming. If they don't have any potential payers and are eligible for funding, we help them apply," she says.
The social workers identify what patients will need after discharge and work with the family to develop a plan for caring for the patient at home if possible.
"If it's a matter of the patient needing services or equipment that may hold up the discharge, we can complete a brief request for funding," Carroll says.
When patients need to be transferred to a lower level of care, the social workers negotiate with post-acute facilities about taking the patient if the hospital will pay for his or her care for a certain period of time, Carroll says.
"The social workers have a working knowledge of which facilities are able to engage in that kind of discussion," she adds.
Collaboration is key
The social workers often collaborate with other facilities to find the services that patients need in their communities, Cayner says.
One patient, who lives in a rural area, was treated for a broken femur and hip and developed an infected wound at the site of one break. He didn't need to stay in the acute care hospital but needed hyperbaric oxygen treatment for the wound, something that wasn't available in his small rural community.
The social workers found a hospital about 40 miles from the man's house that could provide the service. The University of Iowa Hospital gave the man $40 a week for gas and provided the medications. The other hospital provided the treatment for free.
"This is an example of two hospitals working together to provide services. Almost every facility that we work with understands our program and gives us heavy discounts. Some places take patients as charity cases," Cayner says.
When patients need post-acute care, the social workers identify the patient's post-acute needs and develop a list of potential providers in their area from which the patients can choose.
"We ask them for their preference in placement but warn them that their preferred facility may not respond positively to taking someone who is without funding. We try to be realistic and keep them informed of the issues in regards to placement," Carroll says.
Patients who have been severely injured and have intensive post-discharge needs post the biggest challenge, Carroll says.
"Patients who are cognitively impaired due to brain injuries or alcohol abuse need 24-hour supervision in an assisted living center or home setting. Many don't have social support and no money to pay for home care but don't qualify for residential programs. Those are the people who fall through the cracks," Carroll says.
These patients have no financial resources and are using a large amount of hospital resources but the hospital can't discharge them without a safe plan, she points out.
"The social workers get very creative on the inpatient level. If may be a combination of providing physical therapy and occupational therapy here so they can achieve a minimal level of function that enables them to be discharged to another level of care," she says.
For instance, one patient with no social support and no funding had a traumatic brain injury, a history of alcohol abuse, and needed assistance with his activities of daily living. After a course of therapy in the hospital, the social worker was able to find a placement for him in a group home for people with a mental health diagnosis.
In the case of homeless patients who need home health services, the social workers often are able to negotiate with a homeless shelter to allow the patient to stay during the day. They can arrange for visiting nurses funded by the county to take care of the patient's needs.
The hospital is seeing an increasing number of patients who have cognitive impairment and need the equivalent of a baby sitter during the day.
"We always look at family resources first. That tends to be what patients are most comfortable with and it eliminates us having to use outside funding and resources. Family members may want to help but they live in another community or work full time. It's hard to find families with someone home during the day," she says.
(Editor's note: For more information, contact Jill Carroll, social work specialist, University of Iowa Hospitals and Clinics, e-mail: [email protected].)
When patients are medically ready to leave the acute care hospital and have no coverage for post-acute care, it's a "no-brainer" for the hospital to pay to move the patient to a lower level of care, says Jay Cayner, director of social patient and family services at the University of Iowa Hospitals and Clinics.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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