Smooth transfer the goal for 'out-of-plan' patients
Position likely means 'substantial savings'
One of the latest products of Providence Health System's "Seamless Access Initiative" is a new access services position - transfer coordinator - that promises to streamline the movement of patients in and out of the Portland, OR-based health care system.
The job of the new transfer coordinator is to make as "smooth as possible" all out-of-system transfers of patients not covered by its health plan, and the transfer into the system of its own members who have been treated at another health care organization, usually because of an emergency, says Tabitha Warner, MHA, director of the Seamless Access Initiative.
There are two pieces of the transfer coordinator function, Warner explains. One is to communicate to patients at Providence facilities who are "out of plan" what their financial responsibility will be, and to facilitate "in the best customer service fashion" any move they might want to make, she adds. "If, in fact, they want to stay, then there is negotiating with the payers."
The second piece has to do with patients in the Providence health plan who are receiving services at non-participating facilities. "One example, of course, is an emergency situation," Warner says, "but once the patient is stabilized, then we look at, 'Do we want to bring him or her back?' We feel that we can manage that person's care better from start to finish."
Providence's concurrent review nurses, in conjunction with physicians and other medical personnel, work with the patient to make a transfer decision on the clinical side, she says. "The transfer coordinator steps in and arranges that it be as smooth as possible. We want it to be a flawless transfer, with no glitches."
Health plans always have coordinated transfers back to their facilities when appropriate, Warner points out. "The issue is, 'Are they able to cover the volume?' So much of the process is working with access services, doing the footwork. It's a benefit to the nurses to turn over [those arrangements] to a person with access services knowledge. That frees up the nurses to spend the majority of their time doing review rather than coordination of tasks."
Additionally, she says, it can be a "patient dissatisfier" when communication is not open and clear and perfect arrangements are not made during the transfer process. "What room is the patient in? Who's the accepting physician? Somebody shows up in an ambulance and sits there until we get the [bed control] mess straightened out. That's not where the patient should be."
Placing the transfer coordinator in access services is a perfect fit, Warner says. When, for example, a utilization review (UR) nurse finds a patient on the nursing floor that is not covered by the Providence plan, the first call she makes is to central access services. That call is now forwarded to transfer coordinator Terri Patton, a long-time Providence employee who assumed her new position in late July.
Patton, who has access experience in insurance verification and financial counseling, says the benefits from the new position were apparent almost immediately.
"There were a couple of [out-of-plan] intensive care unit patients [at Providence] that were promptly identified and brought to my attention," she says. "I was able to reach the primary care physician and the attending [physician] and get everything coordinated to get [the patients] out. Before, they would have waited maybe another day for the UR department to get involved."
The person representing the other health plan, meanwhile, "was thrilled" with the prompt action, Patton notes. "She was able to get all the information she needed quickly, and get her patient out of a non-contracting provider."
After only working a short time in her new position, Patton said she already had about 10 referrals [of out-of-plan cases] in all, some of which had complicating factors that prevented an immediate transfer. Others were going to be in the hospital such a short time it was not cost-effective to move them, she points out. "[Health plans] don't want to pay the cost of transferring only to release the patient the next day."
Patton's office, along with the central access services area, is in the administration building in Providence Office Park, located off-site from the main hospital campus. Insurance verifiers in central access refer accounts to her that are out of plan, she explains. "There is a report that we just activated that alerts me to how many patients are in the house with non-contracting insurance."
"I find out everything about the case," Patton says. "That includes how long the patient will need to be here, what's going on medically, who's the attending physician, and whether [the patient] will be a candidate for transfer. The whole idea is to jump on it at the point the patient would be transferred to a medical unit [from the emergency department or ICU] and make the transfer to the other hospital instead."
The transfer coordinator is likely to be an extremely cost-effective investment for the health system, notes Barbara Wegner, CHAM, regional director of access services, who oversees the new position. "We just got this off the ground July 27th, and we will be keeping figures," she adds. "We expect substantial savings. It really makes sense. There will be a big difference, for sure."
In fact, Wegner points out, Patton probably paid for her position in her first week on the job from cost savings associated with reduced ICU stays and unnecessary care.
Patton, meanwhile, says she has had nothing but positive feedback from other insurers regarding her role. "It's a win-win situation," she adds. "[Both sides] want to see this happen as long as it's appropriate for the patient."
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