Discharge Planning Advisor
Solutions often found in existing technology
Interdepartmental collaboration key
Collaboration between key hospital departments is crucial to making sure discharge planning starts at the earliest possible point in the patient encounter, and the latest advances in technology certainly can facilitate the necessary interdepartmental communication.
However, there also is much to be said for devising innovative ways to use a hospital’s existing technology, points out Katherine H. Murphy, CHAM, patient access coordinator for Nebo Systems, an Oakbrook Terrace, IL-based company that specializes in real-time electronic data processing for the health care industry.
"Verifying benefits accurately and in a timely manner is critical to maximizing discharge planning," she says, "as is communicating this information and creating a path of communication among the departments that interface with patient access — medical records and utilization management. Sometimes, there is a disconnect."
It’s important, notes Murphy, a former hospital patient access director, "to take a look and say, How can we get our information to the next step in the quickest way?’
"One of the things we created at one of the hospitals where I was access director was an in-house census report that showed financial status," she adds. Prior to that innovation, Murphy notes, "[other departments] would know the patient was there but wouldn’t know anything had been done. So we added a column to show that precert had been done."
In another instance underscoring the importance of communication between systems, she points out, access personnel made the initial call notifying the insurance company that the patient had been admitted and took the precert reference number. "Sometimes a patient’s account required clinical information and then a handoff," Murphy says, "and communicating that efficiently was important."
The good news was that the departments involved had access to each other’s systems, she adds, "so there was harmony there. Utilization management [UM] could access the hospital’s admission/discharge/transfer [ADT] system, and financial counseling/verification staff could take a look at documentation in the UM system."
The question, Murphy says, became, "How do we best communicate? A lot of times there was a handoff from access to UM that said, Here is our preliminary precert number, but UM needs to call back with clinical information.’"
The challenge came when there was a discrepancy at some point, and comments like, "You never let me know that," or "No, I didn’t get that voice mail" were traded back and forth, she adds. "Things fell through the cracks."
The solution that was devised through collaboration between access and UM, and with the help of the on-site information technology department, was simple, cost-effective, and made use of existing technology, Murphy explains. "We created symbols to use in the registration system that would indicate the action that had been taken." Everyone had access to the definition for each symbol, so there was no room for the miscommunication that can occur when someone abbreviates words or uses other shortcuts in language," she adds.
"This was a matter of using the resources we had and creating our own little internal tool, so that there was not a lot of dialogue being keyed in that was subject to interpretation," Murphy points out.
For example, the pound (#) symbol indicated no precertification was required, she says, while the ampersand (&) meant precert was pending clinical information and the insurance company would call UM, or that the call had been transferred to UM. The dollar ($) sign meant precertification was pending clinical information and UM must call the insurance company.
"Using the symbols to communicate with UM allowed for consistency in the format of the message, accurate documentation, and accountability, since the message was stamped with date, time, and user identification," Murphy adds. "We all agreed on, Here’s what it means; here’s how we will use it,’ and if something wasn’t done, it was easier to pinpoint the breakdown."
For facilities in a position to implement the latest in technology solutions, she notes, there now is software that can interface with the registration system or on a stand-alone basis and will determine up front if patients are charity care or qualify for a financial assistance program.
"The software can determine that the patient qualifies for financial assistance and identify the appropriate [assistance] program," Murphy says. "At the beginning of the admission process, [the screen] is populated with information showing, Here’s where we are with this patient.’"
That knowledge, when shared with discharge planners, can greatly enhance the efficiency and timeliness of the patient discharge and post-acute placement processes, she adds.
"Certainly, when your patient is being transferred to a different level of care, it’s extremely important that you know where they stand financially," Murphy points out. "All of these front-end processes can shorten the discharge process and, potentially, the unnecessary delays that increase length of stay."
[For more information, contact:
- Katherine Murphy, CHAM, Patient Access Coordinator, Nebo Systems, Oakbrook Terrace, IL. Phone: (630) 916-8818. E-mail: [email protected].]
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