We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byRaegan Cristy
Modified over 5 years ago
© 2013 MCG. All Rights Reserved. CREATING A 24/7 UTILIZATION REVIEW PROGRAM IN A CRITICAL ACCESS HOSPITAL Sandra Clarke, RN, BSN (Medical/Surgical Director) Jessica Faude, RN-BC (Discharge Planner) Moderator (MCG) A Small Town Success Story Presenters (Memorial Health Center) Jeremy Rittierodt, MSN, RN, CCM, CTT+
2© 2013 MCG. All Rights Reserved. The Big Picture: Rural Health The challenges were: Competition from larger bed/higher acuity facilities Attracting patients who are established at larger facilities Attracting and retaining providers Limited resources Constant battle against thin financial margins
3© 2013 MCG. All Rights Reserved. The Big Picture: Rural Health (continued) The Advantages Personalized care: We know our patients Smoother transitions for change –Ideas easily escalated to senior leadership –Can make changes quickly
4© 2013 MCG. All Rights Reserved. Memorial Health Center Level III trauma care and Critical Access Hospital in northern Wisconsin Celebrated 50 years of service in 2012 Partnered with Aspirus, Inc in 2001 Embarked on Journey of Excellence in 2008
5© 2013 MCG. All Rights Reserved. Memorial Health Center (continued) Not-for-profit, Primary Care Hospital 5 Primary Clinics Specialty Clinics Pharmacy Therapy Centers Public Fitness Center Skilled Nursing Facility Swing Bed Program Assisted Living Facility Senior Income Eligible Apartments
6© 2013 MCG. All Rights Reserved. Memorial Health Center: Challenges Effects and causes Inaccurate status determinations Patient dissatisfaction: Delays, financial impact of inaccurate status determinations Staff stressed: Monday & early morning UR backlog, struggling with medical necessity and required documentation Providers frustrated: Poor coordination, lack of structured process 30-day readmissions at 9.1% Financial challenges: Reimbursement rates
7© 2013 MCG. All Rights Reserved. Criteria for a Potential Solution Needed a program that would impact: Patient care and safety Patient, provider, and staff satisfaction Financial standing Chose Web-based acute care guidelines from MCG: Inpatient & Surgical Care General Recovery Care
8© 2013 MCG. All Rights Reserved. Pre-Development Steps Early buy-in from senior leadership Began trial process in May 2011: UR RN notified of all admissions during office hours Began to manually track inappropriate admissions, inappropriate status, and changed status Trialed a binder with common care guidelines for ED physicians
9© 2013 MCG. All Rights Reserved. Planning Stage Needed an improved process to cover 24/7 utilization review Developed a policy and procedure defining process Utilization Review Committee approval Education provided to ED committee and medical staff and subsequent approval of new process Education provided to departments and staff
10© 2013 MCG. All Rights Reserved. Potential Obstacles: Budget & Staffing Smart phones with 24/7 access to the care guidelines On call compensation Physician advisor role Lesson Early buy-in from senior leadership pays off
11© 2013 MCG. All Rights Reserved. Implementation 24/7 utilization review program initiated (September 19, 2011) 1.UR nurse contacted (all admissions) 2.UR nurse determines appropriate admission status using care guidelines that can be accessed on the smart phone
12© 2013 MCG. All Rights Reserved. Implementation (continued) 3.Admitting provider and UR/charge nurse sign MHC Utilization Review Admission Determination with appropriate status checked 4.Relevant care guideline printed and placed – with criteria highlighted – in medical chart under Physician Orders 5.Daily review documentation and notes written directly on printed guideline
13© 2013 MCG. All Rights Reserved. Outcomes: Before and After Remember those challenges? Inaccurate status determinations –More accurate admissions –30-day readmission rate reduced from 9.1% to 5.6% –Quality Measure benchmarking Patient dissatisfaction –Patient satisfaction scores rose sharply
14© 2013 MCG. All Rights Reserved. Outcomes: Before and After Remember those challenges? Inaccurate status determinations –More accurate admissions –30-day readmission rate reduced from 9.1% to 5.6% –Quality Measure benchmarking Patient dissatisfaction –Patient satisfaction scores rose sharply
15© 2013 MCG. All Rights Reserved. Outcomes: Before and After (continued) Remember those challenges? Staff stressed –Smart phones support flexible hours, happier UR nurses –Increased sense of teamwork –Time savings across departments (medical records, registration, coding, billing) Providers frustrated –Greater sense of trust among providers –Proactive referrals for therapies, skilled nursing facility placements or home health during the admission process Financial challenges –Billable observation hour reimbursement increased $226,666 or 64%
16© 2013 MCG. All Rights Reserved. Outcomes: Before and After (continued) Remember those challenges? Staff stressed –Smart phones support flexible hours, satisfied UR nurses –Increased sense of teamwork –Time savings across departments (medical records, registration, coding, billing) Providers frustrated –Greater sense of trust among providers –Proactive referrals for therapies, skilled nursing facility placements or home health during the admission process Financial challenges –Billable observation hour reimbursement increased $226,666 or 64%
17© 2013 MCG. All Rights Reserved. Driving Effective Care Evidence-based guideline at providers fingertips for all admissions Documentation winsCare plan preparation Faster insurance and clinical reviews Overall, streamlined process from admission to discharge
18© 2013 MCG. All Rights Reserved. Questions? Please contact us. Jessica Faude, RN-BC Jessica.Faude@aspirus.orgJessica.Faude@aspirus.org Sandra Clarke, RN, BSN email@example.com@aspirus.org Jeremy Rittierodt, MSN, RN, CCM, CTT+ firstname.lastname@example.org Memorial Health Center www.memhc.orgwww.memhc.org MCG www.careguidelines.comwww.careguidelines.com Doyle Award careguidelines.com/content/doyle-awardcareguidelines.com/content/doyle-award
Because your patients come first. Coding Jeopardy OutpatientObservationInpatientER / CC 200 Final Jeopardy.
Alabama Primary Health Care Association
Real Time Abstraction A Multidisciplinary Approach
1MLA 2008 NAHRS & ANCC Magnet Accreditation: Whats the Attraction??? Pamela Sherwill-Navarro,MLS, AHIP Peg Allen, MLS, AHIP.
Magnet Status Looking for Quality Patient Outcomes: The American Nurses Credentialing Center's Magnet Program Recognizes Excellence in Patient Care.
©2012 MFMER | slide-1 Mayo Clinic: Models of Clinical Education: Implications for Workforce Development Mayo School of Health Sciences Team – Mayo Clinic.
Health Plans and Hospitals: Working Together to Prevent Readmissions - A Collaborative Approach to Transition Management July 30, 2013 Hosted by the RARE.
Health Care Home and Care Transitions March 15, 2013 Hosted by RARE Operations Partners: Institute for Clinical Systems Improvement, Minnesota Hospital.
RARE Action Learning Day, November 2012 Park Nicollet Post Hospital Discharge Follow Up Calls Karen Loscheider, RN Kris Kopski, MD, PhD.
Community Care of North Carolina The Honorable Verla Insko N.C. House of Representatives.
WRHA Palliative Care Program February 2013
Collaboration for Referral to Mayo Clinic Health System COMPASS Medical Home Inpatient/ ED Transitions RN January 2014.
UNDERSTANDING HEALTH INSURANCE AND YOUR OPTIONS
1 Implementing Internet Web Sites in Counseling and Career Development James P. Sampson, Jr. Florida State University Copyright 2003 by James P. Sampson,
Eligibility, Benefits, and Pre-certifications
The Bed Management Center BMC. BED MANAGEMENT CENTER STAFFING Manager Assistant Manager Care Coordinators(RNs) 3 Admission Coordinators.
Bridging Medication Across Settings of Care Richard Ricker, RPH, MBA Sparrow Hospital Barbara J. Smith, LBSW, MS, CHC, NHA Burcham Hills DATE: May 29,
2008 Johns Hopkins Bloomberg School of Public Health Setting Up a Smoking Cessation Clinic Sophia Chan PhD, MPH, RN, RSCN Department of Nursing Studies.
Exhibit 1 NOTES: Other setting of usual care includes: neighborhood or family health center, free standing surgery center, rural health clinic, company.
Billing & Documentation for Professional Charges for Clinical Trials.
© 2019 SlidePlayer.com Inc. All rights reserved.