1. David Russell, EMT-P 2-7433 david.russell@vanderbilt.edu

2.  More Efficient Discharge Process  EMS 1 hour to bedside  Centralized store of automated forms ▪ Tenncare ▪ Managed Medicare programs ▪ VUMC Medical Necessity  Centralized list and procedures for pre-auth  Faster bed turnover  Centralized data management

3. Acquired an experienced FlightComm Paramedic Shadowed CM and SW to gain knowledge of process, tools and procedures Communicated with all local EMS providers, individually, to become familiar with special procedures and insurance requirements; explained our goals Contacted each identified insurance company to establish procedures Worked with AC and UM to centralize AT# process Developed in-house software to track and report requests

4. Identify patient that will require transport Prepare necessary information, prior to contacting DTM Patient Name, MR Number, Room Number Primary Insurance Weight Primary Diagnosis Special Needs Oxygen Trach Vent Fixtures/Devices Destination

5. Call DTM at 2-RIDE (2-7433) when patient d/c time is determined. DTM will email or fax required paperwork needed to complete/sign VUMC Medical Necessity form, required on all patients, will be faxed/e-mailed Once EMS transport is confirmed, a demographics page, including the transporting service and expected bedside time will be generated As confirmation, our office will be contacted via Nextel when EMS arrives on the patient floor. You (and possibly Bed Management) will receive an automated confirmation that EMS has arrived to transport your patient.

7. What to do when confirmed plans have been altered?

8.  All complaints with EMS should be reported to DTM  Centrally managed conflict resolution  Problem and issue tracking  Ability to have hospital AC involved

9. Shows pending calls in yellow Confirmed calls in blue Overdue calls in red ETA counts down, then up

10. Call Received volumes Bedside time volumes

11. Track EMS Volumes Level of Care By Floor / Unit By Building By specialties Ventilator Bariatric Long Distance By Destination By Caller Name

12. Vast Majority arrive prior to requested time At 5 minutes we call to check Anything over 30 minutes late; follow up with EMS’s admin

13. We issue all AT# UM is able to reconcile with invoice Will allow better cost tracking history HIPPA

14. Ambulance Charges per Month – Calendar Year 200820092010CY Year Month January$ 5,405$11,481$3,795 February $ 5,405$10,232$3,065 March $ 5,405$5,398$5,971 April $ 5,405$9,328 $4,227 May $ 5,405$5,143 $4,227 June $ 5,405$9,108 $4,227 July$5,674$3,046 $4,227 August$5,599$3,046 $4,227 September$8,902$5,145 $4,227 October$6,970$5,145 $4,227 November$2,580$4,868 $4,227 December$2,704$3,946 $4,227 $64,859$75,886$51,324Total $5,405$6,324$4,277Average Ambulance Charges per Month – Fiscal Year 2008-20092009-2010FY Year Month July$5,674$3,046 August$5,599$3,046 September$8,902$5,145 October$6,970$5,145 November$2,580$4,868 December$2,704$3,946 January$11,481$3,795 February$10,232$3,065 March$5,398$5,971 April$9,328 $4,225 May$5,143 $4,225 June$9,108 $4,225 $83,119$50,702Total $6,927$4,225Average Negotiated Rates Quotes on “Out of Town Transports” Projected total for FY 09-10 is $51,000 Average savings of nearly $1,900 per month Pursuing ways to reduce this by another $1,000 per month *Unable to calculate bed stay savings based on current data

15. Requested 36 frequent callers to complete an 8 question survey 100% of responses to all questions were positive Q: (Paraphrased) How many hours per day did you spend arranging ambulance transports before? A: Average 1.5 hours per day Q:(Paraphrased) How many hours per day do you spend arranging ambulance transports after? A: Average.3 hours per day 1.2 hours per staff per day saved; 10 unique callers per day = 12 hours saved per day

16. Centralizing away from approximately 60 CM and SW Using better tools; defined procedures Negotiated transport costs saving thousands of dollars in ambulance costs Saving hundreds of hours of individual time per month Decreasing patient bed stay days by more efficiently moving patients

17. “The Discharge Transportation Management office is fantastic! They make my job so much easier and are a joy to work with.” “I find that much of my time can be utilized elsewhere since the implementation of the Discharge Management Process.” “Having one body make the transportation arrangements seems to have improved the reliability of the ambulance service.” “Have been thrilled with response and accuracy of service. Absolutely no complaints from this case manager!!”