Transferring patient data between providers, payers and post-acute care facilities is easier, thanks to automated systems.
Case managers and those who regularly have to deal with payers may well be the unsung heroes of the healthcare delivery system. While clinicians typically bask in the limelight of technological innovations, case managers, for example, can often be seen standing at fax machines, waiting on the telephone or trapped behind stacks of paper forms. But that’s changing, as hospitals are beginning to install new software solutions that automate the most time-consuming processes.
Transferring patient data between providers, payers and post-acute care facilities is easier, thanks to automated systems.
Case managers and those who regularly have to deal with payers may well be the unsung heroes of the healthcare delivery system. While clinicians typically bask in the limelight of technological innovations, case managers, for example, can often be seen standing at fax machines, waiting on the telephone or trapped behind stacks of paper forms. But that’s changing, as hospitals are beginning to install new software solutions that automate the most time-consuming processes.
More Patients, Less Paper
When a patient needs to enter a post-acute care facility upon discharge from a hospital, case managers need to transmit vast amounts of patient data to multiple facilities prior to the acceptance of that patient by one of these facilities. “When a patient is being discharged, we must ensure that our discharge plan meets the needs of each patient through the services set up on behalf of each patient,” says Ann Hanford, assistant vice president for case management and quality metrics at Winthrop-University Hospital in Minneola, N.Y., a 591-bed hospital affiliated with Stony Brook University.
Once it is determined that after being discharged a patient would benefit from services provided at an inpatient post-acute care facility, it is necessary for the hospital to submit admission requests on the patient’s behalf to a minimum of three different facilities chosen by the patient or the patient’s family. The State of New York also requires that a special form, known as the Peer Review Instrument (PRI), be submitted with each admission request. The PRI form is four pages long and could contain a range of 35 to 128 data elements, depending on the particular patient.
According to Hanford, there are two criteria generally used to determine whether a facility can accept a particular patient. The first revolves around the patient’s medical condition, rehabilitation potential and the ability of the facility to meet the patient’s clinical needs. The second is dependent upon the adequacy of the patient’s own insurance coverage for the provision of post-hospital services, or the patient’s ability to pay out-of-pocket for services rendered. Once this criteria is met, a facility also may request as many as 12 additional pages of a patient’s medical record.
As a vestige of a paper world, these forms are typically filled in by hand and often are illegible or incomplete, says Cheryl Adams, director of case management at the Cleveland Clinic in Cleveland. According to Adams, faxing the information to the facilities is the traditional method, which takes time and there is no guarantee that the information can be sent when you want to send it. Many of the facilities are not technologically advanced—some don’t even have e-mail. “You play a lot of phone-tag,” she says.
Many hospitals are adopting unified communications to streamline patent processing. This new technology can speed up wait times and decrease human error.
Even if the sending and receiving fax machines are working properly and not busy, faxes can take up to 10 to 15 minutes per patient. Similar frustrations arise when transmitting patient data to payers. “Hospitals may have contracts with managed care organizations that require transfer of clinical information on a daily basis,” says Hanford. “And, managed care organizations may have the right to administratively deny reimbursement if the hospital does not transfer that information.” Currently this information is transmitted by telephone. However, all too often case managers can only reach a voice mailbox.
Improved Efficiency
Both Winthrop-University Hospital and the Cleveland Clinic deployed a Web-based case management software solution from Chicago-based ECIN (Extended Care Information Network). Winthrop rolled out the Discharge Planning module in 2001 and the Utilization Management module in 2006. The Cleveland Clinic rolled out the same modules in 2004 and 2005, respectively.
By unifying discharge planning and utilization management applications into a single integrated solution, case managers can compile and transmit all necessary data from a computer with Internet access. Because the processes involved in post-acute care referrals are automated through the system’s ExtendedCare Professional application, case managers can send an electronic referral across ECIN’s proprietary nationwide database of 86,000 providers.
Once the facilities reply, the patient and the patient’s family receive a discharge packet that details facility options, making it easier to choose a facility that meets all their needs. If a post-acute care facility also has the ECIN software in place, it receives a signal announcing the receipt of an admission request. If no ECIN system exists, the admission request goes directly to the facility’s fax machine. Two-thirds of all the facilities to which Winthrop regularly transfers patients are currently subscribers to the ECIN system, says Kathy Grogan, supervisor, continuum of care at Winthrop. “Multiple facilities have learned that they need to upgrade their admission process to accommodate automation or lose their competitive edge.” However, she adds, that the burden is on the hospital to improve efficiencies.
According to Grogan, by grouping the facilities to be contacted and using a broadcast fax feature similar to that found in most computer-based fax applications, information can be sent in under three minutes. Approvals from most facilities can be received in less than an hour. In addition, the system has the ability to archive data. “We often treat patients who have had multiple admissions and multiple request-to-rehabilitate at the facility where they had previously been. Without the ECIN system, more than an hour would be needed to requisition past medical records and find the previous admission requests.” That information now can be pulled up on a computer screen in a matter of seconds.
Automating the referral process also has facilitated the transfer of patients to out-of-state facilities. “We treat patients who are ‘snowbirds,’ who spend winters in Florida and request rehabilitation services there,” says Hanford. Using the manual process, the case management department of the patient’s community hospital in Florida would be called by telephone to obtain the names, addresses and telephone numbers of the facilities to which the patient is requesting admission. “Now that the process is automated, we simply type in the patient’s Florida Zip code and up comes all the facilities that can accept admission requests from us,” says Hanford. Adams says that since rolling out their system, her office has been able to assist patients in getting post-discharge care in 44 states.
Less Confusion, More Safety
Both the Discharge Planning module and the Utilization Management module can improve patient safety. Since clinical data is submitted in an electronic and “typed” format rather than handwritten, it is less likely that confusion will arise over look-alike and sound-alike drugs. According to Adams, the system’s Utilization Management module also allowed her office to improve workflow. There is now better and more detailed reporting of the volume of work completed and staff productivity.
“By being able to better gauge my staff’s productivity, I’m able to readjust assignments to accommodate high-volume units,” she says. Plus, it is now easier to pull up the inpatient census list and identify which patients may need a commercial payer review. From that list, her staff is able to quickly pull together all necessary patient information that would be required by the payer.
The system’s overall effectiveness in saving time and boosting efficiencies also translates into money saved. According to Hanford, even though Winthrop saw a 5 percent increase in admission referral volume last year, no additional personnel were required to accommodate that increase.
Richard R. Rogoski is a free-lance writer and contributing editor to HMT. Contact him at [email protected].
