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Accountable care units can help streamline communication and reduce length of stay

Accountable care units can help streamline communication and reduce length of stay

Learning objective

At the completion of this educational activity, the learner will be able to:

  • Identify the potential advantages and challenges involved with establishing a hospitalist accountable care unit

 

Opening the lines of communication between clinicians and specialists to make care more efficient can be a sizable challenge.

At many facilities, hospitalists shuttle from floor to floor to see patients, each time trying to track down the nurse and other professionals working on each case. Information is typically transferred through an inefficient system of pages and phone calls?sometimes taking hours at a time to deliver crucial pieces of information.

Enter the accountable care unit?a new way of configuring care systems that can help to uncoil tangled communication wires between clinicians and support staff to provide care that is more efficient and streamlined.

In this model, hospitalists work with patients in a specified geographical area of the hospital in conjunction with interdisciplinary teams.

Having patients in one area helps make care more efficient, and as one hospital system in New Mexico learned, can also reduce length of stay and increase cost-efficiency.

 

A push toward regionalization

Regionalization of hospitalist patients is becoming more common today, because of the benefits it’s been shown to bring, says Stefani Daniels, RN, MSNA, ACM, CMAC, founder and managing partner of Phoenix Medical Management in Pompano Beach, Florida. Those benefits include:

  • Improved teamwork, care coordination, and communication
  • Fewer readmissions
  • Improved resource management to lower cost of care
  • Improvements in patient satisfaction
  • Reduction in inefficiencies

"I’m pushing accountable care units at all my hospital clients," says Daniels. But while the will is there in many cases to make the change, it’s not always an easy conversion.

Sometimes these initiatives face pushback from physicians concerned about personnel or scheduling issues.

Other challenges include:

  • The lack of diagnostic diversity that results from having set teams on a unit
  • The challenge of deciding whether teams should be flexible or static
  • Hammering out logistical issues, such as how patients should be triaged and how beds are managed

 

Despite the challenges these initiatives can face, Presbyterian Medical Group in Albuquerque, New Mexico successfully implemented a unit-based model with multidisciplinary rounds about six years ago, says David J. Yu, MD, MBA, FACP, SFHM, medical director of adult inpatient medicine service for Presbyterian Healthcare Services.

The initiative was prompted by a desire to improve inefficiencies and streamline care. "We basically needed to improve patient flow and communication," says Yu. "But we also realized it was a very large process because it involved almost every department, including case managers, physical therapy, nursing, and ancillary services."

To overcome that daunting multi-departmental challenge, officials enlisted the hospital’s Lean Six Sigma group to help coordinate the project.

Presbyterian sought to trade its outmoded care model for something more efficient; one that would improve communication and eliminate delays related to breakdowns in this area.

The changes began as a unit-based project with multidisciplinary whiteboard rounds, a daily meeting that included the hospitalist, nursing staff, care coordination, physical therapy, and other specialists. They discuss the treatment plan and the goals related to the patient care both for that day and the hospitalization for each patient, he says.

The success of that pilot program led officials to implement the same unit-based model in eight of the medical floors at the hospital.

The payoff for the organization has not only been a huge boost in the efficiency of communication, but reduced length of stay for patients. "We’ve seen significant improvements in the average length of stay. This is not because we’ve reduced therapeutic time, but because we’ve reduced inefficiencies," says Yu. Lag time created by communication gaps has been tightened up, allowing patients to move through the system more quickly and efficiently.

To ensure that these new efficiencies weren’t resulting in quality reductions, Yu says the organization also tracked readmissions, which remained steady, confirming that faster discharges weren’t compromising patient care.

 

Overcoming obstacles

Presbyterian has managed to overcome many hurdles that can make this model a challenge. Although these changes have been successful, they have not necessarily been quick.

"I think in many cases people are just interested in a quick fix," says Yu. This process has been anything but. More than half a decade in, Yu says the program is still a work in progress and the team is continually looking to make improvements.

The initiative took time because it addressed the underlying structure of the organization and didn’t just make surface changes that can’t be sustained.

"I like to use the analogy of painting a wall. The painting is the easiest part. What takes time is all the prep work getting the surface ready," he says.

Most organizations just want the paint on the wall?they aren’t willing to address work needed to fix the underlying structure. "This really is a foundational project that takes months and years to develop and mature," he says.

This project not only solved many communication problems at the organization, but it also helped to ready the facility for the new era in healthcare ahead?one where revenue is driven by quality, not volume.

Organizations that want to thrive in this new model will need to rethink antiquated processes and systems going forward, he says. Those that don’t may not survive in this model.

 

Steps to success

For an initiative like this one to be successful, it has to be well designed and have support?both in commitment and in terms of dollars?from upper management.

"A lack of resources is another reason why a lot of these projects fail," says Yu. "The hospital doesn’t want to fund it. If only one department is very excited about the project, it won’t work."

The model involves a major change that requires support from multiple disciplines. "Without the support of leadership it’s not going to succeed," he says.

You also have to give hospital staff members a reason to support it, which may be the biggest challenge.

"It has to successfully answer the question, ‘What’s in it for me?’ " says Yu.

If the changes are onerous and provide little benefit to the people they affect, there’s little incentive for anyone to support it.

"Understand your worker and your project," he says. And overcoming barriers may involve system and even contract changes, he says.

If you can get that support, you can make changes that will improve communication and consequently care at your organization?and help ready it for the changing healthcare landscape of the future.

HCPro.com – Case Management Monthly

Giving a coding presentation to SIU dept with no coder.. help?

I am speaking/giving a presentation on 7/7 on general coding information and coding error trends and how they relate to fraud and abuse to a government payer SIU dept. I have only ever spoken with providers and coders on coding and CDI related topics. I have never spoken with someone who is not well versed in coding guidelines or documentation guidelines.

Is there anyone here that has presented to a group of SIU’s or that IS an SIU that would be willing to connect with me through email?

My email is kiraflintcoder@gmail.com

thanks in advance!

Medical Billing and Coding Forum – Auditing General Discussion

AAA repair using 2 ‘extension’ devices only – Please Help!

I wanted to get input from other vascular coders as to how you would code an endo-AAA repair in which the physician used 2 typical ‘extension’ pieces to overlap and create an aortic only stent…”initial aortic device ends just proximal to the aortic bifurcation” and “the proximal portion of the second graft would end just at the renal arteries with the appropriate overlap with the initial device.”

• Would you code 34800 even though a unibody prosthesis was not used directly but the 2 pieces overlapped to essentially create one?

• Would you code 34825 (coded once, following ‘per vessel’ rule) since extension piece(s) was used even though this was not an extension of a previously placed endograft?

• Would you use an unlisted code?

I appreciate any input.

Medical Billing and Coding Forum – Cardiovascular Thoracic

CRT-P and CRT-D coding help

I normal do not code for cardiology , but I have a staff member asking of CPT-codes for Lead Impedance, Pacing Capture Thresholds, and Phrenic Nerve Stimulation. I have look every where and I can not find any codes that fit them all. Is there just one single code for all these test, or is there individual codes for each. If anyone knows, please pass on your advise.

Thank you,
Felicia Knox, CPC, CPB, AAPC Professional

Medical Billing and Coding Forum – Cardiology

Apg medicaid question help

Hi i am new to billing apg i have a question and i cannot get an answer, the facility bills out contact lens which is a v2521 or v2513 – there are a few of them however, these are never payable according to apg, but the representative told me it has to be billed with another procedure code, i dont know what code it is, would this be the contact lens fitting code? To go with the v codes, i dont have enough informaton on this any help with be greating appreciated.

Medical Billing and Coding Forum – Outpatient Facilities

Need Help with Modifiers

Could someone please help me out with placement of modifiers.

Claim was submitted as below. Line 2, 4, 5 and 6 denied. Invalid modifier, included in another procedure.

Line 1 99213 25 M76.52 Patellar tendinitis left knee, M25.362 Other instability left knee, M25.361 Other instability right knee
Line 2 20611 M76.52 Patellar tendinitis left knee
Line 3 20611 50 M76.51 Patellar tendinitis Right Knee
Line 4 29530 59 M76.52 Patellar tendinitis left knee
Line 5 29530 50 59 M76.51 Patellar tendinitis Right
Line 6 J2000 M76.52 Patellar tendinitis left knee

Thank you

Medical Billing and Coding Forum – Family Practice