Team up with clinical areas to help patients

For a small number of extremely challenging cases, patient access staff at University of California-Los Angeles Medical Center work closely with a multidisciplinary team, including clinical areas.

Using this approach, staff have succeeded in obtaining resources to assist with many patients' complex discharge needs. "Otherwise, these difficult cases may not hit anyone's radar until they've been in for a very long time," says Helen Contreraz, manager of patient access services. "We get involved from the very beginning vs. waiting until the point of discharge. At that point, the patient needs a lot of equipment and support right away. We may need several months to work on it."

In one case, a trauma patient from China who was in the country visiting his daughter arrived through the emergency department and required amputation. The patient was hospitalized for about six months, but patient access started work on the case right away. "We were able to get the hospital bill covered, and in working in partnership with social workers, we were also able to find housing for the patient," says Contreraz. "We worked with our discharge planners to obtain some internal funding to be able to return him home with his family." In addition, vendors were able to donate some necessary durable medical equipment and a wheelchair.

"Vendors may have some indigent funding available, and you can determine if a patient qualifies for that. We've done that for wheelchairs, special beds, and various other things," says Contreraz. "Of course, you don't want to abuse it. We use that only for our most difficult patients, when we have exhausted all other means. As for proving that someone is indigent, usually the patient gets certified through state or federal plans. Some of the vendors will accept that as proof."

Usually, these complex patients are identified either based on their length of stay or because they have complex discharge needs. "We look at things like what payer do they have, what are their benefits, do they have case management available, can some benefits be negotiated, and whether there is state or federal funding that might be available. We file those applications ourselves," says Contreraz. "And if we hear that the patient may be in for a long time and doesn't have insurance benefits, we start working on long-term care applications through the state, or federal funding if applicable."

Social services may inform access staff that a patient just lost his or her job, which is important to know because the patients may qualify for COBRA benefits. If a patient's length of stay exceeds the average for his or her condition, Contreraz says, "I'm going to look into whether the patient has enough benefits or enough pharmacy coverage. If not, there might be something available through some of the pharmaceutical companies."

The department has gotten increasingly involved in discharge planning "both because we want to keep patients healthy and because obviously a readmission is costly," says Contreraz. "We are a support area for our clinical care partners. Obviously we want to make sure that at the end of the day we get paid, but we also want to make sure that the patient's needs are met."