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On-site case managers help coordinate hospital care
Timely discharge is one goal
When a CIGNA member is hospitalized in Tampa Bay, FL, he or she is likely to get a visit in the hospital from Joy Bazo, RN, CMC, LHRN, on-site review nurse for CIGNA in the Tampa Bay area.
Bazo is one of CIGNA’s on-site nurse reviewers, based in major hospitals in major cities across the country. She covers three hospitals in the Tampa Bay area and generally makes 20-24 "patient touches" a day.
Her goal is to make sure that patients get what they need in the hospital and that discharge needs are met when they’re ready to leave the hospital.
"It make a significant difference in discharge when someone proactively works with the member and their physician," Bazo says.
She visits the members within 24 hours of admission. The exception is patients having pre-planned surgery who already have received a pre-operative letter describing what will happen and their anticipated length of stay. She visits those patients the day after surgery.
"When I work with the member, I look for quality issues, such as complication from treatment, or a treatment or test that was prescribed but not done. It is a part of CIGNA’s overall quality management, Bazo says.
She checks in to make sure their discharge needs have been met and to determine if they have an unexpected problem that means they should be referred to CIGNA nurse case managers for a longer-term intervention.
Bazo also conducts short-term case management for patients who need a little more attention after discharge. For instance, she makes a post-discharge call to see that home health or other services recommended by the physician are in place.
If someone is seriously injured, she looks ahead to determine anything they may need long term.
For instance, if a member is going to need wound care after discharge, Bazo sets up a home health evaluation. She looks at what supplies are needed and what should be in place when the member is discharged.
Bazo makes it a point to talk to members about the course of treatment prescribed by their physician each time she speaks to them. "If there is something new going on or the member’s condition has changes, we go from there," she says.
She is proactive with physicians, asking them what the member may need after discharge and whether those needs should be set up in advance.
"If I can set it up ahead of time, it’s one clerical thing that the doctor doesn’t have to worry about any longer," she adds.
Case managers who are going into the hospitals should be diplomatic but also proactive for the members they represent, Bazo says.
"It’s not an adversarial relationship, but working together takes development, mutual respect, knowing to ask the right question, and making yourself available to the treatment team as well. I tell people I put the Midas touch on coordinating for my patient needs," she says.