Fund helps CMs find resources for patients
Last-ditch option pays for post-acute services
Executive Summary
Tampa General Hospital has created a fund that case managers can use to pay for post-discharge services for unfunded patients when there is no other option.
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Case managers can use the fund to pay for home health services, a short stay in a skilled nursing facility, or other post-discharge services to free beds for other patients.
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Case managers and social workers huddle with the treatment team every day and identify challenging patients early in the stay.
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The case management and social work team tries to identify family or other community support that can help care for undocumented patients after discharge.
When all else fails, case managers at Tampa General Hospital can tap into the hospital's SWAT (Safe Ways for Alternative Treatment) fund to provide post-discharge resources and treatment in the community or at an alternative level of care for unfunded patients who otherwise would have to stay in the hospital.
"The case management department is expected to thoroughly assess any options before we use these resources and to justify all spending from the fund to ensure that it's carefully spent. The fund is limited and the money only goes so far, but when there are no alternatives, the fund saves money for the hospital and helps patients to get home sooner. It's a win-win situation," says William Gross, LCSW, manager of social work for the 1,018-bed hospital.
For instance, if an unfunded patient needs two more weeks of IV antibiotics but otherwise is ready for discharge, the case management team uses a tool that allows them to determine the cost of continuing to provide care in the hospital. The case manager then gets a quote on the cost of the medication and home health infusion visits and compares that to the cost of keeping the patient for two more weeks. "It's often less expensive for the hospital to cover the cost of two weeks of IV antibiotics and the cost of administering it, or share the cost with the home health provider, rather than keeping the patient in the hospital," Gross says.
When patients who need the post-discharge services are homeless, the hospital may use the fund to place them in assisted living centers for two weeks or provide transportation for them to come to the hospital outpatient infusion center.
The hospital runs at capacity almost year-round, and patient throughput is a big issue, Gross says. "The fund offers us another way of discharging patients who don't need to be in the hospital anymore and freeing beds for other patients," he says.
The case management team has a daily huddle with nurses and physicians to review patient cases, identify clinical indicators for discharge, and set an anticipated discharge date. The team designates each patient an A, B, or C patient, depending on the difficulty of his or her discharge plan. Patients designated "A" have good support at home and are likely to go home without post-discharge services. "B" patients will need services such as home health or durable medical equipment. Patients identified as "C" have discharge challenges. They may have complex medical issues or need post-discharge services and are homeless, uninsured, or undocumented.
"We assess all patients across the board, but this process helps our team identify the challenging patients early in the stay so they can get started lining up discharge resources," Gross says.
When patients fall into the "C" category, the case management team conducts an extensive assessment to determine the patients' financial and legal status, family and other support, housing situations, medical needs, and psychosocial issues. They talk to patients to find out their desires and choices for a discharge destination, and then they collaborate with the patient to develop a discharge plan.
"We keep digging for resources that can provide what the patients need for discharge. We keep looking and going back to see if there might be other options for services for our patients," he says.
The case manager may contact a sibling or other family member and coordinate a discharge to their home or call a family meeting for a discussion about care for the patient.
When patients are undocumented, the case management team tries to find somebody to help. If the patient doesn't have a family in the area, they look to the community in which the patient lives. "We dig as deeply as we can into family and social support. A lot of undocumented patients have strong support through their church or there may be someone in the migrant worker community who can step in and check on the patient. We try to understand where they are connected and reach out to those people or organizations for support," he says.
Occasionally, a patient will want to go back to his or her home country. In those cases, the hospital may contract with an organization that arranges medical treatment for Latin American citizens in their native countries.
"We don't do a lot of reunification. Many patients don't want to go back. The majority of undocumented patients we treat have been in this country a long time. They have family and other relationships here and don't want to leave. It's their choice," he says.
"Some of the homeless create a unique challenge. Once a homeless patient is stable and ready for discharge, our goal is to have an individualized plan ready to implement. However, we help them as much as each patient will allow," he says.
