Three traditional units combined to create more efficient patient care

Filtering process’ must begin immediately

Three traditional hospital units — access management, hospital information management, and case management — are being combined in an innovative project called "Trio" at ScrippsHealth in San Diego. The idea, says Jack Duffy, FHFMA, corporate director of patient financial services, is to start shaping decisions on how a patient’s care is organized immediately, not three days later when crucial information finally has trickled down from registrar to caregiver.

"There is a filtering process that needs to begin as soon as you know a patient is coming in, so limited resources can be applied where they’ll do the most good," he says. "Otherwise, you’re finding out on the day a patient should clinically leave that you’re clueless as to where you can send them."

Seamless coordination of the functions of those three traditional departments offers several advantages, Duffy points out. "It offers a significant opportunity to reduce the incidence of re-interviewing patients." It also helps identify key clinical indicators of future care and the insurance coverage and benefit design needed to support that care. "If you attempt to assist the physician and the family in arranging post-acute care and are not intimately involved with the patient’s benefit package, you run into dead ends," Duffy says. "In the world of managed care, there is often subordinated risk. You need to know not only that the patient has a skilled nursing facility benefit, you need to know which patients have contracts with us."

Trio represents an effort "to look with 20-20 vision at any key value that originates at the point of first contact in the access process," he says. That access team member would use "push technology" to pass information along the continuum of care, he adds. "That means you don’t have to ask me for an answer; I will push it to you.

"If you can’t have the point-of-service information flow very nicely, the whole concept of working with physicians to enhance the care design falls apart," he says. "Redefinition of the access management department is critical to those seeking the next level of partnership with physicians."

Health information management, he says, is moving into two skill sets. "One is coding, which I think will become part of the access employee’s portfolio. The other major topic for health information is chart management and completion." That has to do with quality of the medical record, archiving and retrieving the record, and distributing it along the continuum of care, Duffy says.

"In the future, this will be done in an electronic environment, so there will be significant overlap in the pre-coding of the record," he notes. "If done right, using the right mix of professionals, those coded messages will not be repeated when the medical record is abstracted and final review is done at discharge. Hospital information management will become more seamless, building the record all along the patient’s stay."

There is a growing recognition at many insti tutions that traditional hospital administrative departments are coming closer together, Duffy says. Often, however, the partnership is not at a level where it’s the driver of care management, he points out. The desired scenario is not simply writing down the diagnosis the physician dictates over the telephone, but pre-coding a chart to include medical necessity, he adds. "It is understanding [whether] the physician’s orders meet the test of medical necessity and feeding them, along with a profile of the patient’s benefits, to the care management team."

Part of making Trio work, Duffy explains, is acknowledging and celebrating the different skill sets brought to the table by the three departments. "That’s so we won’t try to blend [staff] into something they’re not comfortable with. We will leverage information, take a person’s traditional strengths, and make them available at the right time. I think it will be a very deliberate type of sale. You can create an environment resistant to change if this is not done carefully."

Part of that sale will be letting the teams feel they have a significant influence on the process, he adds. "We will let them design their future within our vision. We know we have to spend several days over the next couple of months in retreat."

At these retreats, managers and key support staff in the different silos come together as a group to get input on the new design, he says. "All roles will be modified. Some [managers] will be reassigned. Some will get additional responsibility for enterprise activity.

"There will be some specialization across the enterprise," he adds. "Along with their day-to-day activities, they will have an enterprise portfolio. There might be an electronic record storage specialist. People will get tags like that as their interest and talents lead to some of these activities."