Directory helps patients make informed choices

Hospital compiled information on all providers

When patients at Haywood Regional Medical Center in Clyde, NC, need post-discharge services, they can look for information about the providers they are considering in the hospital’s Western North Carolina Provider Directory, a binder compiled by the case management staff and filled with information on home health services, skilled nursing facilities, and durable medical equipment providers.

"Even before it was a rule, we emphasized patient determination, giving patients the opportunity to choose their provider if they needed services after discharge," says Shirley Trantham, RN, BSN, CCM, director of health resource services, the case management department at the hospital.

Providers requesting inclusion on the hospital’s list of post-discharge options fill out a provider questionnaire including pertinent information, such as what services they provide, what areas they serve, hours of service, information on Medicare and Medicaid certification, and other information patients will need to make informed choices.

In addition to the questionnaire, the binder includes fliers, brochures, and other promotional information the providers give the hospital.

The hospital keeps a copy of the binder on every unit and passes it from patient to patient when post-discharge services are needed. Patients receive a list of names and telephone numbers of providers and then have a chance to check out their choices using the directory.

When a patient is discharged to a skilled nursing facility, the case managers document that the patient made his or her own choice of facilities on the discharge planning record. Patients who choose a particular agency for home health service or durable medical equipment sign a self-determination form, indicating they made the choice.

Some patients already know the provider they want to use. Others spend a lot of time with the directory, checking out providers that can provide all the services they need.

"The directory makes it easy for patients to identify a provider that can meet their needs. If a patient needs more than one item or service, the directory gives them the information they need to find a provider that can supply everything if that’s what they prefer," Trantham explains.

For instance, some home care providers don’t carry liquid oxygen because Centers for Medicare & Medicaid Services (CMS) reimbursement is the same whether oxygen is in liquid or gas form. Many patients want liquid oxygen because it is more portable and lasts longer.

When a patient chooses a provider, the case manager gets verbal permission from the patient to send his or her medical information to the agency to see if it can provide the services the patient needs.

If a skilled nursing facility has a bed available, the case manager makes sure the facility has all the information it needs to accept the patient.

"In our area, we have only a few skilled nursing facilities; and sometimes, the patient’s first choice is full. Then, we come back and get them to choose another facility. Sometimes, we have to just put it out there to all of them so they can make their choice from what’s available," she notes.

The case management staff encourage family members to visit the skilled nursing facilities and to check out the Medicare web site for each skilled nursing facility’s quality of care data.

Sometimes, when the patient is not covered by Medicare or Medicaid, the hospital must indicate to its patients which providers are preferred providers for their particular health plan. North Carolina does not have managed Medicaid or managed Medicare plans.

"Sometimes, their choice is limited, and we tell them that they still can choose but their benefits pay as much and may cost them out of pocket," Trantham points out.

It’s a challenge for discharge planners at Haywood when patients who are dual North Carolina and Florida residents need post- discharge services.

The area has a number of residents who spend their summers in North Carolina and winters in Florida.

If the patients are in a Medicare managed care plan in Florida, it’s not always easy to find a provider that is a preferred provider for their health plan.

"We have a couple of national agencies that provide services in our area; and sometimes, we are able to get service through them. It does push out some of our small hometown companies," Trantham adds.