Ordering DME in the ED

[moffist]

Our hospital is piloting having RN case managers in the ED. Yesterday for the first time I had to order a hospital bed and wheelchair for a Medicare patient. This was an unbelievably difficult procedure ending in failure. There MUST be a better way than having to get our all ready overburdened ED doctors to write a great long progress note for these patients NOT being admitted. Anyone know of a form that has been developed OR an easier way than having to write a "story" for Medicare??? It doesn't help an already overburdened ED OR help the patient very much!!! Any advice appreciated.

[MereSanity]

Wow...in our ED they get it whether they can pay or not.

[SummerGarden, BSN, MSN, RN]

Wow...in our ED they get it whether they can pay or not.

We are not talking about crutches or equipment to cover sprangs. Those are paid out of a different pot/billing system associated with the visit to the ED. DME is entirely different and so I doubt your ED gives it away unless there is some charity that covers the cost or patients and organizations donate used and/or new equipment for your CMs to give away.

[toomuchbaloney]

I work in EDs and I order DME all the time. The process is not that bad and does not require a patient to be admitted to the hospital for any reason to include placing him/her on OBS.

Basically, if the patient has insurance and there is a documented safety and medical need for the equipment, the DME can be ordered the same day to be delivered to the patient's home or the ED and the insurance can be billed directly by the company. If the patient has no insurance and/or no medical safety need for the equipment, then he/she has to pay for the equipment out-of-pocket. There are plenty of places for people to go to get the new equipment when insurance will not cover the equipment, such as drug stores and DME companies found in the local phone book.

So your ED providers complete that paperwork and you facilitate that? This is true 24/7?

I am impressed.

[d'cm]

My experience is similar to MBARNBSN which makes me think the issue for the OP was the DME provider market. Here in NJ it is highly competitive. I have provider reps in my face daily trying to get me to give them business. They know if I have to make more than one call they will not get any more referrals from me.

[SummerGarden, BSN, MSN, RN]

So your ED providers complete that paperwork and you facilitate that? This is true 24/7?

I am impressed.

No, ED providers are too busy to do anything but sign orders for what they want. We (the CMs) complete the paper work and the ED providers look them over and sign. We then fax a packet to the DME company and handle making arrangements to have the DME delivered. We also handle setting up hospice, home health, and SNF (skilled and custodial when people have the means to pay) placements from the ED. It is not rocket science, but it is hard work where one imporves over time.

For example, it is necessary to be able to forge relationships in the community and to make contacts that will do you favors as fast as possible. This occurs over time and it occurs by ED CMs who are looking to make stuff happen for patients as oppose to admitting people that do not meet criteria when he/she gets frustrated.

FYI, my tone in this post/response is not to put anyone on here down ... I am directing my tone to the weak ED CMs I have worked with in the past that cost patients and the hospitals with which we worked a lot of money due to their poor nursing/business/creativity skills. Good luck.

[Altra, BSN, RN]

ED providers are the last people who should be involved in ordering long-term DME or, for goodness sake, placement, for patients they just met 2 hours ago.

Once in a blue moon all the elements can come together for timely SNF admission from the ED - a patient presents with solid-enough history, no POA snafus, the right insurance, near-miraculous immediate bed availability at a facility acceptable to family, and presentation to the ED early enough in the day to complete diagnostics to rule out any new problem. But those are not exactly odds I'd go to the casino with ... and more typical cases like this would wreak havoc on ED length of stay and capacity if potential SNF admits were boarded.

[fostercatmom, ASN, BSN, RN]

This is an old topic...but ambulatory dysfunction is not a 23h obsv stay (at least not anymore) boy, if it was back then...you guys were lucky!!

[Inori, BSN, RN]

Well there's some confusion on the roles. Care coordinators - touches base with all involved parties, reminds, makes, sure patient has follow appointments with thier pcp, etc. This role is not limited to nursing, social worker or even trained care coordinator can do.

NURSE Case manager - the main focus is on the clinical aspect is this pt is meeting medical goals if not why not and address those barriers be it social, medical, psychological, or financial and refer them to those resources. Care coordinators ensure that pt keepts the appointments. So case in point - need bed doesn't mean you chase down the ED doc but you'd coordinate with the PCP or long term care and the receiving facility see how they get beds in there, talk to other case managers.

Nurse case managers spend alot of time doing patient teaching and keeping the PCP in the loop of whats going on and its a partnership with the doctors too as CMs contributes information otherwise PCP would not have. Pt not taking HTN meds because it makes him pee ok simple enough he's willing to take another med so we talk with docs and patient can have a new prescription. We check in with the patients on regular basis, so they and thier families feel cared for, and comfortable to ask questions and are now self educated on caring for themselves and results in better care now BP under control.

Good luck it is alot of work CMs do