Question for Hospital DC Planners

IngyRN · Sep 4, 2008

Being nice, donuts, cards...helps to put your name out there but if your facility's reputation is questionable its not going to get you anywhere. How long have you worked for them? Get a feeling from your hospital case managers what their experience has been in the past -if it is questionable, you will have to work hard to prove otherwise. Look at what their problems , if any have been in the past & try to adress them.

As a case manager, I look for:

1)past pt outcome- are my pt's returning to the hospital worse or with things that could have been treated earlier at the facility. Remeber, 1st & foremost our primary responsibilyt is not just get the pt out but to get them out to place that CAN provide the care they need.

2)what are the pt's opinon re: care if they do return-word of mouth is important.

3)how does your facility rate with the Dept of health score ( if they do that in Florida-in RI the DOH rates the facilities , gives them a score & posts this online).

4)Is your facility known as "cherry pickers" ( as we call them in RI)- do you only take the "easy" pt with good rehab potential or are you willing to help a case manager with one of those "train wrecks". This may help establish a relationship between you and the case managers as apparently there isnt one.

What is your response time when you get a referral in regards to evaluating the pt & accepting them-long response time and giving false hope (ie, after reviewing the WHOLE chart & saying you have a bed at last minute responding with " we cant accomodate their needs is NEVER seen in a positive light!)

5) Offer to give your case managers an inservice to provide some CEU's as well as to tell them what you have to offer at your faciilty. Please do not complain about the case managers to their boss- you will get more with honey than with vinegar. The case manger has to give pt choices-however, there isnt anything to prove that they aren;t giving their opinion about one facility over another (pt's will ask and rely on their opinion). Complaining WILL be worse.

6) You may want to market to MD offices- I have seen this with the orthopeadic groups who know their pt will need rehab postop- the office offers the choices in the pre-op appt.

Essentially, make sure that what you are representing is worth it. If case managers have not seen good outcomes for their pt's, you will not see an increase in referrals if you cannot prove to them otherwise.

Good Luck!!

Katie82, RN · Sep 13, 2008

Essentially, make sure that what you are representing is worth it. If case managers have not seen good outcomes for their pt's, you will not see an increase in referrals if you cannot prove to them otherwise.
Good Luck!!

When I worked for an insurance company in Md. our discharge planners made the final approval/decision in placement. I was a case manager, and I soon learned from the DPs which facilities to avoid for just the reasons you stated. The hospital DPs had little say. When they called for approval of rehab, our DPs would take over, then notify the hospital DP. Must not be the case in Fla.

IngyRN · Sep 14, 2008

When I worked for an insurance company in Md. our discharge planners made the final approval/decision in placement. I was a case manager, and I soon learned from the DPs which facilities to avoid for just the reasons you stated. The hospital DPs had little say. When they called for approval of rehab, our DPs would take over, then notify the hospital DP. Must not be the case in Fla.

I too worked for an insurance company as a DCP. Although the insurance DCP has the final say re: authorizing rehab LOC and payment, the first line of communication with the patient is the hospital DCP. They are the ones who meet w/pt, discuss dc options based on par facilities, location and appropriate setting. The patients always have a choice where they want to be referred to based on the above. Many times they ask for the hospital DCP for their opinions and make their decsion based on that.

butterflyrnFL · Oct 8, 2008

I am a hospital CM/UR/DC planner-- We have 3 local SNFs that all provide very similar services. We refer to 2 of the 3 on a very regular basis. However, with the third one we consistnely have problems. I tried to "spread" my less than desirable patients between the three facilities. This third facility would accept these patients then on discharge would "change their mind" leaving us to scramble for a discharge plan--sometimes they would do this on insurance patients as well. I now will mention this facility when a patient needs SNF, but do not make a referal to them, unless the patient asks for this facility by name.

In addition the inconvience this has caused my department, this facility started accepting post-acute patients from other facilities that in my opinion they cannot care for-- so they send them to the nearest hospital (where I work). Then on dc they will not accept patient back---requiring us to find another facility.

I do not know what problems you have had with this hospital-- but perhaps you need to speak w/ a dc planner that can let you know some of the history.

Good luck

Lucy4 · Oct 24, 2008

I am a DCP at a tertiary medical center and discharge many patients to SNFs, LTACs and acute rehabs - more SNFs than the others. Medicare requires that patients are offered freedom of choice and I, as well as all DCPs, are required to give patients a list of providers within their geographic area. I print a list of providers from ECIN and give to the patients, regardless of their payor source. I encourage families to visit their facilities of choice. Many of my patients are from out of town and have come for specialized care (solid organ transplants) and most are required to remain in town after surgery - unless they live less than one hour from the hospital. Sometimes patients are readmitted for one reason or another some time after transplants and can go near home for rehab.

Though patients are given FOC, I admit I guide them to facilities that can best meet their needs and have experience with medically complex patients. I have indicated to patients which facilities have accepted transplant patients with good outcomes. A couple of the services outright forbid transfer of their patients to one particular hospital based SNF. Overall though, I have found hospital based SNFs to meet the needs of my patients most reliably. A couple other nursing homes with SNFs in town have accepted transplant patients and provided good care and have good outcomes. Have had good luck with one particular corporate facilities outside of town and state.

Whenever I have contact with a patient whom I have discharged to a facility - readmit, phone contact or visiting -I talk with them and ask them about their experiences and whether they would recommend to others. I have found that patients are candid with good and bad experiences. If I consistently get negative feedback from a facility, I do relay that information to the liason.

Recently I sent a patient to a corporate LTAC - patient's families choice due to close proximity to their home. The liason from this LTAC stops by regularly and provides small gifts, brochures, etc and promotes her facilities. The patient who was discharged to this LTAC was the first patient I have sent to this facility. The day after discharge I recieved a call from one of the social workers at my hospital who is a good friend with this patient's wife. She wanted to know what happened on discharge that upset her friend so badly. On investigation, I found out the liason called the wife and wanted to send her husband to the corporate LTAC on the other side of town because the census is down at that location. When the patient's wife said NO, the liason persisted and offered gas cards to assist her with travel experiences. I contacted the admissions office for the LTAC and expressed that I was angry and very disappointed at what happened and now very hesitant to give them any other referrals - also expected that his care be stellar and that I would follow up on his progress. After talking to some of the other CMs, found out they have had similar experiences and the LTACs this liason represents is not their first choice of facilities. Also care issues.

I agree with Ingy on all of the points in her post. Satisfactory patient outcomes are a top priority.

Good Luck!

bossynurse101 · Oct 25, 2008

Wow, what great feedback. Thank you everyone who took the time to respond, I appreciate it. I am very impressed with your integrity and the fact that you are more interested in pt outcomes. Unfortunately, I dont think that is the case with the magor "feeder" hospital in my area. I really dont think that Im too far off base with my suspicions that the CM's are somehow more swayed by my magor competing liaison. She has been in the area for many, many years and altho her facility has a good rep, ours is just as good. This particular rep is very good friends with another liaison who tried to have me "blackballed" because she didnt get my job and then subsequently fired when her sabotaging efforts started affecting the facility. It sounds amazingly juvenile, but it is true, and is very fustrating to deal with. I wish the CM's showed less favortism and more integrity but it is what it is I guess. One CM who is also friends with the liaison who was fired didnt send us referrals for close to six months. How unprofessional is that? Sometimes I just want to hang it up, the politics suck, but the pay is good and it is a job. Who wants to be in the hallway with the economy so horrid? So, I try to be nice and show the CM's that I am not the ogre that these twits portray me as and hope that they do the right thing by the patient, yeah remember them? Anyway, thanks again for listening.

Lucy4 · Oct 25, 2008

Sorry you are having such a difficult time and hope things improve for you. I like to think the great majority of CMs are fair and interested in good outcomes over making referrals to a facility just because they are friends with the liasons. One suggestion I have is to have an open house and inviting the CMs to tour your facility and emphasize the specialized care that can be offered. Marketing to physician groups may be another way to go. Where I work the orthopedic surgeons are very particular about where their patients go for rehab and have personally toured some of the facilities, met with the therapists and discussed what they want for their patients. Market what your facility does best. Several facilities in my city - owned by the same corporation - offers some type of specialized care at each SNf. One has a program for bariatric patients and has staff trained in how to care for them and obtains the necessary beds and equipment. Another has a CHF program. One facility is located across from a community hospital and marketed to the ortho surgeons at this hospital. Now the ortho MDs at this particular hospital send their patients (S/P total joint replacements) there for rehab. Think of what your facility can market and offer that the others do not have. Just a couple ideas. Good luck and keep us posted as to how things continue for you.