I manage a Central Intake office which processess 75 referrals daily, >120 on Friday. Most of my staff have 20 yrs nursing experience with ~ 10yrs in the field. Last 2 RN's I hired had no homecare experience; one is school RN & the other RN worked urgent care clinic; both used computer documentation so skills sets transferred and had hospital experience.
FT benefited staff average $25-$26.00/hr with $1.00 more for second shift.
Why do you hate the OASIS? If because computer system cumbersome, then same thing might occur with direct computer entry in office setting. If still in paper/pencil mode, good computer database is priceless.
A peds nurse tried an intake position and fled after 4 days as HATED being cooped up in cubicle with jangling telephone and bell ringing on the wall (cue that phones all busy and call waiting). Others are glad to be out of the field , have set spot to work at...especially if one hates messy home environments.
My staff view their roles as patient and healthcare advocates:
a. Identify upfront needed skilled and non skilled services
b. Maximize services agency can provide for patients, especially Medicare to prevent re-hospitalization.
c. Promote service programs: CHF, COPD, Diabetes, Rehab to families/patients, physicians and referral sources
d. Obtain initial authorization for homecare for Managed care clients
e. Negotiate maximum payment for agency services for non-contracted payers.
f. Notify patients of co-payments, deductible and covered/non-covered services.
1. Staff are responsible for identifying appropriate services based on diagnosis, functional and caregivers availability; insurance eligibility & benefits.
Patient with DJD had Bilateral hip replacement with staples to be removed in 10 days. Lives alone 2 story home with 2nd fl BR and bath. Ambulates with Rolling walker 50 ft. Depending on insurance
a. Keystone 65 Medicare HMO, eligible for SN, PT, OT and HHA. We can electronically obtain 6 visits each discipline. No deductible or copays.
b. Medicare eligible for same services as Keystone.
c. Aetna Golden Medicare, insurance will give reference # for 1 SN, 2 PT---PT to eval need for OT ; RN needs to eval for HHA and call report to get further visits authorized. Most Aetna Medicare policies will have $20.00/day copay for homecare services while Aetna HMO, especially if small employer group will have only 80% coverage and $1,500.00 deductible. This information needs to be on the patient consent form under Medicare homecare regs.
d. Medicaid HMO: 2 SN, 2 PT---call eval report for other disciplines and further visits.
2. By identifying up front needed skilled and non skilled services and maximize SN, PT., OT., aides at time of intake with referral sources, department aware they need to have staff scheduled next day.
....rather than having RN go out to see patient (within 24-28hrs of start of care request), assessing that patient needs PT, OT and HHA, ordering them + completing HHA care plan and submitting to office ...paperwork arrives 48hrs after admit.
By time services get staffed, it can be 4 to 7 days after patient home before get other needed services.
3. Identifying care needs out of a referral source is an art in itself. We also wear detective hats daily.
Physicians office will call in "Dr's ordering home care...daughter called, Mom been sick for 5 days and can't get downstairs to eat. Dr hasn't seen patient in a year, wants her evaled"
I ask "What is patients diagnosis?"
Response: " I don't know, don't have chart just calling in info from computer".....
My next question: " What diagnosis did doctor bill for last time?"
Response: "Uncontrolled diabetes and DJD"
Anything you can tell me about the patient?....allergies, diet, do they use a cane walker....live alone....daughters name and phone number." Usually get daughter's phone number, but not other info.
Confirm patients address, phone number and services: SN, will eval need for PT.
I find it prudent to next call the daughter to get scoop on patient: dad died 3 months ago and mom been tearful this week; daughter did get her to eat and drink today. Been taking insulin and not checking blood sugars.
Add to referral need to eval for social worker: grief counseling and community linkage; RN to screen for depression.
Hospital discharge planner calls, tells us pt lives at 1266 Oakmont St, Zip 19143. Phone 215 -555-1212
Having worked in area, know there is no Oakmont street in zip 19143, and that phone # associated with Zip 19134.
Call phone number: disconnected. Call emergency contact: wrong number.
Internet search zip code directory---confirms Zip code is 19134. Phone book search shows phone #: 215-555-2121
No day is the same. Some days you get tons of "clinical chit chat" calls: patient delayed in hospital; add ST services; Lovenox dose change;, patient going to temporary address. Next caller might be rehab unit with 3 discharges patients with CVA's with multiple functional deficits, needing multiple services, each referral taking 20 minutes to complete as no prior homecare. Next caller is hospital discharge planner and you take 2 referrals in 10 minutes.
Hope this gives you an overview of what intake Department is like. There may be agency "expectations" that you will grow referral business. That can be a stressor if discharges fall through for one reason or another and productivity goals not met.
I find it is a wonderful way to tie together all I've learned to help patients. Last week had daughter calling to finalize mothers SNF discharge, father distraught that insurance company refused hospital bed. Patients DX was Pulmonary Fibrosis on 5 nasal Oxygen and Rheumatoid Arthritis flair. Reassured her Mom did qualify if referring physician willing to sign orders; would get PT out next day to arrange bed equipment if not ordered by facility.
I had talked with daughter 10 days prior to this when she was saying mom too weak to come downstairs and was having arthritis flare. The arthritis specialist is so and so, pulmonologist is so and so...arthritis doc ordered xyz med, was in to see PCP last week for flu shot. I called the PCP for homecare orders, they declined as only gave patient flu shot---hadn't examined pt since June...filled Office RN on patients issues.. Daughter busy taking and calling "specialists" but left PCP out of loop. Called daughter back, told her needed to call PCP re issues..........VOILA 30 minutes later got orders for SN, PT and Aide. Unfortunately, pt fell that night and was hospitalized, then went to SNF.
This second referral for homecare also included private pay aide 10 hrs day as spouse overwhelmed with patients care needs. When I obtained auth for services, saw facility had given Diagnosis as "hip pain"...grrrrrrrrrr I added above diagnosis and called daughter back. Daughter very grateful for advice given; she called social worker back at SNF --- hospital bed ordered for delivery same day.
Knowing how the "system" works is half the battle in Intake.....once you got that down, referrals will come rolling into the agency.