ACH Case Management at Arkansas Children's Hospital
October 2022
ACH Case Management
at Arkansas Children's Hospital
Arkansas Children's Hospital
Little Rock
,
AR
United States
Jackie Brosi, BSN, RN CCM
Elizabeth Cooper, BSN, RN, CCM
Debbie Elliott, LPN
Rachael Ferraro, BSN, RN, CCM
Rhonda Fleming, RN CCM
Karen Henry, BSN, RN, CCM
Lindsey Holland, BSN, RN CCM
Casey Hunt, RN
Leslie Moore, BSN, RN, CPN, CPXP
Kristen Newton, RN, CCM
Towana Sanders, LPN
Denise Schwartz, LPN
Britini Scott, MNSc, RN, CPN, CCM
Lisa Walters, BSN, RN, CPN, CCM
Kim White, MNSc, RN, CPN, NE-BC
Stephanie White, MSN, RN, CPN, VA-BC
Melissa Parris, BSN, RN, CCM
Beth Proffitt, RN, CCM
Elizabeth Cooper, BSN, RN, CCM
Debbie Elliott, LPN
Rachael Ferraro, BSN, RN, CCM
Rhonda Fleming, RN CCM
Karen Henry, BSN, RN, CCM
Lindsey Holland, BSN, RN CCM
Casey Hunt, RN
Leslie Moore, BSN, RN, CPN, CPXP
Kristen Newton, RN, CCM
Towana Sanders, LPN
Denise Schwartz, LPN
Britini Scott, MNSc, RN, CPN, CCM
Lisa Walters, BSN, RN, CPN, CCM
Kim White, MNSc, RN, CPN, NE-BC
Stephanie White, MSN, RN, CPN, VA-BC
Melissa Parris, BSN, RN, CCM
Beth Proffitt, RN, CCM
The Case Management Team is outstanding, though many in our organization are unaware of the incredible work they do. I have never before experienced a more inter-professional genuine respect of coworkers, than I have here. The Case Management team is comprised of RN Case Managers and LPN Case Manager Assistants. This team's primary responsibilities include DC planning and utilization review (medical necessity review/inpatient authorizations by insurance). The entire team works together to ensure a safe patient discharge disposition.
On a daily basis, the RN Case Managers collaborate with the nursing teams and LIPs to understand the patient's DC needs and get the equipment, home health nurses, skilled visits, or supplies, etc. set up for the patient. Case Managers proactively assess the DC needs of the patient, talking to the patient/parents to obtain that information. It is not unusual for the Case Managers to seek every available option to reduce costs to the families, depending on what their payer will cover. This can consist of contacting local construction companies to provide supplies and labor to construct a wheelchair ramp or obtaining a needed home medication and personally meeting the Home Health nurse so it can be delivered to the patient's home. Case Managers also complete medical necessity assessments on every patient admitted to ACH, ensuring that the patient is authorized by the insurance to be in the hospital. If the patient is denied, the Case Manager assists in obtaining/drafting a letter of medical necessity to be submitted for an appeal. This team had an 85% success rate in FY20 and 93% success rate in turning over denied days at $657,720 in FY21.
Case Managers also coordinate transports from ACH to other facilities, ensuring the transport service, LIPs, nursing teams, and accepting facility are all informed. An example includes contacting other transport services when our own transport team was not available. The Case Manager found a transport solution to get a patient to Atlanta for a specialized rehab center in the way that was best for the patient and without costing the family a great deal of money since the insurance denied the medical air transport.
Case Managers are also available to the nursing and LIP teams in the evening and weekend hours to assist with any questions regarding DC referral setup or contacting agencies with patient information. Case Manager Assistants are vital to the referral process to ensure a safe DC disposition. It takes several hours to contact and coordinate available agencies (AR pediatric community resources are limited), send necessary documentation and orders to initiate referrals, and track progress on these referrals. Often times families have financial limitations and the Assistants will spend hours advocating for the family and locating free or low-cost resources for home use (wheelchairs, lifts, etc.).
Case Manager Assistants also complete discharge follow-up phone calls on every patient discharged from ACH. This includes at least 2 attempts to reach the family within 72 hours of discharge. DC call average = 60 calls/day, totaling 5 hours per day. Winter census can increase daily calls to 90-100 calls. This call includes obtaining real-time feedback on the patient's recent admission so feedback can be sent to the inpatient director for recognition or follow-up. Case Manager Assistants also sign up patients for MyChart during these DC follow-up phone calls to help patients/parents be able to access their EHR and LIP.
Every member of this team genuinely cares about their patients and families and goes above and beyond, sacrificing personal time to provide excellence and quality to each and every patient. It is an honor to lead this amazing team because they truly do champion children by making them better today and healthier tomorrow.
On a daily basis, the RN Case Managers collaborate with the nursing teams and LIPs to understand the patient's DC needs and get the equipment, home health nurses, skilled visits, or supplies, etc. set up for the patient. Case Managers proactively assess the DC needs of the patient, talking to the patient/parents to obtain that information. It is not unusual for the Case Managers to seek every available option to reduce costs to the families, depending on what their payer will cover. This can consist of contacting local construction companies to provide supplies and labor to construct a wheelchair ramp or obtaining a needed home medication and personally meeting the Home Health nurse so it can be delivered to the patient's home. Case Managers also complete medical necessity assessments on every patient admitted to ACH, ensuring that the patient is authorized by the insurance to be in the hospital. If the patient is denied, the Case Manager assists in obtaining/drafting a letter of medical necessity to be submitted for an appeal. This team had an 85% success rate in FY20 and 93% success rate in turning over denied days at $657,720 in FY21.
Case Managers also coordinate transports from ACH to other facilities, ensuring the transport service, LIPs, nursing teams, and accepting facility are all informed. An example includes contacting other transport services when our own transport team was not available. The Case Manager found a transport solution to get a patient to Atlanta for a specialized rehab center in the way that was best for the patient and without costing the family a great deal of money since the insurance denied the medical air transport.
Case Managers are also available to the nursing and LIP teams in the evening and weekend hours to assist with any questions regarding DC referral setup or contacting agencies with patient information. Case Manager Assistants are vital to the referral process to ensure a safe DC disposition. It takes several hours to contact and coordinate available agencies (AR pediatric community resources are limited), send necessary documentation and orders to initiate referrals, and track progress on these referrals. Often times families have financial limitations and the Assistants will spend hours advocating for the family and locating free or low-cost resources for home use (wheelchairs, lifts, etc.).
Case Manager Assistants also complete discharge follow-up phone calls on every patient discharged from ACH. This includes at least 2 attempts to reach the family within 72 hours of discharge. DC call average = 60 calls/day, totaling 5 hours per day. Winter census can increase daily calls to 90-100 calls. This call includes obtaining real-time feedback on the patient's recent admission so feedback can be sent to the inpatient director for recognition or follow-up. Case Manager Assistants also sign up patients for MyChart during these DC follow-up phone calls to help patients/parents be able to access their EHR and LIP.
Every member of this team genuinely cares about their patients and families and goes above and beyond, sacrificing personal time to provide excellence and quality to each and every patient. It is an honor to lead this amazing team because they truly do champion children by making them better today and healthier tomorrow.