Care coordination is comprised of two teams: Case Management/Discharge Planning and Utilization Management. Both offices are located on the second floor at CHM near Medical Records and on the Ground floor at CHW next to administration.
Discharge Planning: Lead Case manager Angi Bollinger can be reached at extension 4585.
Composed of RNs, social workers, licensed counselors and other staff.
- There is a discharge planner assigned to every patient.
- Discharge planners tend to be unit-based, but assignments may vary.
- 7 day/week coverage at CHM. 6 day/week coverage at CHW with staff on call Sundays.
Case managers assist physicians with coordinating care during hospital stay and after discharge.
- Care coordination tries to promote a collaborative relationship between physicians and case managers. We will frequently discuss both short and long-term plan of care with the physicians to allow proactive approach to transitions of care.
Case managers will often ask physicians for orders for necessary SNF placement, durable medical equipment, hospice evaluations etc.
- MDs must enter own orders for medical equipment- phone orders not allowed by Medicare.
- Patients discharged to Skilled Nursing Facilities require hard-copy scripts sent with them for schedule 2 medications.
- Case managers can help navigate all the paperwork that needs to be completed for services such as Coumadin clinic, home health and outpatient therapies. Per Medicare guidelines, many of these forms must be filled out by the physicians themselves.
Types of services we help facilitate include: Nursing home placement, rehab placement, hospice, palliative care, home health, Coumadin monitoring, physical therapy, occupational therapy, medications, wound care, and other post-discharge services.
Utilization Management— Kathy Foor is the lead UM RN and can be reached at extension #3152 with any questions or concerns.
All RNs : Initial and concurrent reviews for status and medical necessity
Use Interqual criteria and secondary reviewers:
- In House Dr. Reyes and his physician group that covers for him
- Outside-Accretive health for our Medicare Observations.
Contact the physicians for change in status orders. We are here as a guide in determining right status.
For Medicare patients going from inpatient to observation causes a “Code 44”. A utilization committee member gets contacted and reviews the chart and has to approve the change. If the Doctor agrees with the ordering physician the ordering physician will be called by UM for the order and reminded to document the change in his progress note. If the physicians don’t agree there will be a conversation between those physicians. Please do not change a in-patient to observation with speaking to a UM RN or leaving a message on their extension.
There is a concern for multiple orders for status, please check with the UM staff before changing status on a patient. At Woodstock #3142 and at Mchenry # 4593
Sometime an insurance company will deny a stay and we will ask the attending physician to do a Dr. to Dr with the insurance medical reviewer.