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Improving the Clinical Review Process for Home Care Patients

Improving the Clinical Review Process for Home Care Patients. Team Members. Paul Gorski Elani Cook Ann Pebelske Greg Horner Jackie Kareb George Krempel. Opportunity Statement and Desired Outcome. There are opportunities in Home Care to:

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Improving the Clinical Review Process for Home Care Patients

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  1. Improving the Clinical Review Process for Home Care Patients Team Members Paul Gorski Elani Cook Ann Pebelske Greg Horner Jackie Kareb George Krempel

  2. Opportunity Statement and Desired Outcome • There are opportunities in Home Care to: • Improve the clinical review process for sending out the Plans of Care (HCFA 485) for a more timely physician review and signature • Desired Outcomes: • To decrease volumes of unsigned Plans of Care, which will then equal a concurrent decrease in our accounts receivable • To decrease the time between the patients start of care and the mailing of the HCFA 485 to the physician

  3. Most Likely Causes for Current Opportunity • Non-efficient workflow of office processes that inhibited the timely creation of a HCFA 485 • Staff responsibilities did not allow for efficient and timely creation of the HCFA 485 in their daily work

  4. Solutions Implemented The HCFA 485 workflow was streamlined with the creation of the Utilization Review specialist position. This position allows for other office staff to focus on their other duties. The UR position oversees the creation of the HCFA 485 and intervenes with appropriate personnel when delays occur. The net effect was FTE budget neutral.

  5. Charges are representative of patient care episodes that occurred between 0-90 days from the start of care date

  6. Results of Data Analysis • In assessing the effectiveness of the UR position, the overall percentage of signed 485s that were created between 0-90 days from the start of care date has increased from 31% to 66%. • Corresponding charges has decreased from an average of $385,020 to $228,903.

  7. Recommendations and Next Steps Continue to monitor the overall quality effect of the UR position and its supporting financial impact. This can be attained by analyzing the percentages of signed HCFA 485s and the outstanding charges.

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