The Bed Management Center BMC

1. The Bed Management CenterBMC

2. BED MANAGEMENT CENTER STAFFING • Manager 216-2062 • Assistant Manager 216-9836 • 8 Care Coordinators(RN’s) • 3 Admission Coordinators • 10.5 Bed Assignment Clerks • 1 Office Manager • Department reports directly to Rhonda Miller, Associate Director of Fiscal Services

3. BMC Primary Goals • Assure patients are placed in the optimal bed in a timely fashion • Expedite the admission process • Physician education • Payer requirements for place of service • Documentation

4. BMC Primary Goals (cont) • Improve data tracking and accuracy • Improve denial management • Improve reimbursements

5. BMC Primary Goals (cont) • Decrease the average LOS • Expedite outside transfers into UNC as indicated

6. Bed Management CenterKey Functions I Physician Education II Observation Management III Assignment of Beds IV Screening of Admissions V Data collection & Analysis VI Authorizations of Urgent/Emergent admissions

7. Observation Vs. Inpatient Vs. Extended Recovery • Observation • periodic monitoring by a hospital’s nursing and other ancillary staff, which is reasonable and necessary to evaluate an outpatients condition or determine the need for possible admission • Decision usually made in < 23 hours

8. Observation Vs. Inpatient Vs. Extended Recovery • Inpatient- • patients that require an acute care bed beyond the initial 23 hours and meet specific inpatient guidelines for admission .

9. Observation Vs. Inpatient Vs. Extended Recovery • Extended Recovery- • Placement in a bed following an outpatient diagnostic, therapeutic or ambulatory surgical procedure that requires a stay beyond the routine 4-6 hours of recovery time.

10. Extended Recovery(cont) • Correct order post op/procedure =“Extended Recovery” • Also known as “outpatients in a bed” • Utilizes Medicare listings of services, outpatient vs. inpatient for all elective admission requests • “Reserves” a bed

11. Extended Recovery(cont) • Can be upgraded • For overnight stay-anytime past the routine 4-6 hours of recovery time is not reimbursed • Utilizes an acute care bed • Start in the clinic to explain to the patient and family surgery is considered outpatient, prepare for discharge early on.

12. ADMISSIONS GUIDELINES • UNC Hospitals is a licensed facility for use of Interqual Admission Guideline

13. ADMISSIONS GUIDELINES • Two main criteria are used in Interqual • SI=Severity of Illness, clinical or laboratory findings • IS=Intensity of Service, what is/are the treatment plan(s) indicated

14. INTERQUAL GUIDELINES • Interqual is available on all clinical workstations • Applies to observation patients and inpatients • Documentation is the key to ensuring reimbursement

15. Observation Management • Written order by physician, i.e. “admit to observation status” • Documentation must include medical necessity(Severity of Illness, SI) and Treatment plan(Intensity of Service, IS) • Orders must be written prior to initiation of observation hours

16. Observation Management • Used in the following circumstances • Outpatient Surgery • Outpatient Therapeutic Services • Patient Evaluation

17. Observation Management(cont) Outpatient Surgery • restricted to when a patient exhibits an uncommon or untoward or unusual reaction to surgical intervention

18. Observation Management(cont) Outpatient Therapeutic Services Restricted to when a significant adverse reaction occurs that is above and beyond the expected response to service

19. Observation Management(cont) • Patient Evaluation • Evaluate the patient when the provider is unsure about admission and additional time is needed to make that determination • Provider believes patient will respond to treatment modalities in less than 23 hours

20. Observation Hours • Common misunderstanding is that Medicare covers up to 48 hours in observation status. This is correct, but only in rare circumstances with significant documentation to support the need • Medicare expects that observation services generally do not exceed 24 hours

21. Observation Hours(cont) • UNC Hospitals’ policy is that a decision regarding observation patients can and should be made within 24 hours. • Discharge patient • Admit as an inpatient only if inpatient criteria has been met.

22. Writing Observation Orders • Correct • “Admit to Observation Status” • Incorrect • “Overnight observation” • “To unit”

23. Writing Observation Orders(cont) • Incorrect • “Admit to 23 hour observation for extended recovery” • “Transfer” • “Overnight stay”

24. Writing Observation Orders(cont) *NOTE • Occasionally patients in observation status need to be transferred from a general nursing unit to a critical care/step-down unit. Physicians orders should state “Admit to” and NOT “Transfer to____”.

25. How does a patient go from Observation status to Inpatient status?? • Observation team of Registered Nurses review ALL observation and extended recovery cases in-house • Utilize Interqual Guidelines • Observation team will make a recommendation to upgrade the patient to inpatient status if criteria are met (review clinical documentation and orders written)

26. How does a patient go from Observation status to Inpatient status?? • Will recommend discharge if criteria not being met for continued stay • Review of status alert sheets

27. How does a patient go from Observation status to Inpatient status?? • Physician must write an order for inpatient admission(Admit to______)including those patients in observation status going to a critical care unit. • Observation status can progress to inpatient status----a patient can never go from inpatient to observation status

28. BMC Observation team PagerHours 216-2669 Days 216-1939 Days 909-0108 Evenings 123-2251 Weekends 0700-1930 Admission Coordinator WP 966-4029

29. BED ASSIGNMENT AREA 966-2041 • Formally known as Bed Control • 10.5 FTE’s • 24/7 operation • 687 acute care beds • Work closely with NURSING supervisors • Daily Bed Planning meeting at 0830

30. SCREENING OF ADMISSIONS • Use of Interqual guidelines • M-F 0800-1700 Call Center in operation(966-2041), with options • All other hours RN coverage as indicated(on call)

31. SCREENING OF ADMISSIONS • SI=Severity of Illness(Dx., S/S) • IS=Intensity of Service(TX. Plans) • Primary responsibility to determine Observation vs. Inpatient status • Correct orders must follow recommendation

32. DATA COLLECTION AND REPORTS • Observation Management database • CRM database • Bed Availability • Transfer data • Quality Assurance(Impact Care reports)

33. Authorizations for Urgent/Emergent Admissions & TRANSFERS • BMC is responsible to authorize all Urgen /Emergent admissions M-F 0800-1700 • Specific demographic & clinical information required along with proposed treatment plans(IS/SI) • All patients start out as Observation and are upgraded to Inpatient as indicated

34. Authorizations for Urgent/Emergent Admissions & TRANSFERS • All transfers are screened utilizing Interqual guidelines to ascertain the need for Tertiary care • Physician Advisor available