Is it the SNF or is it the payer?
Last week I asked our listeners if they knew their top avoidable day reason and if they were willing to chime in with some answers during our live chat segment. Today, I am happy to follow up on many of the responses that I received and thank you so much for those contributions.
The responses aligned with three main categories. Delays related to transitions to the next facility, whether that be a skilled or psychiatric placement. Delays related to family decision making and social factors. And delays related to internal processes such as not having MRI services on weekends or limitations with consulting specialists.
Although I cannot review all the specifics, I think it is important to note that attribution matters and the only way to solve these problems is to ensure you are capturing enough detail to do something with the information. Enough days calculated for delays in weekend MRI services is likely justification to convince the leadership to hire another radiology technician.
When it comes to post-acute authorizations, I would suggest a deeper look. Is the delay related to the insurance company being slow in their process as reported by the skilled nursing facility (SNF)? Or has the SNF just told you that is the reason when it is an internal issue on their part. The SNF may only look at admission packets once a day or are sending out authorization requests to another department that is likely centralized and in another time zone. Or maybe they are telling you it is because of the payer, but when insurance is called, you confirm that nothing has been received. What is later discovered is the SNF has accepted the referral under ‘payer authorization’ but really does not have a bed available and they just did not want to lose the referral to another facility.
Dig deep and get to the root of the problem. Maybe the case manager is not proactively planning for SNF with clear evidence that the patient meets medical necessity for placement. Has patient’s medical necessity been confirmed in the documentation that was sent over to the payer and SNF for placement requests?
Once the source is evaluated, move into action. If one can decern the cause is the payer, request adjustments in the contract to improve these delays or request additional per diem payments while patients sit in the hospital. If it is the SNF, call this to their attention and discuss with their leadership how you can establish a more streamlined referral process to guarantee a smooth patient transition. If it is because of the case management team, it may be time to complete more training or look at department process improvement efforts.
In all of this I say to our listeners you are not alone, nor do you need to accept that this is your permanent reality. Change can occur!
With that I would like to ask our listeners, are there efforts at your hospital to decrease your avoidable days?
The responses from Monitor Monday listeners may surprise you; they can be viewed here.
Programming Note: Listen to Tiffany Ferguson’s live reporting on the SDoH every Monday on Monitor Mondays at 10 a.m. EST.
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In last week’s article, I focused on the screening and discharge planning policy requirements for §482.43 Discharge Planningfound in the Centers for Medicare & Medicaid
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