December 28, 2021

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1 referral, 4 skilled nursing facilities: On your mark, get set … Go!

Automating the business processes around patient decisions creates efficiency and accountability for the decisions being made.

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Scott Magers

Account Manager of Post-Acute Care for Hyland

Three medical professionals work using a tablet, physical paper forms, and a desktop computer.

If you follow any of the industry’s social media, it is being reported that the average daily census is reaching new lows across skilled nursing facilities (SNFs).

Building the base of long-term care residents in the healthcare industry is one option to protect the bottom line, but that reduces the number of beds available for any potential short-term patient.

Every referral is critical if you have built your business around rehabilitation services for the short-term patient population. Time is of the essence to win that admission.

Start the clock, you have 15 minutes

I’ve been at the table in collaboration meetings between hospitals and SNFs. It is common to hear that a hospital will send the initial referral to more than one SNF and expect a decision within 15 minutes.

The first to respond will get the admission. These collaborations have done a nice job working closely with the SNFs involved and identifying the clinical capabilities of these facilities.

The referrals are generally made to the facilities most prepared to deliver the appropriate level of care. However, this does not mitigate the risks if a referral is agreed to be admitted without careful review of all the protected health information (PHI) and medical records available.

A quick decision

It seems easy, just respond ‘yes’ to all referrals as quickly as possible. The beds are filled and the average daily census is improved.

Was this the correct decision or did you need to chalk a few up as “the cost of doing business”?

We’ve been there, agreed to admit a patient without thoroughly verifying the patient’s insurance (prior-authorization delays are a topic for another day). You now have a patient coming to your SNF and are at risk for reduced or no payment. The patient needs care, so it’s too late to turn back, and you certainly do not want to disappoint your referral sources by forcing them to scramble to find new placement.

What about the patient arriving with a big surprise? You now have someone in your care with an unexpected laundry list of costly medications requiring a carve-out or an unknown DME need which required a prior-authorization.

I am confident there are patients admitted who were more medically complicated than expected. What is the probable outcome for these patients? An emergency room visit or preventable readmission is likely. That’s why we need to make more-informed decisions when it comes to referrals.

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The best decision

We need to see all the PHI and the complete patient picture of the care received at the hospital for the following reasons:

  • Insurance Verification: Can this referral come to your facility?
  • Medical Review: Can you provide the necessary level of care for the primary diagnosis and all associated comorbidities?

The clock is ticking

Leveraging the right capture technology to ingest and securely store all the hospital records makes these documents readily available from any electronic device for review.

There is no need to print multiple copies of these records to then chase down the necessary people needed to complete the business office and clinical reviews. Everything you need is at the tips of your fingers.

Going further, robust referral management workflow and case management solutions allow for routing to both the business office and medical reviewers, tracking all decisions as they are being made and stopping the lifecycle in either queue at the moment a decision is made that the patient cannot be admitted.

Why continue to spend time reviewing a referral in either queue if that patient will not be admitted?

The best business and clinical decisions need to be made quickly and by the correct people. Automating the business processes around these decisions creates efficiency and accountability for the decisions being made. This allows your SNFs to admit the appropriate referrals timely and sets the stage to provide the best care possible for the episode of care.

Stop the clock, you’ve made the best-informed decision

Expect improved outcomes and happier patients in your SNFs. Expect improved relationships with your referral sources as a result of these quick decisions, better outcomes and happier patients.

And don’t forget, all these documents are securely stored in a central location.

This eliminates the labor-intensive task of manually scanning these documents to an unsecured shared drive, inconsistently naming these files and allowing them to be viewed by nearly everyone. If these scattered records can even be found again.