What are the tangible results generated for your customers?
Without fail, all our hospitals have experienced, at minimum, between 20% and 30% increases in their transfer volume. Several of our facilities have seen between 75% and 125% increases. It comes down to creating consistency and simplicity in the process. Whatever facility makes the process efficient and streamlined, will get the transfer every time!
How do you keep track of physician on-call schedules?
We have access to physician call schedules in a variety of ways. The majority of facilities have electronic on-call systems that we remote in to. Some do have hardcopy call schedules that are either faxed or emailed. While paper schedules are normally sent the first of every month, we are also notified of daily changes by physicians or the party responsible for maintaining the schedules.
What if you are unable to reach a physician?
All protocols have an escalation component. Typically the protocol will direct the Coordinator to re-page or call the physician, after they have been unsuccessful reaching them, initially. Depending on the acuity of the request, we may have a second physician to contact or possibly the Chief of Service or AOC (Administrator on Call). We typically include time parameters. So, if we don’t receive a callback within five minutes, we try again. If still no contact, we move to option two. If it is a more critical transfer, the ED physician may play a role early on in the call.
What role do Admitting or Bed Assignments play?
We communicate with Admitting and Bed Assignments through all hours of the day and night. They keep us abreast of their bed situation. Some hospitals require we check beds prior to every transfer and some hospitals have a policy that regardless of the situation they will make a bed available. For some facilities we represent, we remote in to their bed management system, so we know the “pulse” of the facility and have a global view of capacity.
We also request demographic sheets for each transfer. Once these are received and acceptance is obtained, we either preregister the patient ourselves or fax the demographic sheet to Admitting so they can preregister the patient.
Who is the best person to be the administrative contact? What can they expect and what is their role?
The Admin contact should be someone who has longevity with the facility. This way they are known and respected by the physician groups and have no issue enforcing policies and following up on concerns. This person can typically expect a 25% increase to their current workload PER HOSPITAL. If they are an administrator for a system, they need to be prepared for a 50-75% increase. This workload will drastically decrease after the first three months of service. After six months, it will be simple maintenance.
Do we collect insurance information?
Yes, we can. Typically, it is collected off the demographic sheet that is faxed to us. For emergent ER to ER transfers, we don’t request the information.
How do you know who to call for transportation?
All processes within the coordination center are driven by protocol, which is approved by each facility we represent. Transportation is no different. We will call the preferred provider for both ground and air. Through our system we have the opportunity to expedite transport times, particularly when our own assets are utilized. This is done via technology and congruent communication with our dispatch center.
What is the point of the EMTALA questions?
These questions were put into place to help determine appropriateness of transfer. They can be helpful if a facility is typically full and concerned about dumps, but they can also be a hindrance if a hospital is trying to boost referral relationships and increase volume. A typical response from a sending physician might be, “I wouldn’t be calling you if it wasn’t an emergency.” The questions are:
- Is this referral an emergency medical condition at this time?
- Does your facility have the capability or capacity to care for the patient? If not, what are you lacking?
Do you prescreen patients?
We always recommend an “administrative review” protocol. This review process is typically used only for inpatient transfers. An additional set of questions may be asked during the intake. For example, “Has this patient been seen here before?” “When was the patient admitted at your facility?” “Is this patient a resident of this state?” Based on the answer to these questions, we may involve a case manager to determine appropriateness of the request, prior to contacting a physician.
Do we monitor denials?
Yes. Each call is assigned a status (i.e., accepted, denied, referred, consult only, or cancelled). Each facility can establish parameters around what we monitor and review. If a facility is concerned about denials, we can mark these calls for review. The administrator in charge will receive an email explaining what occurred. At which time, they can request the tapes. We can also monitor physician behavior, diversions, delays in receiving bed assignments, delays in transportation, etc. All information gathered throughout the call is recorded and documented. Each facility has access to its own records and recordings.
Are the Coordinators nurses or medically-trained staff?
Medical training or experience is not a requirement of the job, simply because we are not making medical decisions. We are only facilitating them. We are getting the appropriate medical personnel connected so they can make decisions relative to care and placement. However, we do have 24-hour clinical oversight. There are medically-trained professionals on our Quality Assurance as well as Operational teams. This way, if there is a question or high-acuity case, they are able to step in and help provide direction. Keep in mind, all process are protocol-driven. This workflow-based technology and service drives the pathway of the call and ensures the appropriate service line is contacted.
What are the requirements to hire Coordinators?
We look for candidates with excellent customer service backgrounds, professionalism, confidence and intelligence.
What is the hiring/training process and how do you screen candidates?
First, a candidate is interviewed over the phone. If they pass that interview, we invite them for further testing. If they pass the testing phase (consisting of multi-tasking, reading comprehension, medical terminology, typing and responsiveness to emergent situations), we conduct a second interview. Part of the second interview includes having a candidate spend time on the floor shadowing a Coordinator and observing the process. Once a candidate is offered a job, she/he goes through a thorough background screening. Ultimately, only 10 – 15% of the candidates that apply become Coordinators.
How much clinical information is obtained by the Coordinators?
Depends on the protocol, but we suggest very little. What we want to avoid is having the sending physician repeat him/herself. By gathering basic information and connecting physicians, we ensure accurate information is communicated allowing for the best decisions to be made.
What kind of performance standards are set? Is there a Quality Assurance process?
All the calls facilitated through the Coordination Center go through a quality assurance process. We have a three-tier process:
- First, the call goes through peer audit.
- If the call has errors in process or data catchment, it goes to the second-level, Supervisor review.
- If there are negative trends in performance, the manager is brought in and the Coordinator may go on a Training Action Plan (TAP).
We also do audio reviews on 10% of requests that come through the Coordination Center. Each Coordinator is given a monthly performance review form to show where they are exceeding or requiring improvement. Additionally, we also have a medical review process, where a clinician (RN or Paramedic) will review higher acuity cases to ensure the Coordinator met timelines and performance benchmarks, as well as used and spelled medical lingo and terminology, appropriately.
What is the timeline to get a hospital up and running?
From the date we receive a signed contract, we can typically have a hospital up and running within 90 days. The Project Manager guides this process with an action plan and weekly meetings. She/he also makes recommendations on process and protocol based on his/her evaluation of the facility.
What is the length of your contracts?
The contracts are three-year terms, with annual escalators.
Do we offer exclusivity in our agreements?
The price of our solutions is typically not negotiable, though the various clauses in our agreements are. However, because exclusivity limits our ability to commercialize our solutions more broadly, a premium is usually attached to our fees for such requests.