1. The Bed Management Center BMC

2. BED MANAGEMENT CENTER STAFFING Manager216-2062 Assistant Manager 216-9836 8 Care Coordinators(RNs) 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 Center Key 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 hospitals 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 216-2669Days 216-1939Days 909-0108Evenings 123-2251Weekends 0700-1930 Admission Coordinator WP 966-4029

29. BED ASSIGNMENT AREA 966-2041 Formally known as Bed Control 10.5 FTEs 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