Newsletter - Bartlett Regional Hospital

More documents

Recommendations

Info

Hospice and Home Health Services for Bartlett Patients Thinking outside the walls A strong and collegial relationship became even stronger in May of this year when Bartlett Regional Hospital contracted with Hospice and Home Care of Juneau (HHJC) to provide more home health and hospice services to Bartlett’s patients. “We were looking at what we could do differently that would reduce the hospital readmission rate,” says Nancy Davis, RN, who job-shares a position at Hospice and Home Care with Rosemary Gruening, RN. Davis is credited with initiating the discussion with hospital management. Before the agreement was signed, most reimbursements for home health services, including those from Medicare, required a patient to be classified as homebound; in other words, hospice services provided in a hospital setting are rarely reimbursable. “We saw a real need for people who did not meet the severe standard of being homebound,” Davis says, “but who clearly needed help getting a better plan for home care.” “With this arrangement, we can see patients at the hospital or in their homes,” explains Gruening. For such services, Bartlett now reimburses Hospice and Home Care. According to both Davis and Gruening, a major reason for people requiring readmission to the hospital is the failure to adhere to a medication regime. “Usually there is a good reason they cannot adhere to their prescriptions,” says Gruening. “Rarely is it purposeful.” Davis gives the example of patients with early-onset dementia who are at risk of not properly taking their medications. “People with this condition usually function really well at home and may live alone with minimal help,” she says, describing the very type of person who would probably not qualify under Medicare as homebound. “But their inability to manage a medication regime is right up there with other executive function difficulties like bill paying.” You don’t have to be afflicted with early dementia to have trouble keeping your medication schedule straight, adds Gruening. Many people who would not otherwise qualify for home care coverage are dealing with very serious medical conditions, such as complications from diabetes, heart disease, or emphysema, or multiple illnesses, and have to take a series of medications. “They may not be sure how to use the medications carefully,” says Gruening. “We can help structure their drug intake.” In return for the reimbursement, home health and hospice services are provided to all Bartlett patients who are in need. Previously, pre-discharge services were often provided to hospital patients, but at a loss to Hospice and Home Care of Juneau because reimbursements from insurance programs would not kick in until a patient had returned home. In addition, many patients coming out of the hospital do not meet the strict insurance qualifications for reimbursed home health and hospice services. Now, under the terms of the contract, a qualified Hospice and Home Health RN— usually Gruening or Davis— attends the daily discharge meetings with the hospital’s case management workers, and a home health nurse is available to meet with patients and families prior to discharge from the hospital and provide education as needed. For an at-risk patient, a nurse assigned by HHCJ will visit the patient’s home prior to discharge to assess the readiness and ability of the domestic arrangement to ensure safe care at home. And, upon discharge, in-home nursing services will be provided to those patients at high risk for readmission to the hospital. While one might think that having a revolving door of readmissions would be a good thing for a hospital, such a business model doesn’t work in the realm of health care. Bartlett Regional Hospital provides care to whomever comes in the door, regardless of whether the patient has insurance or monetary resources. Unfunded care quickly adds up, so reducing or preventing hospital readmissions helps to mitigate financial losses. The rubber meets the road in the office of Case Management. “We prepare the way for a patient to leave the hospital,” says Maureen “Mo” Lodovici, RN, a case manager. “Before, if we thought there might be a referral, we’d call and let Hospice know there was a patient needing their services. This just slowed the process. Now, with the new agreement, a hospice nurse attends the daily discharge meetings and is very much a part of the collaboration for those patients who will need hospice services.” Lodovici says that without this close collaboration, a patient who is ready for discharge on Friday might have to remain in the hospital until Monday to HouseCalls — 12
wait for home health services to become available. “Now it is a more streamlined process.” The contract negotiations involved Rosemary Hagevig, Executive Director of Hospice and Home Care of Juneau, and hospice nurses Gruening and Davis. “Bob Urata, our medical director, also participated,” recalls Davis, “as did board members Kevin Richie and Dr. Lindy Jones.” Bartlett personnel included Chief Executive Officer Shawn Morrow, Chief Financial Officer Garth Hamlin, and Cathy Carter, Director of Nursing. “I give Bartlett a huge amount of credit for thinking outside the walls,” says Davis, who will soon complete her three-year term as President of the Alaska Nurses Association. “The hospital really wants the health of our community to improve. People should be as healthy as possible, and Hospice and Home Care of Juneau and Bartlett Regional Hospital have come together with a plan that makes sense for our community.” The Necessity of Medivacs When illness or injury requires transport to specialty medical centers At 18 months, Jason was the picture of health—happy, exuberant, and speaking his first words. Then, suddenly, while in his father’s arms, the boy began convulsing. His eyes rolled back in his head, and he stopped breathing. Quick action by Jason’s father, who applied CPR, may have saved his life. Alerted by a frantic phone call from the boy’s mother, Bartlett’s Emergency Department was prepared to receive the child the moment he arrived by ambulance. Upon examination, Jason presented no obvious symptoms, so he was admitted to the hospital for a period of observation. The next morning, while being examined by family practice physician Richard Welling, MD, Jason seized again. “He doesn’t present the symptoms we are hoping for,” Dr. Welling explained to Jason’s parents. If Jason had a febrile seizure caused by elevated body temperature, Welling said, that would be the answer. “It is not unusual for children this age to seize when ill with a viral infection.” The alternative diagnoses were much more serious than a febrile fever: a possible brain bleed, which could have been caused by head trauma, or perhaps an organic malfunction similar to epilepsy. Dr. Welling briefly considered a CT scan or an MRI—both difficult to perform with a child of Jason’s age. The doctor then reasoned that if a scan revealed a problem with the brain, pediatric neurological care would be required that is not available at Bartlett. All things considered, it was time to medivac Jason to a pediatric care facility. Jason, a grateful customer, now two years of age poses in the arms of Shelly Deering, RN, who stands with the Airlift Northwest crew, from left to right, Joy Gaddis, RN; Lori Avaiusini, RN; Garth Rydell, pilot; Chad Stilp, pilot; Jeremy Fradet, pilot; Carl Bottorf, RN; Eric Barry, pilot; and Diana Paul, RN. Continued, next page 13 — Fall 2011
Page 1 and 2: HouseCalls Fall We bring healthcare
Page 3 and 4: Caring for the Mentally Ill A highl
Page 5 and 6: me and describe the situation,” h
Page 7 and 8: earning a Bachelor of Science Nursi
Page 9 and 10: Heart Attack Care We achieved a 100
Page 11: New Diagnostic Imaging Director: Ro
Page 15 and 16: and assisted Bill Palmer in finishi
Page 17 and 18: approved an operating budget— tha
Page 19 and 20: Profile: Dr. Saltzman, from page 10

Newsletter - Bartlett Regional Hospital

Create successful ePaper yourself

Delete template?

Save as template?