NEWS RELEASE

FOR IMMEDIATE RELEASE

Tampa, Fla. – [October 22, 2024] – Brundage Group is excited to announce a partnership with Iodine Software, bringing our Physician Advisors into the AwareUM platform. This collaboration enables seamless integration of Brundage Group Physician Advisors with hospital utilization management (UM) teams, creating new opportunities for optimized decision-making, workflow efficiency, and improved patient outcomes.

Taylor Smith, Vice President of Business Development at Brundage Group, shared his excitement for the partnership:

“This collaboration enhances support for hospitals in managing utilization and revenue cycles. By integrating our Physician Advisors into the AwareUM platform, we combine real-time expertise with innovative technology, empowering hospitals to make informed decisions and capture their earned revenue.”

Brundage Group’s Physician Advisors manage over 4,000 peer-to-peer calls monthly across major payers, including Medicare Advantage and Commercial payers such as UnitedHealthCare, Aetna, Cigna, Humana, Blue Cross Blue Shield, WellCare, and more. Now, with the integration of AwareUM, our Physician Advisors can offer hospitals even greater efficiency in real-time case management, patient status determination, and denials management.

Brundage Group’s Physician Advisors specialize in reviewing medical necessity and documentation, bridging clinical and business aspects of medicine, and ensuring accurate patient statuses based on medical necessity.

Brundage Group’s expert team of Physician Advisors and denial management specialists meticulously analyze and resolve denials, identifying trends and root causes to develop targeted prevention strategies, ensuring accurate reimbursement for hospitals.

Our revenue integrity analytics platform provides data-driven insights to identify trends, improve utilization, and make revenue-positive decisions.

Brundage Group is the trusted choice of hospital systems for revenue cycle management solutions. We support hospitals nationwide with customized solutions that include a full suite of Physician Advisory services, staff augmentation/workforce solutions, proprietary level of care analytics, and physician-led documentation education to relay high-quality care. Our programs help hospital organizations break down departmental silos by unifying all departments in the mid-revenue cycle. Our dedicated staffing division provides seasoned, veteran RN case managers, utilization review nurses, and appeals/denials professionals, all backed by our team of expert Physician Advisors and documentation and coding experts.

Lacey Thompson
Brundage Group
Email: lthompson@brundagegroup.com
https://brundagegroup.com/

As we celebrate Case Management Week, let’s explore how case management has evolved and recognize Physician Advisors’ vital role in supporting this essential function. Here’s a look at the evolution of case management and the value Physician Advisors bring:

As case management has evolved, Physician Advisors have become indispensable in helping case management teams navigate today’s complex healthcare landscape.

Here’s how they contribute:

• Physician Advisors provide real-time clinical guidance to support accurate patient status decisions and efficient resource utilization.
• By leveraging analytics and benchmark data, Physician Advisors offer insights that improve care coordination and help uncover revenue opportunities.
• Physician Advisors collaborate with case managers to ensure timely discharge planning, which reduces lengths of stay.

Reducing the length of stay holds much significance for both patients and hospitals. Shorter stays contribute to improved patient well-being, minimize exposure to potential hazards like infections, and lower costs significantly. Longer durations can strain hospital resources as well, potentially compromising the quality of health services provided by these institutions.

Hence, reducing the time spent in hospitals is key to not only ensuring optimal patient recovery but also fostering efficient functioning within our healthcare systems.

When you’re admitted to a hospital, your end goal is getting better. However, staying in for longer than necessary can impact the quality of care received and overall well-being. Even subtle shifts can enhance patient flow through acute care hospitals, which underscores our main focus here: reducing length of stay (LOS).

Lengthy stays not only wear on patients physically but also emotionally, causing undue stress that could potentially hinder recovery processes. Shortened LOS means less strain for staff, too; they can direct resources more effectively towards providing exceptional treatment. Data from hospitals worldwide indicate that strategies to reduce Length of Stay (LOS) can be effectively implemented without sacrificing patient safety or the quality of healthcare outcomes.

Following suit isn’t easy; it takes planning plus commitment. Applying proven techniques such as FOCUS-PDSA, a method for organizing data collection, can help an organization determine how to refine discharge procedures to lower the average LOS. Reduction in the average LOS translates into amplified benefits across the healthcare system, including higher bed availability, partly addressing another significant challenge faced by most healthcare institutions.

Reducing the length of stay has a direct association with decreased healthcare costs. It’s vital for hospitals to deliver expedited care without sacrificing treatment quality. Shorter visits empower hospitals to manage their resources more efficiently while concurrently offering optimum care services.

These cost savings don’t merely provide financial relief but enhance overall sector efficiency, too! More funds become available for other essential areas, like preventative health initiatives and research efforts, when less cash is spent on lengthy inpatient admissions. Hospital administration makes crucial decisions based on these aspects, formulating strategies that rally around best practices that reduce patient days logged in bed swiftly and safely.

This approach creates an environment where everyone prospers: patients experience quicker recoveries coupled with lower out-of-pocket expenses, while hospitals streamline operational procedures, thus solidifying trust between both parties and concentrating on collective well-being outcomes.

Boosting staff efficiency and productivity is a crucial aspect of minimizing hospital stays. Optimizing operations not only allows medical personnel to handle their responsibilities more proficiently, but it also accelerates the treatment processes essential for patient wellbeing. By implementing strategies like care coordination or early mobility programs, professionals can streamline healthcare service delivery, resulting in less waiting time between procedures and faster recovery times for patients during their stay.

Moreover, employing solutions such as multidisciplinary teams fosters collaboration among different units within the facility, potentially enhancing problem-solving capabilities and lowering the chances of discharge delays attributable to decision-making bottlenecks. Remember that your staff’s effectiveness directly impacts how long a patient remains in your institution before receiving clearance for homebound recovery. Therefore, taking steps towards optimizing employee performance goes hand-in-hand with efforts aimed at reducing the length of stay, ultimately benefiting both patients’ wellness and hospital resource allocation.

Maximizing bed availability in hospitals is always a struggle, especially when demand surges unexpectedly. When patient flow improves, and length of stay decreases, more patients can promptly access the care they need. Remember that every moment counts in acute case scenarios.

More available beds mean fewer cancellations for elective procedures as well. Imagine how grateful you would be if your long-awaited surgery didn’t face postponement due to lack of space. Furthermore, efficient use of resources reduces overcrowding pressures on healthcare workers by spreading out their workload evenly over time.

Moreover, an increased bed turnover rate offers opportunities for sanitation practices between admissions. This ensures hygienic standards are maintained at all times to keep infections under control within hospital premises. Thus, overly lengthy stays don’t only affect individual patients; they impinge significantly upon entire system efficiencies, too!

So let’s work together towards reducing delays where we can so everyone can benefit from the ripple effects.

By Cheryl Ericson, RN, MS, CCDS, CDIP

Director, CDI, UM/CM, Brundage Group

Hospitals require a physician order to guide hospital care. The patient status order (often referred to as “admission order”) determines if hospital care will be delivered as an outpatient or inpatient service. This is basically a billing determination as it does not affect your ability to order additional services; however, it does impact hospital reimbursement and patient financial responsibilities. It’s best to use the term “hospitalize” rather than “admit” when letting a patient know they will be staying in the hospital overnight.

Did you know the hospital is required by Medicare to officially notify patients of their hospital status? Leave it to the utilization review experts to have that conversation with the patient.

• The Medicare Outpatient Observation Notice (MOON) is provided to Medicare patients who receive observation services as outpatients for more than 24 hours.
• The purpose of the MOON is to ensure patients who spend a night in the hospital receiving observation services understand that they are not currently inpatients and will be responsible for co-pays associated with their Medicare Part B benefits.
• Additionally, patients receiving observation services will not meet the three-day inpatient admission requirement for Medicare Skilled Nursing Facility coverage.

Providers who treat Medicare beneficiaries have an obligation to deliver medically reasonable and necessary care. Services are considered medically necessary if they meet the standards of good medical practice and are:

• Proper and needed for the diagnosis or treatment of the beneficiary’s medical condition;
• Furnished for the diagnosis, direct care and treatment of the beneficiary’s medical condition; and
• Not mainly for the convenience of the beneficiary or provider.

Medicare expects a provider to order the appropriate type of hospital service, which is validated by hospital utilization review staff.  Unfortunately, the patent cannot request a particular patient status. The ordered hospital status must be rooted in documentation that specifies the patient’s acuity, comorbidities, specific risk if care is not provided in the hospital setting and associated treatment plan.

Providers should not automatically default to observation services for patients who qualify for inpatient services to avoid patient frustration and the associated hospital administrative burden.  According to Medicare, “Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge.”

“When a physician orders that a patient receive observation care, the patient’s status is that of an outpatient. The purpose of observation is to determine the need for further treatment or inpatient admission. Thus, a patient receiving observation services may improve and be released or be admitted as an inpatient.”

Observation services may be appropriate when:

• Active care or further observation is needed following emergency room care to determine if the patient is stabilized.
• Intense physician or nursing care is expected to be necessary for less than 2 midnights.
• Further diagnostic testing and/or observation is needed to make a diagnosis and establish appropriate treatment.

Although a patient can be upgraded from observation status to inpatient status, if a provider expects the patient will need two or more nights of hospital services or their acuity is such that they need an intense level of hospital services, e.g., mechanical ventilation, intensive care service, etc., it is appropriate to order inpatient status.

In the ever-evolving landscape of modern healthcare, the concept of hospital levels of care plays a crucial role in ensuring efficient and effective patient treatment. These levels of care are essential in providing a structured approach to medical services and resource allocation, ensuring that patients receive the appropriate level of attention based on the severity and complexity of their conditions.

A key distinction within these levels of care is between observation and inpatient admission, which carries significant implications for both hospitals and patients.

Hospital levels of care create a tiered system that allows patients to access the most suitable medical attention according to their specific healthcare needs. This classification is structured to provide a continuum of care, starting from basic primary care services focusing on preventive healthcare and general wellness and escalating to specialized quaternary care centers offering cutting-edge medical research and innovative treatments.

Properly understanding and implementing hospital levels of care is paramount for patients and healthcare providers alike. By appropriately identifying the level of care needed, hospitals can ensure optimal resource allocation and streamline patient flow, leading to better overall healthcare outcomes.

The observation level of care, commonly associated with the Emergency Room, is critical in providing immediate medical attention to patients with acute and urgent medical conditions. The ER acts as a crucial gateway to the healthcare system, operating 24/7 to address medical emergencies regardless of the time of day.

Upon arriving at the ER, patients are rapidly triaged based on the severity and urgency of their conditions. Skilled medical professionals, including emergency physicians, nurses, and other healthcare providers, assess and stabilize patients to prevent further deterioration. The observation level of care allows for rapid intervention and often determines the course of treatment for critically ill or injured patients.

In the ER, patients may receive initial diagnostic tests, such as blood work, X-rays, or CT scans, to identify the underlying cause of their symptoms. Treatment in the ER may involve administering medications, providing wound care, immobilizing fractures, or performing life-saving interventions, such as cardiopulmonary resuscitation for cardiac arrest.

The observation level of care is time-sensitive, and patients with less severe conditions may be discharged with appropriate instructions for follow-up care. At the same time, those with more critical needs are admitted to inpatient units for further medical management.

Moving up the hierarchy of hospital levels of care, the inpatient admission level is characterized by continuous and comprehensive medical care provided to patients with conditions that require ongoing monitoring and treatment. Inpatient admission is typically required for patients who cannot be adequately managed in an outpatient setting due to the complexity and severity of their conditions.

When admitted to inpatient units, patients receive specialized care from multidisciplinary teams, which may include physicians, nurses, therapists, and other healthcare professionals. The inpatient setting allows for 24/7 monitoring and immediate intervention as needed.

Patients undergo a thorough assessment during the inpatient stay, and a personalized treatment plan is developed based on their medical needs. The medical team closely monitors the patient’s progress, adjusts treatment as necessary, and ensures that the patient is on the path to recovery.

Inpatient units are equipped to handle various medical conditions, from post-surgical care and complex chronic illnesses to acute infections and severe injuries. Depending on their specific healthcare needs, patients may receive various interventions, such as intravenous medications, physiotherapy, respiratory support, and rehabilitation.

The duration of the inpatient stay varies depending on the patient’s condition and response to treatment. The goal of inpatient care is to stabilize the patient’s health, manage their condition effectively, and prepare them for a safe transition to a lower level of care, such as outpatient or home-based care, once their condition permits.

It’s important to note that patients may transition between different levels of care based on changes in their condition. For example, a patient initially admitted for inpatient care may improve and be deemed appropriate for observation level of care or even discharged for outpatient follow-up if their condition stabilizes further.

For hospitals, the distinction between observation and inpatient admission is critical for patient care and has financial implications. Medical necessity is required for payers to reimburse hospitals appropriately when patients are admitted for inpatient care. Demonstrating medical necessity through thorough documentation and evidence is essential for validating the appropriateness of the level of care provided.

Hospitals must meticulously document the patient’s condition, the necessity for inpatient care, and the treatment plan to meet payer requirements for reimbursement. Properly establishing the level of care is vital for hospitals to ensure their financial viability while delivering the highest quality care to their patients.

There are challenges and limitations that healthcare providers and patients may encounter:

In some regions, especially rural or underserved areas, access to specialized healthcare services at higher levels of care may be limited. This disparity can lead to delayed diagnoses and treatments, affecting patient outcomes.

In tertiary and quaternary care centers, where specialized expertise is concentrated, long waiting times for appointments and treatments can hinder timely access to necessary medical interventions.

The ever-increasing demand for specialized healthcare services poses resource allocation challenges to healthcare systems worldwide. Ensuring equitable distribution of resources and maintaining high-quality care across all levels can be complex.

Higher levels of care, such as quaternary care, often involve cutting-edge treatments and technologies, which can be costly. Balancing the pursuit of advanced medical interventions with cost considerations is a constant challenge for healthcare institutions.

As patients move between different levels of care, ensuring smooth coordination and continuity of care becomes critical. Effective communication and information sharing among healthcare providers are essential to prevent gaps in patient care.

The future of hospital levels of care holds exciting prospects as technology continues to advance. Telemedicine, fueled by advancements in communication and digital technology, is revolutionizing how healthcare services are delivered. Telemedicine allows patients in remote or underserved areas to access specialized care through virtual consultations, reducing the burden of travel and improving overall healthcare accessibility.

Furthermore, artificial intelligence and machine learning are revolutionizing diagnostics, personalized treatment plans, and patient monitoring, leading to more accurate and efficient medical interventions.

Understanding and effectively managing hospital levels of care is a crucial aspect of our work at Brundage Group. We recognize the significance of differentiating between observation and inpatient admission and the challenges and limitations faced in providing the appropriate level of care.

By comprehending these complexities, we empower our clients to overcome challenges, optimize resources, and provide the highest quality care to their patients.