Observation Patients
With the increasing importance placed on medical necessity, we are researching the idea of reviewing observation patients. My question is, are there any other facilities that are looking at observation patients concurrently and if so, how do you track these reviews without altering all of your other data since they are not DRG based? We use JATA Guide software and cannot figure out a way to track our work without altering all of our other inpatient data.
Comments
Tracy M Peyton RN, CCDS
Case Management
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
If you are reviewing observation patients for medical necessity, you'd probably be better off not using the Guide software and just either using whatever case management uses for their admission and continued stay reviews, or creating a spreadsheet with your data. It shouldn't be too hard to develop a simple query form.
Would be interested in hearing what you finally decide to do and what implementation model you use.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
We ran into the same issue when we wanted to start reviewing patients with short LOS, diagnosis of CHF, AMI, etc. that did not fall into the DRG-based payment system or they were self-pay. I called JATA and they added a Payer option of "other" that we could use for these patients. They set up the blended rate and baseline CMI at 0 so our numbers would not be affected. The only impact that is recorded is that the chart was reviewed and if we did any clarifications. No financial, RW, or CMI impact.
Kristen
Thank you so much!!!!!!!!
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center