David Russell, EMT-P2-7433david.russell@vanderbilt.edu

More Efficient Discharge Process EMS 1 hour to bedside Centralized store of automated forms▪ Tenncare▪ Managed Medicare programs▪ VUMC Medical Necessity

Centralized list and procedures for pre-auth

Faster bed turnover Centralized data management

•Acquired an experienced FlightComm Paramedic

•Shadowed CM and SW to gain knowledge of process, tools and procedures

•Communicated with all local EMS providers, individually, to become familiar with special procedures and insurance requirements; explained our goals

•Contacted each identified insurance company to establish procedures

•Worked with AC and UM to centralize AT# process

•Developed in-house software to track and report requests

•Identify patient that will require transport•Prepare necessary information, prior to contacting DTM

•Patient Name, MR Number, Room Number•Primary Insurance•Weight•Primary Diagnosis•Special Needs

•Oxygen•Trach•Vent•Fixtures/Devices

•Destination

•Call DTM at 2-RIDE (2-7433) when patient d/c time is determined.

•DTM will email or fax required paperwork needed to complete/sign

• VUMC Medical Necessity form, required on all patients, will be faxed/e-mailed

•Once EMS transport is confirmed, a demographics page, including the transporting service and expected bedside time will be generated

•As confirmation, our office will be contacted via Nextel when EMS arrives on the patient floor. You (and possibly Bed Management) will receive an automated confirmation that EMS has arrived to transport your patient.

All complaints with EMS should be reported to DTM

Centrally managed conflict resolution

Problem and issue trackingAbility to have hospital AC involved

•Shows pending calls in yellow

•Confirmed calls in blue

•Overdue calls in red

•ETA counts down, then up

•Call Received volumes

•Bedside time volumes

•Track EMS Volumes•Level of Care•By Floor / Unit•By Building•By specialties

•Ventilator•Bariatric•Long Distance

•By Destination•By Caller Name

•Vast Majority arrive prior to requested time

•At 5 minutes we call to check

•Anything over 30 minutes late; follow up with EMS’s admin

•We issue all AT#•UM is able to reconcile with invoice•Will allow better cost tracking history

HIP

PA

Ambulance Charges per Month – Calendar Year

2008 2009 2010 CY YearMonth    January $ 5,405 $11,481  $3,795  February  $ 5,405 $10,232  $3,065  March  $ 5,405 $5,398  $5,971  April  $ 5,405 $9,328   $4,227  May  $ 5,405 $5,143   $4,227  June  $ 5,405 $9,108   $4,227  July $5,674  $3,046   $4,227  

August $5,599  $3,046   $4,227  September $8,902  $5,145   $4,227  October $6,970  $5,145   $4,227  

November $2,580  $4,868   $4,227  December $2,704  $3,946   $4,227  

$64,859 $75,886 $51,324 Total $5,405 $6,324 $4,277 Average

Ambulance Charges per Month – Fiscal Year

2008-2009 2009-2010 FY YearMonth  July $5,674  $3,046   

August $5,599  $3,046   September $8,902  $5,145   October $6,970  $5,145   

November $2,580  $4,868   December $2,704  $3,946   January $11,481  $3,795  February $10,232  $3,065  March $5,398  $5,971  April $9,328   $4,225  May $5,143   $4,225  June $9,108   $4,225  

$83,119 $50,702 Total $6,927 $4,225 Average

•Negotiated Rates•Quotes on “Out of Town Transports”•Projected total for FY 09-10 is $51,000•Average savings of nearly $1,900 per month•Pursuing ways to reduce this by another $1,000 per month *Unable to calculate bed stay savings based on

current data

•Requested 36 frequent callers to complete an 8 question survey•100% of responses to all questions were positive

•Q: (Paraphrased) How many hours per day did you spend arranging ambulance transports before?•A: Average 1.5 hours per day

•Q:(Paraphrased) How many hours per day do you spend arranging ambulance transports after?•A: Average .3 hours per day

•1.2 hours per staff per day saved; 10 unique callers per day = 12 hours saved per day

•Centralizing away from approximately 60 CM and SW

•Using better tools; defined procedures

•Negotiated transport costs saving thousands of dollars in ambulance costs

•Saving hundreds of hours of individual time per month

•Decreasing patient bed stay days by more efficiently moving patients

“The Discharge Transportation Management office is fantastic! They make my job so much easier and are a joy to work with.”

“I find that much of my time can be utilized elsewhere since the implementation of the Discharge Management Process.”

“Having one body make the transportation arrangements seems to have improved the reliability of the ambulance service.”

“Have been thrilled with response and accuracy of service. Absolutely no complaints from this case manager!!”