Specialty network providers, like Apricus, play a crucial role in keeping hospital discharge planning on track. Between the injured employee, the injured employee's family, case manager, employer, and provider, there are multiple stakeholders involved in even the simplest hospital discharge. Most workers' compensation hospital discharge cases will require specialty solution services such as durable medical equipment (DME), home health, transportation, translation and diagnostic services. Efficient coordination of these services is critical to reducing time spent in the hospital and streamlining treatment, which helps get the injured employee back home and recovering faster. In the final installment of our series, we will examine the discharge planning process from the perspective of an Apricus care coordinator, what a catastrophic discharge request includes and how specialty service providers ensure an injured employees' needs are met.
The Role of Hospital Discharge Care Coordinators
Care coordinators involved in hospital discharge for workers' compensation are responsible for coordinating all services an injured employee needs to be successfully discharged from the hospital. They often work in a demanding environment, responding to complex issues and overseeing multiple assignments simultaneously. A care coordinator's goal is to get the injured employee discharged from the hospital successfully, delivering outstanding results and injured employee satisfaction while also avoiding another hospital stay. Their tasks can include:
Scheduling durable medical equipment, diagnostic imaging, physical medicine, home health, transportation and translation, among other specialty offerings
Making sure all required information for the injured employee is received and processed accurately and efficiently
Working closely with the hospital discharge planner or case manager to obtain information on an injured employee's discharge, including working with their preferred or contracted vendor to avoid delivery or discharge delays
Conducting local and nationwide searches for medical products and services in a timely manner
Communicating with the client, case manager and injured employee and their family at all stages of the hospital discharge process and keeping them informed of status updates and changes
How the Process Works at Apricus
The process begins when an email, phone call, fax, or online referral request comes in for an injured employee's discharge from the hospital after a workplace injury. Generally, the referral is placed by the injured employee's case manager, discharge planner or an adjuster. The request is then created by the assigned intake coordinator in the Apricus' proprietary software system by adding information that was provided in the initial referral for discharge. At this point, an email is sent to the adjuster confirming the referral was received and may require authorization. Apricus intake coordinators are constantly watching for incoming referrals and aim to respond to the client within 30 minutes of receipt of a request.
Once a case has been assigned, the dedicated Apricus care coordinator will send an email to the injured employee's case manager and adjuster introducing themself as their central point of contact, explaining what they will be doing and how they can work together to assist in the injured employee's recovery. All services, whether it be home health, durable medical equipment or transportation services, will all be scheduled by a single designated Apricus representative. If home modifications are required, the care coordinator will work closely with an Apricus specialized home modification representative. At this time, the coordinator will also request any information that may be missing from the referral including the expected discharge date, prescription information, delivery address, injured employee's height and weight and the treating provider's contact information. The coordinator will also call the injured employee to introduce themselves, advise them on what services are being worked on and confirm or collect any additional missing information from their patient file.
Apricus care coordinators then go to work on obtaining the proper authorization for the injured employee's needs, such as medical equipment and home health services that can be essential to ensure a successful and timely hospital discharge. Care coordinators reach out to the adjuster directly through phone and email if authorization for an item is missing, but also have the option to request approval from their Apricus supervisor in the event of emergency or same day discharge. Once a request is approved, the Apricus system automatically sends an updated email to the adjuster notifying them of what services have been scheduled and provides delivery dates.
The Apricus Advantage
When it comes to hospital discharge planning, Apricus coordinators are actively involved in the evaluation and contracting of the services provided, ensuring access to care and clinical decision-making is well-timed, while serving as a compassionate voice and advocate for the injured employee.
It is estimated that nearly 75% of Apricus discharge planning referrals are for same day or next day discharge. Not only does Apricus offer a one-stop-shop experience for all equipment and service needs, but care coordinators are trained to recognize that timely delivery of care demands a higher level of coordination and organization. On a regular basis, our coordinators work proactively with case managers and adjusters in requesting any information that is needed to facilitate an injured employees’ hospital discharge and avoid unnecessary delivery delays.
At Apricus, communication is key to supporting injured employees on their road to recovery. Care coordinators actively engage the injured employee as soon as they become involved in their care, and from that point on serve as their central point of contact. Many times, it's the injured employee's family members that are instrumental in maintaining the flow of communication. The family will often provide useful information for the coordinator, such as:
Confirming the injured employee's height and weight
An address for where goods need to be delivered
If household items need to be removed or disassembled before delivery of DME
Whether the right number of supplies are being ordered, and in the correct size
Planning For a Catastrophic Case Discharge
The following example highlights how Apricus care coordinators manage complex cases and their ability to go above and beyond for an injured employee. This case illustrates how coordinated specialty services with an outcomes-driven approach, offering quick coordination with a quality focus can make the journey easier for injured employees and their families.
A male employee in his twenties was injured on the job in a motor vehicle accident. The employee suffered a catastrophic injury and was diagnosed with paraplegia, a common spinal cord injury, and lost muscle function in the lower half of his body including both legs.
After spending 30 weeks in a rehabilitation facility, he was ready to transition home. At this time, the injured employee's case manager sent a discharge referral to Apricus.
Working together as a team, the Apricus coordinator and case manager reviewed the injured employee's information and discussed discharge needs, including various durable medical equipment products, home health services and home modification.
The discharge orders included:
24-hour RN home health aide services
Home lift system
The care coordinator then contacted the injured employee and his family. Because extensive home renovation was required to ensure wheelchair mobility in the home, it was crucial in this case to know if the injured employee lived by himself and who else might be available to assist. These questions helped ensure the injured employee received the right level of care moving forward and that the correct home modification needs would be met.
For the coordinator, the next step is to start with the most crucial item on the discharge order. In this case it was home health services and home modification. At Apricus, a specialized team works in tandem with the care coordinator to manage home modification due to the complexity and time needed to complete modifications. For the home health service, the coordinator has access to Apricus provider selection tools to search national vendors that can best handle the referrals and complete the request in the timeline specified.
Unfortunately, for this case the provider selection process proved difficult. Finding 24-hour care can be challenging, especially in rural areas which was the case with this injured employee. When the care coordinator ran out of national provider agencies, they expanded their search to smaller local agencies to meet his needs.
Communicating closely with the injured employee, medical providers and the case manager, Apricus removed obstacles related to discharge, including obtaining a 24-hour RN home health service and provided education and updates to the injured employee throughout the entire process. Apricus worked to establish trust with him ensuring they were engaged in his discharge process and vested in his health and well-being.
Successful Hospital Discharge Planning Relies on Empathy
Recovering from a workplace injury after hospitalization often requires a little extra assistance. Care coordinators make sure injured employees get what they need when they need it prior to departing the hospital all while demonstrating an ability to be empathetic and compassionate.
"One thing I tell all my agents is they need to put themselves in the injured employee's shoes because they just went to work one day, and their life has changed. Sometimes they change forever; sometimes they change for a year because of their injury, so they are going to be upset. They are going to be mad. They are going to be frustrated. They are not going to want to talk to you. We must give them that grace. We need to give them empathy and ensure that they know we are here to help them. And that is all we are here to do", says Fabian Romo-Romero, an operations supervisor for Apricus. Well-organized and coordinated hospital discharge planning is critical to promoting a swift recovery for injured employees. At Apricus, agents go above and beyond every day to coordinate specialty services for injured employees.
"We will be the middleman. The injured employee does not have to communicate with all the vendors. We are going to be the only person that they need to speak with regarding all their services. We try to make our client, the injured employee, feel that they can rely on us”, says Martha Gutierrez, from Apricus medical service support.
Dedicated, dependable and empathetic, the people of Apricus are what make it unique and allow the company to focus on what really matters in hospital discharge planning – driving better outcomes for injured employees.