How can hospitals streamline patient admissions by effectively managing advance directives, patient rights, and medical testing procedures? Discover the answers.

Streamlining Patient Admissions: The Importance of Advance Directives

Advance directives are essential legal documents that outline an individual’s healthcare preferences and wishes in the event they become incapacitated. During the patient admission process, it is crucial for hospitals to promptly identify and obtain any existing advance directives. This ensures that the patient’s autonomy and end-of-life decisions are respected, and that their care aligns with their personal preferences. By having a clear understanding of a patient’s advance directive, healthcare teams can provide care that is tailored to the individual’s needs and values.

Upholding Patient Rights: A Critical Component of Admission

Respecting patient rights is a fundamental aspect of the admission process. Hospitals must ensure that patients are fully informed of their rights, including the right to make decisions about their care, the right to privacy and confidentiality, and the right to access their medical records. By proactively addressing patient rights during admission, healthcare providers can build trust, foster open communication, and empower patients to be active participants in their own healthcare journey.

Medical Testing Requirements: Ensuring Comprehensive Care

The admission process often involves various medical tests and screenings to gather important information about the patient’s health status. These tests may include physical examinations, lab work, imaging studies, and other diagnostic procedures. It is crucial for hospitals to have a clear understanding of the necessary medical testing requirements, and to communicate these expectations to both patients and referring healthcare providers. Streamlining the testing process can help to expedite patient admissions, reduce delays, and facilitate the delivery of comprehensive, personalized care.

Effective Communication: The Key to Successful Admissions

Efficient and transparent communication is essential throughout the patient admission process. Healthcare providers must actively engage with patients, families, and referring clinicians to ensure that all relevant information is shared and understood. This includes clearly explaining the admission process, discussing any financial implications, and addressing any concerns or questions that may arise. Effective communication can help to alleviate patient anxiety, promote collaboration, and ultimately, enhance the overall admission experience.

Leveraging Technology to Optimize Admissions

Advancements in healthcare technology have the potential to greatly improve the patient admission process. Electronic medical record systems, online patient portals, and automated appointment scheduling tools can streamline administrative tasks, improve data accuracy, and enhance the overall efficiency of the admission workflow. By embracing these technological solutions, hospitals can enhance the patient experience, reduce errors, and free up healthcare staff to focus on providing high-quality, personalized care.

Continuous Improvement: Enhancing the Admission Process

Improving the patient admission process is an ongoing endeavor. Hospitals should regularly review their admission policies, identify areas for improvement, and implement evidence-based best practices. This may involve gathering feedback from patients, analyzing data on admission-related metrics, and collaborating with cross-functional teams to develop and implement innovative solutions. By fostering a culture of continuous improvement, healthcare organizations can ensure that the admission process remains efficient, patient-centered, and aligned with evolving healthcare standards and regulations.

Addressing Challenges and Maximizing Opportunities

The patient admission process can present various challenges, such as managing complex patient needs, navigating regulatory requirements, and ensuring seamless coordination between different healthcare providers. However, by proactively addressing these challenges and leveraging available resources and best practices, hospitals can transform the admission process into a streamlined, personalized, and patient-centric experience. By prioritizing advance directives, respecting patient rights, optimizing medical testing procedures, and embracing technological solutions, healthcare organizations can enhance the overall quality of care and improve patient outcomes.

CMS Allows Residents, Advanced Practitioners to Admit Inpatients

A federal rule that some hospitalists feared would bar nonstaff physicians from writing admission orders for hospital inpatients has been clarified to extend those privileges to resident physicians and advanced practitioners.

On Aug. 19, the Centers for Medicare & Medicaid Services (CMS) published its fiscal 2014 hospital Inpatient Prospective Payment System (IPPS) Final Rule, which is effective Oct. 1. Although this document impacts a number of important areas for hospitals, including the use of inpatient admission and observation status, hospitalists also were left with the impression that resident physicians and advanced practitioners (NPs and PAs) were being barred from writing admission orders.

Medical residents, NPs, and PAs do not have admitting privileges in most hospitals, and their inability to write admission orders would pose significant logistical and financial hurdles for many hospitals and physician groups, including hospitalists.

In most academic centers, residents have the opportunity and responsibility to evaluate patients at the time of hospitalization, write initial hospitalization orders, and then discuss patients with the attending physician. The “staffing” of patients typically occurs either later the same day or the following morning. The provision requiring an attending physician knowledgeable of the case to furnish the admission order, and not allowing delegation of this order to their residents, could fundamentally change the way our physicians are trained.

Many hospitals rely on NPs and PAs for the care of hospitalized patients under the supervision of a staff physician. These nonphysician providers often care for hospitalized patients, admit patients, and provide overnight coverage. Requiring admission orders to be placed by physicians with admitting privileges would require a greater presence of staff physicians, which would increase costs.

Some of these concerns were voiced Aug. 15 on CMS’ Special Open Door Forum on CMS Rule 1599-F. While clarification was not offered, it was indicated that CMS did not intend to place such limitations on residents, NPs, and PAs. On Sept. 5, CMS released clarifications to some of these provisions in the IPPS Final Rule, and noted that admission orders may come from a physician or other practitioner.

This clarification suggests that when a resident, NP, or PA writes admission orders, they are doing so at the direction of a physician with admitting privileges. This may occur in the form of a verbal order, which requires documentation of the name of the admitting physician, as well as the date and time of the verbal order. This verbal order must then be countersigned by a qualified physician prior to patient discharge.

Failures to obtain appropriate orders co-signed by an appropriate physician are likely at high risk for Medicare payment denial. This clarification appears to address previously held concerns about this new rule.

How to Admit a Patient

For a General Practitioner to have a patient admitted to Shepparton Private Hospital they must either refer the patient to a specialist credentialed at the hospital or obtain admitting rights with the hospital.

For a list of accredited specialists please refer to Specialists

In order to obtain admitting rights at Shepparton Private Hospital please contact the Executive Office on 03 5832 1270 for an Application Form and a copy of the Hospital’s By Laws/Rules.

Admitting to Shepparton Private Hospital

Credentialed Specialists Consulting suites and Credentialed GP’s (on request) are supplied with Admission Booklets which are given to patients following consultation. Separate Request for Admission forms are provided to the Doctors.

For Elective admissions, the appropriate sections of the booklet (Registration and Patient History forms) once completed, are to be returned to the hospital by the patient.

A Request for Admission form (including a Consent section) is completed by the by the Doctor requesting admission and forwarded to the Bookings Office.

Admissions staff then processes the forms and the patient is booked in. Patients will be contacted by the hospital with their admission details and given a quote for any out of pocket costs.

For Non Elective admissions, the hospital may be called on 03 5832 1200 to determine bed availability and to give the patient details including:

• Name, Address & Phone Number of patient
• Date of Birth
• Diagnosis
• Treatment Orders
• Admitting Drs name
• Insurance Status- Insured / Self Insured
• If admitting from home or another hospital
• Requirement for an operating theatre

All patients will be required to present insurance details, or pay the estimated cost of their stay if self insured prior to admission.

Workcover and TAC approval must be obtained by the admitting doctor prior to admission.

Hospital Admitting Privileges: Do They Matter?

If you are searching for a primary care physician, you’re probably asking several questions about things that matter in your decision making process.

Do you like the doctor’s personality? Does the doctor have the experience you need? Will they be accessible? Where is the office located? Do they take your insurance?

You might also be concerned about something called hospital admitting privileges. They might not be the top consideration on your list, but when it comes to you and your family, you prepare for everything.

You ask yourself — what can my primary care physician do for me or my family in the event of a trip to the emergency room? For most people, that’s where the concept of hospital admitting privileges enters the picture.

But what exactly are hospital admitting privileges?  Are they still used today? Is it important for your doctor to have hospital admitting privileges?  And how do concierge medicine practices handle hospital visits by their patients?

Let’s get you some answers.

What are hospital admitting privileges?

Hospital admitting privileges are the rights granted to a doctor by a hospital to admit patients to that particular hospital.

The basic premise is that, if you need to go the hospital, your primary care physician can admit you at any hospital that has granted them privileges.

It might not be the closest hospital to your home or the best hospital in the area, but rather one where they have established privileges. Maybe it’s the one where they used to work. Maybe it’s the hospital across the street. Or it might be one that is operated by the same parent company as their primary care practice.

Regardless, the concept of admitting privileges is that your doctor would be able to admit you with some paperwork and a quick phone call.

They would then be able to come to the hospital — often once in the morning and once in at night on “rounds” — to coordinate your care. They would order tests, prescribe medications, and schedule procedures.

At least that’s the concept.

How are hospital admitting privileges used today?

Over the last 20+ years, the model for patient care in hospitals has changed. As such, the prevalence of hospital admitting privileges for primary care doctors has dramatically declined.  They are now mostly a thing of the past.

This is because both hospitals and primary care physicians realized it was too difficult to provide the level of patient care required today.

Caring for patients at a hospital requires different skills than at a primary care physician’s office, and vice versa. It’s in the best interests of the patient to separate the roles. 

For primary care doctors, making rounds at the hospital in the morning or at night also took away from their already limited time and availability to see their other patients at the office. How could they justify keeping people waiting in their lobby for appointments while they spend a couple hours at the hospital?

It also was unfair to the patient, as test results and medication adjustments at the hospital had to wait until your doctor returned and could review information. If they weren’t coming back until the following morning, it could be a long 24 hours of waiting for your next update.

These situations gave rise to role of a “hospitalist.” There were zero hospitalists in the late 1990s. Now, there are more than 50,000 hospitalists in the United States. More than 75% of hospitals in the United States have hospitalists.

Hospitalists are the point person for patient care at the hospital and effectively serve as the primary care physician for a patient during their hospital stay. They — along with emergency room staff, other doctors, and hospital administrators — decide who gets admitted and when.

The days of a primary care physician admitting one of their patients thanks to their privileges are over.

Is it important for your doctor to have hospital admitting privileges?

Not anymore. With the rise of the hospitalist role, admitting privileges for primary care physicians are few and far between.

If they still have them, they aren’t particularly useful. They won’t help you “cut the line” to get admitted before any other patients at the ER.

In addition to hospitalists who run the show at the hospital, ER doctors and nurses are still obligated to admit the most urgent patients first. No admitting privileges are going to replace that responsibility.

Hospital Care and Concierge Medicine      

While hospital admitting privileges are no longer prevalent, it doesn’t mean your doctor cannot be an integral part of your care at the hospital. That much is true for both traditional and concierge practices.

With proper authorization in accordance with HIPAA regulations, you can authorize the hospital to share information with your doctor. You or your family member can also contact your doctor to provide the information themselves.

With concierge medicine, the difference comes in the access you might have and the availability of a doctor to quarterback your care in the hospital. With fewer patients, a concierge medicine physician could have the time to speak with you or the hospital staff about your care as opposed to just running from appointment to appointment.

In addition, emergencies don’t strike only during business hours. Most concierge practices offer some version of 24/7/365 access. Some offer a nurse hotline, some hire a third-party service that triages calls from across the country, and others, like PartnerMD, guarantee one of their docs from your city will be on-call.

With concierge medicine, you can expect to connect with someone quickly no matter if its 3:00 p.m. on a Saturday afternoon and your child suffers an injury on the soccer field or if its 2:00 a.m. on a Sunday night and a loved one is being rushed to the hospital.

PartnerMD, Hospital Admitting Privileges, and Hospital Care

PartnerMD doctors encourage patients to notify them as soon as possible of a hospital visit. Once notified, our doctors can serve as a trusted resource during a hectic situation.

The PartnerMD difference comes down to the relationships our doctors develop with their patients. With fewer patients and longer appointments, our doctors have to the time to get to know their patients on a deeper level. This allows them to be prepared with helpful information well before any visit to a hospital.

Armed with in-depth knowledge of your health history, our physicians can be an advocate for you during a hospital visit. Patients often tell us that having a PartnerMD doctor is like having a doctor in the family. There is no better time to take advantage of that relationship than when you or a loved one is at the hospital.

This knowledge could make your hospital care more efficient. Instead of the hospital trying needless tests and medications that cost you time and money, our doctors can provide the kind of background knowledge to help the hospital doctors and nurses efficiently treat whatever is going on.

Whether you’re having a planned surgery — a knee replacement for example — or facing a sudden emergency, PartnerMD doctors can assist with hospital care in several ways:

• Pre-surgery Prep: Your doctor can answer any questions you might have ahead of the procedure and prepare you for what to expect at the hospital. We can also recommend questions to ask while at the hospital to alleviate any concerns you may have.
• Emergency Advice: In the case of a sudden emergency, the 24/7/365 access you have to a PartnerMD physician can be crucial. You should always call 9-1-1 upon any sudden emergency, but we can be an on-call resource once on the way or at the hospital and help interpret or explain the care you are receiving.
• Hospital Advocate: PartnerMD’s doctors can also speak directly to the doctors at the hospital to quarterback your care and provide relevant background information. This could help cut through the noise and standard procedures to get you the efficient care you need.
• Post-Visit Care: The PartnerMD difference is even more apparent after a sudden hospital visit. Some insurance, like Medicare, requires you to visit your primary care physician within a certain amount of time after a hospital stay. Even if your insurance doesn’t require a visit, it is good practice to visit your doctor after a hospital visit to discuss next steps and ask any additional questions. After all, you went to the hospital. It’s something to be taken seriously. PartnerMD’s same-day or next-day appointments means a post-hospital visit can happen quickly. Our 30-minute appointments mean you will be able to spend time with your doctor and talk extensively about what happened, instead of rushing through the appointment in 7 minutes.

We know any trip to the hospital is a stressful time. Hospital doctors and nurses work extremely hard to provide you the care you need. However, you may have questions or concerns you are uncomfortable bringing up at the hospital, or that the hospital staff may not have time to discuss in detail.

That’s where having a true partner in health at your side can make a difference. If you’re interested in learning more about PartnerMD, download our free “Understanding Concierge Medicine” eBook.

Inpatient Admission Process Improves Patient Experience

Featured Outcomes

• 55 percent reduction in average inpatient admission time.
• Ranked 99th percentile for patient experience.

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience. Waiting for admission paperwork, or for a bed to be assigned can be frustrating for anyone. But for patients who are sick, or for an exhausted mother with a crying baby who needs to be admitted, wait times can become emotionally and physically difficult as well.

Thibodaux Regional Medical Center’s consistent focus on patient satisfaction has earned the 185-bed community hospital, located one hour southwest of New Orleans, the Healthgrades® Outstanding Patient Experience Award™ every year since 1998. Not surprisingly, when Thibodaux leadership recently analyzed the hospital’s inpatient admit process, they did so from their patients’ point of view and were determined to cut admission wait times. Using focused process improvement methodologies, areas of waste were uncovered, exposing problems such as redundant data collection, and inconsistent processes, which would require innovative solutions.

Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.

ADMISSION PROCESS TIED TO SATISFACTION, REIMBURSEMENT

Each year, American hospitals conduct 35.4 million admissions, according to the American Hospital Association. Of those, 16 million occur through the emergency department (ED), suggesting that more than 19 million are direct admits.¹  A direct admit may be either planned or unplanned. Planned direct admits happen, for example, when a patient is scheduled for a routine procedure. Unplanned direct admits can happen when a sick patient presents at a physician’s office, for instance, and the physician decides to admit them directly to the hospital rather than send them through the ED.

Direct admission has the advantage of driving improved patient flow, shorter ED wait times, a better patient experience, and improved quality and continuity of care. ²  However, admitting a patient to inpatient care, whether planned or unplanned, is a complex process that requires careful coordination among physicians, nurses, registration staff, and others within the organization. Ineffective admission processes can lead to long wait times for patients, staff frustration, and a negative patient experience, as well as communication and handoff problems that can impact patient safety and quality.

Long wait times, in particular, are associated with decreased patient satisfaction. This is true whether a patient is waiting in their doctor’s office, in the ED, or to be admitted to a hospital. In fact, the difference between a five-minute wait and a 30-minute wait is a significant 15 percent drop in patient satisfaction.³  The tight correlation between wait time and patient satisfaction is important not only to maintaining customer loyalty but also because patient satisfaction scores have been used in determining hospital reimbursement from CMS since 2012.

Long before then, Thibodaux had developed an innovative approach to providing patient services via a “Medical Mall.” Its Medical Mall offers a number of outpatient services such as same-day surgery, a Center for Digestive Disorders, a Heart & Vascular Center, and a Cardiac Rehabilitation Facility.

Many of Thibodaux’s over 1,000 annual direct admits come from its physician offices. When the hospital’s leadership recognized that inefficient and redundant processes were leading to unacceptably long delays for patients being admitted to the hospital from their Medical Mall, they set out to address the problem.

UNCOVERING GAPS IN THE ADMIT PROCESS

Thibodaux’s first step in improving the inpatient admit process was to assess their current admission practices and identify gaps or areas for refinement. The project was the result of a request that came directly from the hospital’s Chief Executive Officer, Greg Stock, and his vision to improve ease of use for all involved in the admit process. Mr. Stock challenged the process improvement team to analyze the admit process with a focus on improving ease of use for staff, decreasing wait times for patients and creating an easier process for physicians to admit patients into the hospital.

After carefully reviewing the process with frontline staff, Thibodaux identified three primary areas of concern, similar to those found in hospitals nationwide: 1) the process was cumbersome and mostly manual; 2) there were several breakdowns in communication along the admission pathway; and 3) the process was not patient-centric.

Cumbersome manual process

While Thibodaux had invested millions in its EHR and other information technologies designed to improve patient care, the hospital’s inpatient admission process was still entirely manual, involving documentation on paper and faxing. This led to errors such as lost faxes, and to cumbersome processes such as multiple phone calls to track down information while patients waited. The manual process also led to inefficient handoffs, redundant data collection, as well as delays in getting necessary information, doctor’s orders, and bed assignments so care could be initiated.

Communication breakdowns

Another problem they observed was that patients often showed up at the admit desk without physician orders, or without advance notice. They would then have to wait while the admit coordinator tracked down the information needed to admit them and assign a bed so care could begin. Even when orders were received before the patient’s arrival, they seldom contained all of the necessary information. As a result, staff wasted time making follow-up phone calls, and in re-work. Moreover, the admitting phone call was typically made by a non-clinical person at the physician’s office who was unable to provide the information needed to determine the patient’s acuity, and where best to place them.

Non-patient centered process

In addition to problems with communication and efficiency, Thibodaux’s inpatient admission process generally was not designed with the patient at the center. Rather than moving swiftly through the admit process to receive care, patients had to wait for orders to arrive, for a room to be assigned, or for paperwork to be filled out. In addition to waiting, family members sometimes had to leave their loved one at a time of need to complete necessary paperwork. Patients and family members had to spend prolonged time in a public waiting area when they were unwell, tired, or anxious.

MAPPING OUT A SOLUTION

Once Thibodaux’s leaders had identified the issues with the hospital’s existing inpatient admit process, they established an interdisciplinary core team tasked with improving admission times. The team consisted of members from case management, customer service, organizational engagement, patient care services and nursing. Integrating concepts from the Health Catalyst improvement methodology into their own Lean Six Sigma processes, and using the support of professional services from Health Catalyst, Thibodaux’s core team leveraged a data-informed prioritization process to identify their project, baseline, and aims.

The team started by mapping out their current admit process and analyzing problem areas using fishbone diagrams to drill down into root causes and possible solutions. The team knew that it was critical to ensure the right people in the right roles were engaged in creating solutions, therefore throughout the improvement process, the team called in additional team members with special expertise, such as admissions, information technology, and engineering.

The team’s original aim statement set a target of reducing admission time by 20 percent. But they soon decided to further challenge themselves by adopting a more aggressive stretch goal—one that they felt would be impactful enough to be recognized by the patients and families, and that would improve patient experience in a demonstrable way. They eventually settled on the ambitious aim of reducing inpatient admission time for direct admits by 30 percent and improving the corresponding balance metric of patient experience to the 99th percentile.

A MULTI-PRONGED APPROACH TO IMPROVING THE INPATIENT ADMISSION PROCESS

Thibodaux’s executive leadership had spent years nurturing a culture of continuous improvement and patient-centered care. That organizational mandate gave the core team the support they needed to implement solutions to the admissions process in three key areas:

• Eliminating the paper process.
• Collaborating with partners.
• Putting the patient first.

A better way: eliminating the paper process

The team’s first priority was to explore viable alternatives to paper forms and faxes. Partnering with their IT colleagues, they were pleased to learn that their current computer system would support the development of online processes. Working with Thibodaux’s IT analysts, the team developed an online “short form” registration process, which contains all of the information required to preregister a patient, assign a bed, and alert others that a patient will be admitted. Eliminating the use of faxes also removed a lot of stress and inconvenience for the staff who no longer had to wonder whether a fax made it to its destination or whether the right fax had been received.

Taking automation one step further, the team also implemented an online bed board to alert others when a patient will be admitted. Today, when a patient arrives at the admit desk, they are expected, and the admit clerks pull up the needed information on their computer, eliminating unnecessary waiting and phone calls. After eliminating the manual process, Thibodaux immediately experienced an improvement in efficiency and wait time.

Collaboration and education improves admission process

The next step was to improve the quality of the information coming from the admitting physicians’ offices. To that end, the admit coordinator reached out to physician clinic managers, and reeducated them regarding appropriate completion of forms and which patient-specific information they must share when calling to admit a patient. The admit coordinator also shared a checklist of key information needed to admit a patient that could be posted near the nurse’s desk. This information helps to determine if the patient meets the criteria for admission, what their acuity is to make sure they get admitted to the right unit, and whether they have special needs, such as making oxygen available when they arrive.

As soon as the clinic staff understood what happened to their patients when they arrived at the hospital, and how long they would have to wait if they did not have the right information, the staff were motivated to help. This collaboration improved the quality of the data received from the clinics, speeding the admit process by eliminating unnecessary phone calls to track down missing information, and gave the patient confidence that the inpatient unit was expecting them.

Putting the patient first

Once the team had resolved the key issues slowing the admission process prior to the patient’s arrival, they focused on improving the registration process post-arrival. The old registration process required the patient to sit at an admit desk located in the public lobby while the registration was completed. The team wanted to do away with this process and complete registration at the point of care, speeding the patient to the floor as quickly as possible. Additionally, studies have shown that switching to bedside registration improves patient satisfaction.⁴

With mobile, or “bedside” registration, the admit clerk accompanies the patient to their room and completes the registration process there. This eliminates a source of waiting, gets the patient and family comfortably out of the public area, and enables care to be initiated as soon as the patient arrives.

To switch to mobile registration, Thibodaux needed a way to transport the patient to the room while carrying a computer and scanner. They reached out to their engineering department and presented them with the problem. Ultimately, Danny Hebert, a member of the hospital’s maintenance crew, eagerly accepted the challenge. Hebert built an innovative mobile registration cart (see Figure 1) that was attached to the back of a wheel chair, yet still light enough for a registration clerk to push wherever the patient needed to go, included a back-up battery system, and a removable top that enabled clerks to place the laptop on a bedside table or counter in order to face the patient bed while they filled out the registration information.

Figure 1. Mobile Registration Cart

Thanks to the mobile cart, and the ability of the registration process to follow the patient, families no longer had to leave their loved one’s side to finish paperwork. Patients no longer had to wait in a public waiting area while ill. This relieved stress and frustration for both the registration staff and the patient.

The success of the new process was demonstrated recently when a patient arrived at the hospital by ambulance to be admitted to the intensive care unit (ICU). The patient had been pre-registered prior to arrival, and was assigned to a bed. When the patient came through the door, the ICU nurse was waiting for her, and she was immediately transported to her room. Registration staff were in the ICU waiting with the mobile registration cart, and worked with the family to complete the registration while the nurse worked on admitting and treating the patient.

Many patients have commented positively on the new mobile registration process. The registration staff unanimously supports the new process, convinced that they are contributing significantly to an improved patient and family experience.

RESULTS

Thibodaux’s commitment to patients, use of proven process improvement methodology, innovative solutions, and collaborative interdisciplinary teamwork paid off in an impressive reduction in admission times, surpassing the team’s stretch goal of 30 percent:

• Decreased average inpatient admission time by 40 percent – from a median of 43 minutes to a median of 26 minutes (see Figure 2).
• Ranked 99th percentile for patient experience during the admission process and speed of admission.

Figure 2. Arrival to Medical Mall to room time (minutes)

By redesigning its inpatient admit process, Thibodaux has improved patient and family experience, reduced staff stress and frustration, and improved communication and handoffs at every stage of the process.

“The registration aspect of a patient admission has always been viewed as tedious and repetitive, in most instances. Our clerks are excited about our innovative new process and patients have been quite satisfied, as well. We feel that giving a patient our full attention by greeting them at the door and bringing them to their room for immediate care has enforced our team effort to put our patients first!”

– Sheri Sothern
Patient Access Manager

WHAT’S NEXT

Thibodaux plans to sustain the gains made through its new inpatient admit process with ongoing education and collaboration with community providers. The hospital also plans to expand its improved process to patient admissions from the ED. In the long term, Thibodaux is working towards a fully electronic admission and registration process to provide patients with an even faster and more efficient registration experience.

REFERENCES

1. Vogelsmeier, A. & Despins, L. (2016). A Room Without Orders. Patient Safety Network.
2. Hostetter, M. & Klein, S. (2013). In focus: Improving patient flow-in and out of hospitals and beyond. Quality Matters.
3. Stempniak, M. (2013). The push is on to eliminate hospital wait times. Hospitals and Health Networks.
4. ED Management. (1997). Switching to bedside registration increases patient satisfaction. 9(3), 25-30.

ABOUT HEALTH CATALYST

Health Catalyst is a mission-driven data warehousing and analytics company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 50 million patients for organizations ranging from the largest US health system to forward-thinking physician practices.

For more information, visit healthcatalyst.com, and follow us on Twitter, LinkedIn, and Facebook.

Doctors more apt to admit patients to hospitals that own their practices, study says

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital, researchers found.

Why did hospitals binge-buy doctor practices in recent years?

To improve care coordination, lower costs and upgrade patient experiences, say hospitals. To raise costs, gain pricing power and steer patient referrals, say skeptics.

Researchers at Stanford University tested those opposing arguments by comparing referral patterns between independent doctors and those working for hospitals.

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital, they found. Worse, from the viewpoint of reformers, it boosts chances that patients will go to higher-cost, lower-quality hospitals.

“One of the things that was most surprising to me about the paper was the quality and cost effect,” said economist Laurence Baker, one of the authors.

While not as pronounced as doctors’ hospital referral pattern, the findings that hospital-physician ownership hurts care quality “head in the direction that might make us concerned,” he said.

The findings were published in August by the National Bureau of Economic Research.

The report is not the final word. More research is needed, the authors say.

The 2009 Medicare data they used don’t reflect substantial quality improvements made in many hospitals since then, said Caroline Steinberg, vice president of trends analysis at the American Hospital Association.

Even so, the paper raises questions about hospital-doctor lockups and the idea that consumers are in charge of where they buy health services.

Doctors are the hospital’s sales force, although they don’t like to think of it that way. Without doctors there are no admissions and no revenue to pay hospitals’ huge fixed expenses.

So hospitals have long been interested in owning physician practices, including a spurt of acquisitions in the 1990s in which many lost money and a renewed boom in the last decade as the Affordable Care Act promised to squeeze costs.

But few researchers have closely studied admission patterns of hospital-owned doctors’ practices next to those of docs working for themselves.

Baker and colleagues analyzed millions of 2009 admissions using a model that predicts patient hospital choice based on historical patterns.

Hospital ownership raised the probability that an admitting doctor would send her patients to the owner hospital by a third, they report. Doctors working for hospitals admitted an average of 83 percent of their hospitalized patients to the proprietor hospital.

What’s more, the researchers found that patients are more likely to be treated in “a high-cost, low-quality hospital when their admitting physician’s practice is owned by that hospital.”

To score hospitals the authors used Medicare cost records as well as data on mortality and other quality gauges.

As policymakers try to revamp a system that often harms patients and delivers billions of dollars in unnecessary care, the researchers’ findings about hospital-owned practices aren’t in line with the way the system things are supposed to work.

“If these results are valid, then there are large implications,” said Martin Gaynor, a health economist at Carnegie Mellon University who was not involved in the study. “Hospital acquisitions of physician practices could disadvantage rival hospitals and harm competition.”

A less alarming interpretation is that hospitals hire doctors who already admit most of their patients to that hospital.

“You would expect that the entities would be approaching the ones that they’re already working with,” said the AHA’s Steinberg.

But tests of the data suggest that’s not the case, said Baker. The matter needs further investigation, but, the results “are not reassuring,” said Gaynor.

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With the passage of the Affordable Care Act taking place since the activity measured by the paper, “it’s really kind of looking at the past,” said Steinberg. “It would be interesting to know whether affiliation with physicians allows hospitals to improve their quality.”

The health law encourages doctor-hospital collaboration in groups called accountable care organizations that put participants on the hook for financial and quality results.

ACOs are supposed to reduce incentives for hospitals to gobble market share, raise prices and slight quality — the kind highlighted by the Stanford paper.

“I’m optimistic about ACOs,” said Baker. “But I think we should still be paying attention to these issues.”

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Twitter: @HFNewsTweet

Ohio law changed to permit advanced practice nurses and physician assistants to admit patients to hospitals under certain conditions

Thursday, February 20, 2014

On February 18, 2014, Ohio Governor Kasich signed into law H.B. 139 permitting clinical nurse specialists (CNS), certified nurse-midwives (CNM), certified nurse practitioners (CNP) and physician assistants (PA) to admit patients to hospitals under certain conditions.

Under current law, only a doctor, dentist, or podiatrist who is a member of a hospital’s medical staff may admit a patient to the hospital (Ohio Revised Code 3727.06). However, H.B. 139 authorizes a CNS, CNM, or CNP to admit a patient to a hospital if three conditions are met.

1. The CNS, CNM or CNP has a standard care arrangement with a collaborating doctor or podiatrist who is a member of the medical staff.
2. The patient will be under the medical supervision of the collaborating doctor or podiatrist.
3. The hospital has granted the CNS, CNM, or CNP admitting privileges and appropriate credentials.

Similarly, under H.B. 139, a PA may admit a patient to a hospital if the following conditions are met:

1. The PA listed on an approved supervision agreement for a doctor or podiatrist who is a member of the hospital’s medical staff.
2. The patient will be under the medical supervision of the supervising physician or podiatrist.
3. The hospital has granted the PA admitting privileges and appropriate credentials.

The CNS, CNM, CNP, or PA is required to notify the collaborating or supervising doctor or podiatrist of the planned admission prior to admitting a patient.

The bill modifies Ohio Revised Code Sections 3727.06, 4723.431 and 4730.09 to reflect these changes. The new law becomes effective on May 20, 2014.

Hospitals should take the following actions in order to permit a CNS, CNM, CNP, or PA to admit patients to the hospital:

1. Review the new law and the requirements contained therein and determine how the hospital will assure compliance with the requirements.
2. Amend the applicable privilege sets to permit the CNP, CNM, CNS, or PA to request admitting privileges; act upon requests for admitting privileges effective on/after the date the new law takes effect.
3. Verify whether there are any medical staff or hospital policies that need to be updated with respect to admission/discharge of patients by a CNP, CNM, CNS or PA and amend accordingly.
4. Verify whether there are any hospital computer systems/processes that need to be updated to reflect the ability of a CNP, CNM, CNS and/or PA to admit/discharge a patient.
5. Determine what education/communication will be needed regarding the change to hospital staff, the medical staff, etc.
6. The CNP, CNM, or CNS (if the CNS is required to have one) will need to revise their standard care arrangement with his/her collaborating collaborating doctor or podiatrist to permit the CNP, CNM, or CNS to admit a patient to the hospital in accordance with ORC 3727.06.

This is for informational purposes only. It is not intended to be legal advice and does not create or imply an attorney-client relationship.

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What Physicians Need to Know • Advantum Health

Medical credentialing and hospital privileging are both pertinent processes for physicians and other medical staff that ensure the quality care of patients and proper delivery of medical treatment from qualified practitioners.

So as not to confuse the two, medical credentialing, aka healthcare credentialing, must occur before a physician’s hospital privileges can be granted. Both are complicated and lengthy processes, and if done incorrectly can lead to costly liabilities as well as downgrading a hospital or practitioner’s reputation and rating.

What are hospital privileges?

Hospital privileges authorize medical practitioners for a specific practice of patient care in a specified healthcare facility. Privileges are granted to physicians based on their current medical credentials and previous performance.

 Types of hospital privileges:

• Admitting privilege: authorizes physicians to admit patients into specific hospitals or medical centers.
• Courtesy privilege: authorizes physicians to occasionally treat or admit patients into specific hospitals.
• Surgical privileges: authorizes physicians to perform outpatient or operating room surgeries.

Why do physicians need hospital privileges?

In order for a physician to perform specific procedures at a specific hospital, they must apply for privileges. Appointment and re-appointment for hospital privileges cost providers vast amounts of time and attention but are an essential component to high-quality healthcare and patient safety. If physicians don’t have hospital privileges, they can’t provide services to patients.

Who awards physicians their privileges?

The Joint Commission and Medicare hold hospitals responsible for granting privileges to their physicians. This means hospitals take full responsibility for awarding appropriate privileges, which means if the physician is not granted privileges, they cannot practice in that hospital. Whether or not a physician receives hospital privileges is decided by a committee of the hospital’s medical staff.

How physicians obtain hospital privileges

In order for physicians to receive privileges, they must complete and submit an application to that hospital. This process can be quite tedious and complicated as it requires extensive information, forms, and paperwork to be completed correctly.

• Before you apply for privileges at a specific healthcare facility, you should check the medical staff bylaws to make sure you meet their eligibility criteria.
• A hospital’s medical staff bylaws establish the rights, responsibilities, and accountability of all practicing medical staff. They also set out the organization and structure of each hospital.
• In order to award privileges, the hospital will review a physician’s credentials. This means the medical credentialing process must be completed before the hospital privileges process can begin. Credentials review a physicians’ education, residencies, fellowships, board certifications, and practice experience.

How do hospitals determine a physician’s competency for hospital privileges?

Set out by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS), the following areas provide a framework to determine a physician’s competency for hospital privileges:

• Patient care
• Medical clinical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• System-based practice

How long do hospital privileges last once they’re obtained?

According to The Joint Commission, hospital privileges for physicians need to be renewed every two years (except for Illinois, which requires every three years).

How can physicians make the process of obtaining hospital privileges easier?

Physicians can spend enormous amounts of time and energy filling out piles of paperwork and applications and gathering all of the correct and complete information to obtain their hospital privileges. With plenty of room for error and mistakes to occur along the way, the credentialing application process has great potential to be delayed. Plus, when mistakes are made, physicians and hospitals run the risk of delivering practices they’re not licensed to perform which can then lead to costly liabilities and diminished reputations.

Through our subsidiary Med Advantage, Advantum Health offers Provider Enrollment Services that take care of the time-consuming credentialing work for physicians, hospitals, and medical practices. As an affordable outsourcing solution with flexible plans tailor-made for offices with one provider or facilities and organizations with hundreds of providers, our services make the hospital privileging process easy, fast, and stress-free.

Contact us now and let’s talk about how we can make your healthcare credentialing easier.

90,000 Cancer patients want to take pills at home

The All-Russian Union of Patients has appealed to the Ministry of Health and the Federal Fund for Compulsory Medical Insurance (FFOMS) regarding the provision of cancer patients with drugs in a day hospital. As follows from the text of the letter, which Vedomosti got acquainted with, people suffering from oncological diseases have to visit medical institutions every day to get one pill.

In the framework of the study on health problems “Evaluation of patients and patient NGOs”, it was found that with such difficulties in 2020.faced 57% of 1320 respondents, according to the letter of the union. A number of combined therapy regimens provide for the administration of drugs both with the help of infusions (droppers) and in the form of tablets, it is noted there. The requirement to dispense the drug only in a day hospital environment forces patients, for example, with renal cell carcinoma or endometrial cancer, to visit the day hospital every day. This condition often precludes the appointment of combination therapy, thereby reducing the potential for recovery.

The All-Russian Union of Patients asks the Ministry of Health and FFOMS to clarify whether, in the case of combined therapy regimens, it is possible to abandon the daily issue of pills and provide patients with drugs either completely for the course of treatment, or for other periods of time. This is especially important for the safety of cancer patients during the covid pandemic, according to the organization.

The Union of Patients has not received a response from the Ministry of Health, says its co-chairman Yuri Zhulev, and in the letter received from FFOMS “there is no substantive response” to the organization’s proposal.The problem is faced by “tens, if not hundreds of thousands of people”, not only cancer patients, but also people with other chronic diseases in all regions of Russia, Zhulev said. In some cases, of course, a visit to the hospital is required – for example, if the patient is also observed by a doctor with complications, but in most cases of combination therapy, the visit to the day hospital is “purely formal,” Zhulev says.

A large number of patients are faced with the problem of receiving medicines through the day hospital, says President of the Foundation for Support of Anti-Cancer Organizations “Together Against Cancer”, urologist Bahodur Kamolov.He believes that the current system limits the ability to receive drug therapy. From a medical point of view, there is no need to take most drugs under supervision, in a hospital, the doctor is sure: for example, cardiological and endocrinological patients “take pills at home” – they are given drugs with a month or two in reserve under special programs. The problem has affected cancer patients very sharply – “due to the high cost of drugs”, which are not allocated according to a similar scheme, says Kamolov.

Founder of the Law Firm “Faculty of Medical Law” Polina Gabai explained that the dispensing of drugs to patients through a day hospital in hospitals can actually replace the outpatient dispensing of prescription drugs for which there is not enough funds for a regional benefit.

The Ministry of Health and FFOMS did not respond to requests from Vedomosti.

Moscow Ophthalmological Center began accepting patients

On December 30, 2019, a long-awaited event took place at the Botkin Hospital – the Moscow City Ophthalmological Center opened its doors for patients.This is the most modern not only in the capital, but also one of the largest and most modern eye clinics in Europe. More than 1,000 units of specialized equipment have been purchased for the ophthalmic center! A full cycle of specialized treatment is organized here – diagnostics and outpatient care, treatment of patients with diseases and traumatic eye injuries, the most complex operations, including ophthalmic oncology and corneal transplantation.

The structure of the ophthalmological center includes: a specialized ophthalmological polyclinic with a powerful diagnostic complex, which allows to receive 110 thous.patients annually; 24-hour emergency department; 4 bedside ophthalmology departments, including a unique ophthalmic-oncology department, a short-term ophthalmological hospital (SKP-2). The ophthalmological operating unit consists of 11 operating rooms equipped with the best modern specialized equipment. It is planned that ophthalmology surgeons will perform up to 25 thousand operations per year, including 1.5 thousand high-tech ones.

Photo slit lamps, non-contact tonometers, autorefractometers, an optical coherence tomograph with angiography function, a device for short-range X-ray therapy, radio wave and electrosurgery devices, new generation laser devices, and corneal examination devices were purchased for the Center.So, the femtosecond laser does not damage the corneal endothelium, makes a smooth incision without steps. An operating microscope with a navigation system, ophthalmic surgical combines for operations on the anterior and posterior segments of the eye were purchased for the operating unit. All this equipment will allow Botkinskaya’s ophthalmologists to use the most modern technologies for treating patients, and to increase the level of ophthalmological care for Muscovites.

90,000 The infectious diseases hospital in the Troitsky and Novomoskovsky administrative areas built in a month began accepting patients

The infectious diseases hospital in the Troitsky and Novomoskovsky administrative areas in the Voronovsky settlement received 90,027 20 first patients with coronavirus infection .This was reported at the operational headquarters for control and monitoring of the situation with coronavirus in Moscow.

“During the day, 20 patients were admitted to the new hospital. The center is designed for 800 beds, if necessary, the capacity can be increased to 900. The clinic will employ more than a thousand medical specialists, including doctors, nurses and nurses. To date, more than 500 employees have started work, and we continue to recruit specialists, “said Sergei Perehodov, chief physician of the city clinical hospital No. 68 named after V.P. Demikhova.

There are no analogues in the world

The new hospital is provided with everything you need. More than 26 thousand units of medical equipment and furniture were purchased for the center, as well as protective suits for personnel.

“All beds are equipped to supply medical gases. Each bed, if necessary, can be converted into an intensive care unit. This is very important for prompt assistance to patients with coronavirus infection who have developed pulmonary insufficiency, ”said Sergei Perekhodov.

The new infectious diseases hospital is unique and has no analogues in the world. The complex was designed in compliance with all the necessary security measures.

Oxygen supply to the chambers is provided by its own oxygen-gasification station , installed on the territory of the complex. All necessary analyzes will be carried out in our own laboratory. Its capacity makes it possible to organize more than more than 10 thousand studies per day. This will help save time for testing and obtaining results.

Air supply systems for medical buildings are absolutely hermetically sealed. The air is decontaminated at the entrance and exit to each room. Sewage drains are discharged to autonomous treatment facilities, also equipped with disinfection systems.

The hospital is located far from the city center. In this regard, a comfortable dormitory was built for the personnel on the territory of the complex. This allows doctors not to waste time on the way home and back.The building will accommodate about 1300 people in single and double rooms. There is a sports ground next to the complex.

Security perimeter established around the hospital. Inbound and outbound vehicles undergo special sanitation. The buildings also have separate gateways for patients and staff, significantly reducing the potential for infection to spread.

Built in a month: an infectious diseases hospital was opened in Voronovsky

New Infectious Diseases Hospital opened April 17 .She became a part of the city clinical hospital No. 68 named after V.P. Demikhova. The chief physician is Sergei Perehodov.

Unlike similar institutions that are opening in many countries during the fight against COVID-19, this hospital will operate on a permanent basis . After the end of the pandemic, all types of infections will be treated here. The service life of the housings is designed for several decades.

Medvedev urged doctors to take patients “as needed” :: Politics :: RBC

Russian Prime Minister Dmitry Medvedev proposed to reduce “unnecessary bureaucratization” in the work of doctors.The head of the government said this at a meeting with the activists of the United Russia party, RIA Novosti reports.

In particular, he remembered the standards for a doctor’s appointment. “Any doctor should see a patient as much as necessary. A recommendation of 15 minutes is just some kind of target, ”Medvedev said.

In his opinion, it is necessary to optimize the reporting systems of doctors. “It is necessary to make electronic circulation competent, accessible, technological, understandable, so that communication with papers, even in electronic form, would take 20% of the specialists’ time,” the prime minister added.The rest of the time should be spent on the patient.

Medvedev also supported the idea of ​​the transition of Russian doctors to electronic document management. A similar proposal was made by the children’s surgeon Dmitry Morozov, stating that the need to keep a paper report complicates the work and creates a great burden on doctors. According to Medvedev, “it is impossible to simply refuse to write something <...> everything must be done to optimize these processes.”

In March 2015, more than 20 employees of several Moscow clinics began the “Italian strike”.The participants of the action opposed the reduction of staff in the outpatient department, the system of unpaid overtime and ineffective labor organization, which, according to doctors, does not allow providing proper care to patients. The protest implied strict adherence to standards of medical care: for example, doctors refused to see patients for more than 10 minutes.

Radiation therapy center in Yekaterinburg began accepting patients

07/19/2020

The center of radiation therapy in Yekaterinburg, the first in the announced project of MedInvestGroup “100 linear accelerators”, today received the first patient.

Pre-radiation topometric preparation of patients is carried out on a GE Healthcare Discovery RT computed tomograph. MedInvestGroup was one of the first in Russia to start working on the newest Varian Halcyon radiotherapy system!

Varian Halcyon is the latest high precision radiation therapy system developed by Varian Medical Systems for the treatment of cancer. The Halcyon system uses Intensive Modulated Radiotherapy (IMRT) technology, which redirects high doses of radiation directly to cancer cells, protecting the surrounding healthy tissue and thereby reducing harmful side effects.Halcyon’s innovative technology can be used to treat prostate, breast, head and neck cancers, as well as many other forms of malignant neoplasms.

A team of professionals led by the chief physician Vadim Viktorovich Bryukhanov is ready for stable work in a 5/2 mode, and for receiving about 60 patients a day.

The joint project of GAUZ SO “SOOD” and “MedInvestGroup” was implemented within the framework of the approved roadmap “Creation of a nuclear medicine center” on the territory of the Sverdlovsk region.

The center became the first in the announced project of MedInvestGroup “100 linear accelerators”. Equipped with the most modern radiotherapy equipment, the Radiation Therapy Center is becoming the leading medical institution providing high-tech care in the Ural Federal District. The center has installed and put into clinical operation 3 linear medical accelerators from Varian: Halcyon; TrueBeam STx; TrueBeam Tx.

By the end of 2020, MedIvestGroup will launch two more new projects in the Sverdlovsk region: a drug therapy center in Yekaterinburg, a clinical diagnostic center and a drug therapy center in St.Nizhny Tagil. The centers will also operate in the compulsory medical insurance system and any patient in need of diagnosis and / or treatment will be able to receive assistance within the compulsory medical insurance system.

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90,000 Almazov Center began accepting patients with covid for the third time

St. Petersburg National Medical Research Center named after Almazov partially switched to receiving patients with covid.Coronavirus beds were allocated in a clinic on Parkhomenko Avenue.

Every fifth patient in St. Petersburg hospitals has a severe form of COVID

Coronavirus

Every fifth patient in St. Petersburg hospitals has a severe form of COVID

The press service of the medical institution announced the start of receiving patients with coronavirus.The treatment and rehabilitation complex on Parkhomenko provided 250 beds.

“The presence of high-tech equipment at the VA Almazov National Medical Research Center will help save patients even with a severe course of the disease,” the clinic said.

For the first time, the Almazov Center was redesigned to treat patients with coronavirus infection in May 2020. The second time, the covid bunks were deployed there in December 2020. A medical facility on Parkhomenko Avenue has created 230 beds for patients with coronavirus and pneumonia.Then another 150 beds were opened in the branch of the hospital on Mayakovsky Street. With the beginning of March 2021, both hospitals returned to normal operation.

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90,000 Mariinsky Hospital will stop admitting patients with coronavirus

Mariinsky hospital will stop accepting patients with coronavirus
Anna Kryuchkova

20:46 16.07.2021

Patients with a dangerous infection will be transferred to other city hospitals in special ambulances.

The Mariinsky Hospital returns to its usual mode of operation without coronavirus patients.Those suffering from a dangerous infection will be transferred to other hospitals. Information about this appeared on the website of the medical institution.

“For the transfer of patients, specialized ambulances and reanimobiles equipped with ventilators and all the necessary equipment will be used,” – is said in the message.

Routine and emergency care in the hospital will begin after thorough disinfection. Citizens with negative tests for covid will be able to contact doctors.

The hospital resumed admission of patients with a fatal infection last month. Then the hospital placed an additional 680 beds, including 74 intensive care units. The NEVSKIE NEWS wrote about this.

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