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While there is general agreement that temporary staff can threaten patient safety and increase malpractice risks, the question is not quite so clear with nurse practitioners (NPs) and physician assistants (PAs) in the emergency department (ED).
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E-mail practices and mobile e-mail cause the most concern for data protection and regulatory compliance, according to the 830 individuals whose responses were included in a study conducted by the Ponemon Institute and Zix Corp., an e-mail encryption service.
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The March of Dimes, based in White Plains, NY, recently began an initiative in New York, California, Florida, Texas, and Illinois to implement a "39-week toolkit" in hospitals to discourage C-sections or inductions before that minimum gestation.
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Brian A. Todd, CHAM, manager of patient access staff development and training at Lourdes Health System in Camden, NJ, is seeing additional restrictions coming from companies that are doing clinical necessity checking.
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After a registrar immediately blamed a clinic because she wasn't able to verify a patient's demographics, Nicole Marsoobian, supervisor of pre-registration at Tufts Medical Center in Boston, sent her to the clinic for an hour.
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At St. Joseph East/St. Joseph Jessamine in Lexington, KY, collections in a newly opened women's hospital went from only about $100 in March 2010 to $15,000 a year later, and preadmissions collections, which were just $1,300 monthly, now range from $15,000 to $40,000. Stanford (CA) Hospitals and Clinics expects to collect $1 million more at point-of-service in 2012.
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If an admitted patient is impatiently waiting for a bed to become available, and all he or she sees is access staff, it's easy to come to the wrong conclusion about who is really responsible for the delay.
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Keeping up with all the new payer requirements "is getting overwhelming," reports Margie Mukite, director of patient access at Advocate Condell Medical Center in Libertyville, IL. Here are some trends the department is seeing:
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Payers are frequently requiring additional clinical information from the provider or medical staff as to the medical necessity for a procedure or surgery, says Nan Olivieri, a supervisor at the Financial Clearance Center at Hennepin County Medical Center in Minneapolis.
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Has your access staff been wrongly blamed for mistakes, delays, or other problems related to clinical areas? To avoid this problem, patient access must "link themselves with clinical departments and establish a relationship a tight one," says Barbara Snodgrass, patient access manager at Legacy Mount Hood Medical Center in Gresham, OR. Snodgrass gives these recommendations:
