Patient Placement Center Improves Patient Flow—and Billable Charges

By Kent Giles, Janet Harris, and Louann Parker

The University of Mississippi Medical Center (UMMC)—a 722-bed healthcare system located in Jackson, Mississippi—recently began an initiative to enhance patient access and flow throughout the organization.

One of the key components of UMMC’s new operational model deals with coordinating patient access. Through the assessment, the organization realized that patient registrations were coming from multiple sources, leading to inconsistent processes and access procedures that were a major source of dissatisfaction for physicians as well as an on-going planning challenge for staff. Often, access was controlled by resident physicians without any hospital involvement in acceptance or denial of the patient. This practice had a severe impact on patient throughput and often resulted in payment denials for lack of medical necessity or appropriate payer authorization.

To address this issue, UMMC developed an RN-staffed Patient Placement Center (PPC) that coordinates all inpatient admissions. Akin to an air traffic control center, this nurse-staffed unit combines all of the bed control functions, admitting nurse functions, and front-end utilization review nurse activities. This level of centralization enables the PPC to maintain accountability over bed control, place patients in accordance with best-practice algorithms, and even cluster patients by attending physician to enable physicians to complete their rounds more efficiently.

Since its implementation, the PPC has had a dramatic impact on controlling patient placement. As of December 2008, 99 percent of UMMC inpatient admissions and transfers are processed through the PPC and 85 percent of patients now meet InterQual criteria for medical necessity and severity of illness.

In addition, 70 percent of patients now have the appropriate precertification and authorization for elective procedures and transfers, which has greatly reduced payment denials for services.

According to Kimberly O’Reilly, director of patient access: “We are very pleased with this level of compliance and with the high level of collaboration that has been developed with admitting physicians, physician office personnel, and the business office.”

“Prior to implementation of the PPC, a one-month review of admissions showed 68 patients that were admitted did not meet medical necessity and severity of illness criteria. These cases resulted in $2,040,000 in charges that had limited to no opportunity for reimbursement."
 

This article is excerpted from a longer feature on UMMC’s patient flow initiative, which is posted on HFMA’s CFO Forum. Read the full article. (CFO Forum membership required.)

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