St. Joseph’s Health improves care management and Medicare compliance

Learn how one health system partnered with Oracle Health to provide better documentation, care for its community, and improve overall compliance.

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Our staff is happy, patients are meeting Medicare requirements, and the process just runs smoothly.

Tom StanczakDirector of Care Management, St. Joseph’s Health System

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When Paterson, New Jersey-based St. Joseph’s Health audited its case management department, it discovered opportunities to improve its processes to better meet regulatory compliance. One challenge the health system faced included delivering the Important Message from Medicare (IM) to all traditional and health maintenance organization (HMO) patients upon admission and within two calendar days of discharge. It informs inpatient Medicare beneficiaries of their hospital discharge appeal rights. The Centers for Medicare & Medicaid Services (CMS) relies on Quality Improvement Organizations (QIOs) to improve the quality of healthcare for all Medicare beneficiaries.

A QIO can audit organizations at any time, and audits occur when the patient decides to appeal his or her discharge or post-discharge during a regulatory review. The QIO will determine if the IM was given within two calendar days of discharge, but not less than four hours prior to discharge if the discharge date could not be predicted. It is up to organizations to have controls and audits in place to make sure they are compliant with CMS guidelines.

“We found we were limited on paper,” says Tom Stanczak, director of care management. “We could lose the IM when signed and placed in the chart, somewhere between chart breakdown, and copying into a medical record.”

Prior to implementation, St. Joseph’s decided to reevaluate its acute case management process to provide better documentation, care for its community, and improve overall compliance. In May 2019, staff worked with Oracle Health to implement Cerner Acute Case Management and used Patient eSignature on iPads as a tool for patients to complete their required forms electronically.

“We could use iPads with a unique signature that would automatically link to Cerner and allow us to print a copy from anywhere,” says Stanczak. “Once the document is reviewed with the patient or family, a signature is obtained. The system then automatically stamps the date and time of that signature, and the document is saved in our system for a patient copy and for our electronic health record.”

St. Joseph’s Health hovered at approximately 85% for IM compliance before implementation. That number improved to more than 95% after the new technologies and processes were in place.1

“This was at the top of our priority list and something I lost sleep over in the past,” says Stanczak. “If your improvement plan fails, you could lose Medicare Certification, and that would be devastating to an organization. When our numbers improved into the nineties, we all felt relieved, and it made me proud of the work we are doing.”

After initially starting with IM, St. Joseph’s Health staff began working on its patient preference list. Medicare requires hospitals to provide patients with a list of agencies or sub-acute facilities in the area that are Medicare-certified where patients could receive care post discharge.

“Medicare wants to make sure we’re not funneling everyone to one facility that we are aligned with,” says Linda Lioy-Bsales, nurse care manager. “We want the patient to choose where they’re comfortable, and we try to do that at the earliest possible point in the hospitalization.”

Similar to the IM process, St. Joseph’s Health and Oracle Health created documentation areas as a live field on the iPad. The patient preference form is signed, dated, and electronically saved into the medical record. The patient preference form compliance rate rose from 85% to 96%.2

Eliminating paper also helped save costs.

“When we update our preference list about three times a year, it can cost hundreds of dollars,” says Stanczak. “We're saving at least three-quarters of that previous cost by not having to order carbon triple duplicate copies every time.”

During the COVID-19 pandemic, Acute Case Management and Patient eSignature helped reduce unnecessary exposure but still allowed for regulatory compliance.

“[Acute Case Management and eSignature] definitely make my staff’s lives easier,” says Stanczak. “When considering hospital cost and personal protective equipment cost, being able to call the family or patient if they’re COVID-positive without putting people at risk and still meet the requirements, is a win-win.”

 

1 Comparing average compliance rate between Wayne and Paterson facilities from Q1 to Q4 2018 against Q4 2020.

2 Comparing average compliance rate between Wayne and Paterson facilities from Q1 to Q4 2018 against Q4 2020.

For more information about best practices for Acute Case Management, visit our Model Experience Page. For more information about best practices for COVID-19: Acute Case Management, visit our Model Experience Page. For more information about best practices for Acute Case Management, visit our Model Experience Page. For more information about best practices for Cerner Millennium Enterprise Document Management, visit our Model Experience Page. For more information about best practices for Enterprise Document Management - eSignature workflow, visit our Model Experience Page.

Outcomes achieved prior to Oracle acquisition of Cerner. Company name updated to reflect current organization name.

Published:May 5, 2021

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