Personalized Service
A dedicated senior level member of our team will be your account manager throughout your relationship with Proven Healthcare Solutions, and will provide you with the high quality service you need to support you in meeting your goals.

Flexible Coverage
Proven Healthcare Solutions' Admission Review Screening Service provides hospitals and healthcare systems a flexible, cost-effective, turn-key solution to address the ever-challenging requirements of ensuring real time, point of service medical necessity review determinations of patients coming in through the Emergency Department and the key outpatient service lines. This includes utilization review using the latest evidence-based screening criteria to determine the appropriateness of setting for these patients: Inpatient, Outpatient Observation or Outpatient follow-up.

By taking a Six Sigma, lean approach, Proven Healthcare Solutions (PHS) has designed coverage options to accommodate all of your Admission Review needs including:

• Nights
• Weekends
• Holidays
• Specific Shifts
• Vacation/leave of absence

You have the flexibility of choosing any of these coverage combinations, including complete outsourcing of your hospital's Emergency Department-review for medical necessity and appropriateness of setting of all potential new admissions. We also provide medical necessity review for key outpatient service lines.

In the new era of an alphabet of healthcare oversight including- Recovery Audit Contractors (RACs), Medicare Administrative Contractor (MACs), Comprehensive Error Rate Testing (CERTs), Payment Error Rate Measurement (PERMs), the Office of the Inspector General (OIG), the Office of the Medicaid Inspector General (OMIG), Managed Care Organizations (MCOs), and many others, PHS enables you to fortify your hospital's compliance .

Strategically Balancing Hospital Performance with Compliance
Hospitals and Health Systems that select Proven Healthcare Solutions will realize the following benefits:

• Consistency of medical necessity and appropriateness of setting review for new inpatient admissions originating in the Emergency Department and key outpatient service lines
• Reduction in denied days for inappropriate admissions
• Ensuring appropriate placement of readmissions
• Appropriate placement of patients into the observation setting
• Improved Emergency Department patient throughput
• Use of the latest evidence based screening criteria

Transparent Pricing
There are no hidden or surprise costs with our service. You have the choice of either paying on a per-encounter basis or an annual subscription fee based upon your ED volume and historical rate of admissions.

State of the Art Technology
Our state-of-the-art Electronic Admission Review Manager (E-ARM™) application is easy to implement, easy to learn, and provides value across many departments within the hospital. This enables our experienced Screeners to provide your facility with the flexibility of just-in-time coverage using the most up to date industry accepted evidence based screening criteria.

Rapid Implementation
Proven Healthcare Solution's comprehensive turn-key approach allows for rapid implementation at your site.

Ongoing Reporting
Your facility is provided with a standardized reporting package which will identify opportunities for provider and staff education. Additionally, ad hoc reporting is available. Additional fees may apply.

Background

The Jersey City Medical Center (JCMC) is located on a 15-acre campus overlooking the New York Harbor and Liberty State Park. The Campus presently includes two facilities, the Wilzig Hospital and the Provident Bank Ambulatory Center. The hospital serves as a regional referral center and teaching hospital providing the highest level of care for women and infants, trauma, and cardiac patients. The Medical Center is a major teaching affiliate of the Mount Sinai School of Medicine. The Emergency Department at Jersey City Medical Center is a Level II Trauma Center, staffed 24 hours a day by board-certified and board-eligible emergency physicians. JCMC also operates a fast track area in the ED from 10am to 10pm to care for less emergent conditions and has a separate pediatric emergency department.

Challenge

In 2009, JCMC’s Senior Vice President of Nursing, Rita Smith, was cooncerned with the variations in shift coverage by hospital case managers to review admissions from the emergency department. The ED had a dedicated case manager providing single coverage one shift per week day, and limited coverage on alternate weekends.

Like many hospitals, the variability in volume coupled with the difficulty in recruiting experienced case managered made it difficult to justify the expense of providing 24/7 ED coverage. However, with the changing landscape of regulatory compliance for federal, state and commerical payers, JCMC recognized the need to proactively increase the percent of admissions from the ED that received screening for medical necessity.

Solution: On-line admission screening for 24/7/365 coverage

"When we heard about Proven Healthcare Solutions (PHS) real time admission review screening we were eager to give it a try," says Rita Smith, SVP of Nursing. "Their business model was perfect for our situation. They are available 24/7 and only charge us for the cases we send them. This allows us to use them as an addition to our case management staff to cover open shifts and increases in volume without changing our staffing."

PHS has an innovative model of utilizing experienced nurse reviewers, trained on the most up-to-date, web-based versions of Interqual and Milliman, as part of a two-tiered approach. On average, 80% of cases can be handled by the nurse reviewers in 30 minutes or less. When necessary, PHS’ second tier provides experienced physician reviewers who will interact directly with the hospital’s medical staff.

This two-tiered approach enables hospitals to implement a strong review program while keeping the average cost of screenings reasonable.

PHS developed an interface between their proprietary E-ARM System and JCMC’s electronic medical record system, EDIMS. Physicians are able to request a screening directly from the main ED tracking grid. In combination with the E-ARM viewer, they are also able to easily view the results on their computers and provide additional information if required. "With the E-ARM interface connected to our EMR, our physicians needed less than 30 minutes of training to begin using PHS," states Dr. Michael Bessette, MD, FACEP, Emergency Department Director.

"We know that the PHS reviewers utilize the latest criteria and they have helped our ED case managers fine tune their use of criteria," said Leigh Baillie, Director of Case Management. "The PHS staff is extremely helpful and knowledgeable and we view them as part of our team."

The PHS pricing model meets JCMC’s needs and situation. "We only pay per chart for each case we submit for screening and we can submit as many charts as we need at any time. That was particularly important to us since our primary area of interest was screening our soft-cases, such as chest pain, abdominal pain, and syncope, cases which are at higher risk for noncompliance and placement in the wrong setting," states Ms. Baillie.