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17

Eliminating Scheduling NON-DHS Patients to DHS Outpatient Facilities

Advocacy Plan

Harbor-UCLA Medical Center Improving Patient-Centered Care

By Eliminating Scheduling NON-DHS Patients to DHS Outpatient Facilities

Nicole R. Codd

Mount Saint Mary University

July 16, 2017

The Problem

Harbor-UCLA hospital emergency staff is not efficiently identifying NON-DHS managed care patients and continues to schedule appointments that negatively effects patient-centered care and contributes to lost revenue for the medical center. When a patient arrives at the emergency room, a nurse performs the intake, and an ED registration staff obtains patients information to determine medical coverage to cover the ER visit. It is important to identify the medical coverage accurately and correctly because ED providers always advise a follow-up appointment after an Emergency Room visit.

The Emergency Department staff create appointments for NON-DHS managed patients that fill appointments that should be filled with DHS-managed care patients. When an NON-DHS managed care patient receive medical services at Harbor-UCLA Medical Center, the hospital does not receive any payment. NON-DHS managed care patients have primary care providers that receive capitation payments every month for medical services. Harbor-UCLA Medical Center are treating NON-DHS patients for free when they arrive at Harbor-UCLA outpatient clinic. At times, outpatient staff can recognize the error and redirect the patient to their primary care provider, which the patient can become irritated that leads to poor patient care. Harbor-UCLA Medical Center have at least 2% of NON-DHS managed care, self-pay and out-of-county that have appointments to outpatient clinics.

Harbor-UCLA Medical Center’s emergency department have over 7,136 visits per month with patients that have all different types of health insurance (DHS-Office of Planning; DHS Housing for Health). The emergency department accepts all insurances. However, Harbor-UCLA emergency department should only schedule follow-up appointments for DHS-managed care patients to improve patient-centered care and increase revenue.

Current Policy and Procedures for NON-DHS PATIENTS

The Emergency department have several policies in placed to avoid scheduling NON-DHS patients’ appointments to outpatient clients:

1. During registration, the Registration staff inputs NON-DHS primary care provider (PCP) information into the patient’s accounts and the information is available for Emergency department staff such as the doctors, nurses and clerks.