Submitted by Shelby Donahoo, Bandera Therapy Resource, Tucson, AZ
The La Canada IDT team in Tucson, Arizona, presented on the Big Therapy Call in October at their ABCDE meeting.
The last thing they wanted was another meeting! They’d been having errors impacting operations-managed care contract criteria, payer tree errors, and lack of PASSR accuracy, and it was costly. With most of their case mix being managed care (like most of Arizona), these issues were becoming true frustrations. Each team member was doing their part, but they were doing it in a silo, and there were too many moving parts to do this effectively.
The La Canada team identified meeting criteria and assigned roles. They created a tracking sheet to use each day. They set an assigned time to meet daily and took on an attitude of “no blame.” If they found errors, they corrected them as a team early on and moved on.
Here’s how La Canada divided up tasks:
● Admissions: Managed care criteria, days verified, external facility contracts (VA, Optum), verifying correct MD per managed care payer, health knowledge of NTAs to translate to daily rate knowledge and profitable admissions
● Business Office: Authorizations, admissions notifications to insurance and secondary insurance, verification of payer tree; levels opportunities, tracking days remaining to prevent benefit exhaust.
● Case Manager: PASSR, NOMNC: D/C planning
● DOR: Open contracts during meeting and review for carve-outs, UHC Bari rates, identifying ALTCS (Arizona Long Term Care) candidates, D/C planning
● ED: Assist the team as needed!
They meet daily right after clinicals. The Daily Technical Meeting is now divided into clinical and operations pieces. They review admissions from the day before. Mondays are longer, but efficiency has improved, and most days, it’s a 15-minute meeting.
This process improved teamwork, ownership, and accountability through “everyone on the same page.” Feel free to reach out to La Canada for questions!
Pictured (L-R): Cynthia Runk, BOM; Amelia Gabuski, SS; Donovan Pla, ED; Annie Combs, Therapy Leader; Morgan Curlee, Case Manager; Jamie Jackson, ABOM