SGH CM Weekly Update

"People don't care how much you know until you show them that you care."

-Theodore Roosevelt

Through service excellence, we create meaningful and positively memorable experiences.

• I acknowledge everyone with care, compassion and empathy.
• I stay connected and engaged with those I serve.
• I promote peace of mind and relieve anxiety by explaining what we are doing and why.
• I keep team members, patients and family members informed about the process and expected time frames.
• I take action to prevent delays and proactively notify those impacted when delays are known in advance.
• I go above and beyond to provide the best Sharp Experience for everyone.

Please join me in welcoming three new team members!

Laila Parwani

Lauree Whitcomb

Dovie Almadres

We hope you enjoy your experience with us at Sharp Grossmont Case Management!

Congrats team!!!! For the 2nd quarter in a row, the clinical support teams throughout the hospital have ranked you as top team players and advocates for our patients! And, we moved up two levels from Gold to Diamond winners! I am so proud of all of you! Pat yourselves on the back because you deserve it!

Sharp Case Management Team,

Sharp Home Health has suspended accepting new patients in Jacumba, zip code 91934 due to several employee safety factors. The updated service area zip code list with Jacumba removed is attached. We are working now with the Sharp Security team to assess these safety issues to determine if they can be mitigated in the future. While we are completing this assessment please feel free to contact Sharp Home Health Intake team to assist with finding alternative care at 858-541-4805.

Joshua McCabe MSN, RN, NE-BC

Director, Sharp Home Health

Download the newly updated Zip Code list to see the areas covered by Sharp Home Health

From: Joshua McCabe MSN, RN, CEN, NE-BC, Director, Sharp Home Health

December 6, 2019

Re: Immediate Acceptance for SCMG and SRS patients

Sharp Home Health is pleased to announce that effective immediately we will be giving an automatic ‘YES’ reply in Ensocare for Sharp Rees-Stealy and Sharp Community Medical Group patients.

Previously, a reply of ‘Considering’ was provided. Then within 2 hours this was changed to either a ‘Yes’, or ‘No’. The Case Management teams reported that this process caused delay and additional work. Sharp Home Health will continue to communicate with the Case Manager if there are any concerns or questions regarding a patient or if the patient later declines home health services.

We will continue to listen to the feedback from our Case Management teams to improve our service and assure our patients continue to receive the Sharp Experience for any Home Health needs.

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** For SCMG patients, if you received any response other than a "YES" from Sharp Home Health, please let me know. This pertains only to patients who meet home health requirements.

• Completion of all documentation (check boxes & narrative) for comprehensive discharge and readiness of all stroke patients
• Ensure list of homeless patients given to charge RN daily. Please inform them when there are none as well
• Check off as complete all referrals when done, especially those related to assessment for suicidal ideation
• As there are several ongoing committees and weekly phone calls, PLEASE inform leads/director with any issues related to Molina, SCMG or any SNF not accepting return of patient

• Please make sure that SNF intake forms are filled out COMPLETELY, before sending the SNF referral
• For any Medi-Cal type patient (presumptive, pending, managed plan, etc) that you receive a request for SNF referral, please check with your case manager whether patient should be on the Call-List
• Our beloved ED Director (aka: Marguerite) needs assistance while our beloved ex-CRC (aka: Blair) is on leave. Brittanie has graciously accepted to assist Marguerite in Blair's absence. Thank you Brittanie!

Thank you for 15 years of dedication to Sharp Healthcare! We are honored that you are a part of our team!

Molina updates:

• No initial or concurrent reviews needed from UR The process for the OEMR includes a call to the UR reviewer to discuss the case prior to the issuance of a denial. (This is an expectation as a Role & Responsibility)
• Patient EMR will not be made visible to the Molina reviewer until 12 hours after the patient has been bedded.
• Molina does not include ARU or Distinct Part in the OEMR process at the present time. Therefore, the process remains unchanged.
• A clinical review is not necessary for Molina to provide SNF authorization. (If this happens please escalate the example)
• Patient EMR will not be made visible to the Molina reviewer until 12 hours after the patient has been bedded.

Molina's Emergency Department Support Unit (EDSU) is not just for our emergency department staff. The EDSU is a dedicated team, available 24 hours a day, seven days a week (weekends and holidays included) to provide support the hospital to ensure our that all Molina members receive the right care, at the right time, at the right place.

Phone: (844) 9Molina or (844) 966-5462

Fax: 877-Molina5 or 877-655-4625

•Assisting in determining appropriate level of placement using Nationally recognized, evidenced based criteria for medical necessity.

•Issuing authorizations necessary for admission, transportation, or discharge needs.

•Involving a Hospitalist or On-Call Medical Director for any Peer to Peer reviews needed.

•Transferring of members who are deemed stable to facilities within the Molina provider network.

•Work with pharmacy to establish any home infusion services needed.

•Obtain SNF placement if clinically indicated.

•Early identification and referrals of members with complex medical and behavioral health conditions into Case Management with Molina Healthcare when appropriate.

•Begin the process of discharge planning and follow-up appointments with a primary care provider if indicated.

SNF Intake Form

The updated SNF Intake Form on SharpNet is the only form we should be using as the SNF Intake Form. You can download the form from the link below, or go SharpNet and go to "C" in the A-Z Director, and choose Case Management. The form is located under "Forms and Letters"

Correct contact numbers from Annie @ United Healthcare

• UHC Medi-Cal Patients: Donna Howser at 866-301-8283
• UHC patients (all others): 877-842-3210, weekends included

(Thank you Maryann for passing along this info!)

Sharp Home Infusion Services (SHIS)

• Weekend pharmacist: Sarah Michael, 619-782-2213
• Ok to leave voice mail with your name and number if she does not answer right away as she may be assisting other patients
• SHIS answering service 800-627-5600 can also assist in connecting you with pharmacist or nurse if you do not hear back from weekend pharmacist
• On weekends/holidays, please call SHIS at 800-627-5600 for confirmation of patient's discharge to avoid miscommunication in SHIS start of service time

Documentation

• Completion of all documentation (check boxes & narrative) for comprehensive discharge and readiness of all stroke patients