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Care Coordination Models

In our previous blog, I discussed how LTACHs have been slow to improve care coordination and reduce re-admissions. I said that only aggressive action towards in-house care coordination could ensure the long-term survival of your business while significantly improving outcomes for your patients.

But what, really, is care coordination? And how do you achieve it? What are care coordination models?

The term is used frequently, but very few can offer a clear definition, or describe discrete steps to accomplish it. Without a clear understanding of the term, it runs the risk of becoming just another meaningless buzzword.

Coordinated Care Explained

The official definition of care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshaling of personnel and other resources needed to carry out all required patient care activities and is often managed by the exchange of information among participants responsible for different aspects of care.

Translation: coordinated care is really just a fancy term for improved communication.

So what is coordinated care explained? The key to coordinated care is improved communication across the care continuum. When caregivers at different points of care have access to detailed, complete documentation, they are able to make more effective clinical decisions. On the other end of the spectrum, this detailed documentation then has positive impacts on reimbursement processes, reducing AR days and increasing overall revenue.

The business team – coders and billers – must be able to provide feedback if documentation is missing or incomplete. When they are dealing with a stack of paper forms with multiple serious errors – or, worse, a stack of paper forms with only one serious error – they then must trace down the clinician to have them correct the error(s). This may involve a series of emails, scans, faxes, or phone calls, each of which take significant amounts of time. And then the claim gets denied by Medicare. Lather, rinse, repeat.

This feedback loop shrinks dramatically when coders, billers, and practitioners all fully understand guidelines, processes, and procedures.