Acentra Health’s Immediate Advocacy (IA) and Immediate Advocacy Discharge Assistance (IADA) Services

SUMMARY

As a contractor for Medicare, Acentra Health serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Acentra Health provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare.  

This episode is a conversation with our guests, David Miller, MHA, RN, Operations Director, and Natalie Palmer, BSN, RN, Clinical Review Manager, from Acentra Health. In this podcast, our guests will share information about our free Immediate Advocacy services that can assist with solving medical problems quickly and our IADA services that are available to Medicare beneficiaries that have filed a discharge appeal. 

For more information about Acentra Health BFCC-QIO, please visit www.acentraqio.com. 

KEY TOPICS                                                                                                                      

00:21: Overview, introduction of guests, David Miller and Natalie Palmer 

02:09: What is Immediate Advocacy and how does it work? 

03:37: Examples of Immediate Advocacy 

09:53: What is Immediate Advocacy Discharge Assistance? 

13:34: Differences between Immediate Advocacy and other Acentra Health review types 

15:23: Final thoughts 

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RESOURCES 

BFCC-QIO Information for stakeholders: www.acentraqio.com/partners 

BFCC-QIO Information for people who have Medicare: www.acentraqio.com/bene 

Acentra Health’s Immediate Advocacy Information - https://acentraqio.com/bene/advocacy.aspx 

Acentra Health’s Immediate Advocacy Discharge Assistance Information - https://acentraqio.com/providers/appeals.aspx 

Music: Motivational Upbeat Corporate by RinkevichMusic 

https://soundcloud.com/rinkevichmusic

https://protunes.net/  

Video Link: https://bit.ly/3NNqGTs 

Transcript

Welcome to Aging Health Matters, a podcast from Acentra Health, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today's show may help you or someone you know in their healthcare journey. Thanks for joining us. Now let's get started. 

Hello everybody and welcome to another edition of our podcast, Aging Health Matters. My name is Scott Fortin, and I'll be your host today. And a little bit about us as a BFCC-QIO, if you've not tuned into our podcasts in the past, we work on behalf of Medicare over a 29-state area.

There are two contractors that cover all states within the United States and the territories, and we have three key services for people that have Medicare. Appeals, so hospital discharge appeals, skilled service termination appeals, quality of care complaints, and Immediate Advocacy, which is today's topic.

So with me today, I have two of my colleagues that have actually been on here before. You'll hear a reminder from me later on to go back and listen to some of our previous podcasts on Immediate Advocacy. But we wanted to give an update on some of the work that we've been doing and put out a fresh podcast for people that have interest in this topic.

So, without further ado, David Miller and Natalie Palmer, are two folks that cover this topic for us. So, David and Natalie, would you tell the audience a little bit about yourself? And welcome. 

Thanks, Scott. Great to be here and always wonderful to be able to provide some information to the wonderful audience that we reach out to. I'm David, I'm a registered nurse by background and have been with the QIO for about eight years assisting with quality of care and Immediate Advocacy. 

Thanks, David. Natalie. 

Hi, I am Natalie. I am a nurse by background as well, and I am in my first year with Acentra Health but so excited to be here with the organization and talking with you all today.

Great. Thank you, Natalie. And we'll hear more from Natalie on some of her specialty, which is the IADA area later on. So glad to have both of you with us. So, to outline our time a little bit, let me just kind of mention some of the information that we have. And this is available on our website, acentraqio.com. To give you a sense of what Immediate Advocacy is, for those in the audience that may not be as familiar, it's a free service for people who have Medicare. It's used to quickly resolve problems, usually faster than the appeal or quality of care process. And this is something where the patient and the healthcare provider or the facility talk along with us through some of these issues.

We usually speak on the patient's behalf and hold a conference call or represent them with the provider as talking through this. As we talk a little bit through this process, it's usually something that's resolved, these complaints, in various settings as well as suppliers, right, David? Durable medical equipment is another one.

Absolutely. 

Okay. And then I know that this is intended to provide that quick answer. Just make sure that everybody's satisfied on all sides of this, and it just really kind of moves people through the process because the goal is to resolve it in less than two business days. Is that correct? 

That is correct. We try to get it done as quickly as we can. 

Okay, wonderful. Could either one of you or both of you provide some kind of examples for the audience of things that they might encounter that might be appropriate for Immediate Advocacy? 

I can chime in, Scott. You know, much as Scott had mentioned, this is a really fast, kind of a verbal conversation that we have between a Medicare beneficiary or the representatives and the provider community being hospitals, SNFs, LTACs, durable medical equipment companies, physician's offices, those type of things. And again, it is really just a conversation, kind of mediate a complaint or a concern and try to get it rectified as quickly as we possibly can. Most of the things that we will intervene on are not going to be something you're going to find in a medical record. 

It might be something like, I'm having difficulty getting a follow-up doctor's appointment. My doctor ordered a wheelchair, it's not been delivered or hospital bed, something along those lines. I have questions about my medications, and I'm really not getting good answers from my physician or my physician's office. Some high level things that we can really try to intervene on. And again, it is a very fast turnaround time, and we do engage with that provider community and involve the beneficiary or their representative as much as we possibly can. 

That's great, David. And I do know that there are some things, and we have guidance for those that are interested in the Show Notes. We will be providing a link to our website and to the web page where some of this is contained. But I know that, for example, on the website, we have a can and cannot list for things that can occur during the Immediate Advocacy process. And I know one of them, for example, on the cannot list is that we cannot require the provider to participate in the IA process or speak directly with the Medicare recipient or their family. Is that correct? 

That's correct. It's a completely voluntary process. The beneficiary or the representative of their family or their provider community can pretty much say no at any moment in time, and then we would just move it towards a quality of care complaint as much as we possibly could. One of the other no things too, Scott, since you kind of brought that up, is we cannot intervene on any type of a billing matter. If there's monetary or a question about a bill, that's really out of our purview, so it's not something we're able to assist. We can provide you some guidance as to who may be able to help, you know, maybe a state agency or Medicare itself that we can provide some resources in those things. 

Okay, great. And again, we will provide the link to that page in our Show Notes for the can and can nots, but thanks for giving us a little bit of a sense of some of the things that can and can't be accomplished. As we look at this, I'm always the kind of person who deals best in an example or a story. Do you guys have any sort of examples that you can provide to myself and the audience to kind of give us some sense of how this works a little better?

Sure, we actually have a really great example that just occurred very recently. We had a Medicare beneficiary, and actually it was the daughter of the Medicare beneficiary called Acentra Health, and had some concerns about the mother's discharge from the hospital. Basically, the mother was in there for a procedure and was being discharged to a rehabilitation center.

The daughter didn't know where she was going. The hospital was kind of driving this from the outside. And the daughter was not necessarily kept in the loop closely or as much as she had desired to be. So, she called Acentra Health to see can we kind of facilitate some communication on the discharge plans were with the mom and where she was going to be transferred to.

This team, on our Immediate Advocacy, are all clinicians. They are registered nurses, registered and licensed practical nurses as well as social workers. One of our representatives did listen to the daughter's complaint and concerns, and we ensured that she had filed a discharge appeal just to help kind of facilitate some time.

After we determined there was some concern about where the mom was going for rehab, our clinicians did reach out to the hospital and had a conversation with the case manager as to the discharge plan and do we have facilities that the beneficiary's representative, the daughter, can look at and maybe make some better choices?

What we ended up finding out was that there was only one facility that was able to accept the Medicare beneficiary due to her needs. They actually had just communicated that to the daughter, and the daughter was able to go visit that particular rehabilitation facility. When we kind of did a follow-up with the daughter, she did say she did have an opportunity to visit the facility that the mother was going to be discharged to, and she was really appreciative of Acentra Health kind of stepping in to the process in providing some guidance and clarity for her and having the hospital provide the information she needed.

So, it was a really, really great conversation. Again, this was done in probably about a day and a half until we played a little bit of phone tag with the hospital, but it was very quick, very beneficial to all involved. 

Well, that's great. And I, you know, David, I think that's one of the biggest things that our organization tries to do. And that is to be that party that brings people together to provide the information that's needed to resolve issues. And if I could put it into a capsule, that to me is what I think we do each day and especially one of the goals of the IA process. So, thanks for sharing that success story. 

Absolutely.

Anything else that either one of you want to talk about in general about IAs or would you like to talk a little bit more about the newer work, the Immediate Advocacy Discharge Assistance process? 

Really nothing else. The Immediate Advocacy process in itself is a great way to mitigate different concerns and get them hopefully some resolution quickly. I will actually turn it over to my colleague, Natalie, Scott. She can help me discuss some of the discharge assistance. 

Great. Thanks, David. 

Thanks, Scott. So, very similar to what David was talking about with the IA program, our Immediate Advocacy Discharge Assistance program is a little bit more scaled approach from a standpoint of we are working with traditional Medicare beneficiaries who are just in an acute care hospital, whether it's long-term acute care, acute rehab, or the hospital.

And so, what we are doing, if there are concerns with a discharge plan, and those patients or representatives have filed an appeal, then after they have filed their hospital appeal based upon concerns that they have about being ready to discharge from the hospital or just making sure that they have services available to start helping them once they get home. That caller has the option, which is strictly a voluntary approach.

If they would like to speak with one of our clinical staff to kind of talk through what their concerns are, it does not impact the appeal that they have placed regarding their discharge. But we again, similar to the Immediate Advocacy program, will act on their behalf and help try to reach out to the hospital discharge planning team to see if we can help facilitate further conversation and clarity regarding any of their concerns.

We can do that a variety of ways. It might be a three-way call with the patient or beneficiary's family on the phone. Or it might be that they want us to call the hospital on their behalf. Very similar to the traditional IA, again, we do not have access to the medical records. So, it is strictly a conversation that's being had between the parties involved to try to, like you and David said, we want to resolve or help provide any clarity that makes everybody more comfortable with the next step of the beneficiary's phase of care. 

By reaching out to the hospital providers, we're able to find out if services have been arranged, if there is an issue with not being able to get those services arranged and help guide the beneficiaries on what is the next step. Sometimes they might have a plan in place, but everything is just kind of new. It could be transportation. It could be making sure their equipment, whether it's oxygen, is going to be there prior to them leaving the hospital.

And sometimes it's just the family member that's been playing phone tag with the hospital. And it's us making that phone call to connect the two and figure out how to get everything clear for them right there, so that they are ready to move to the next level. After this IADA has been handled, then the beneficiary has the right to continue with their appeal, or they can elect to stop the appeal and proceed on with their next discharge that is scheduled and arranged for them.

We, again, are just wanting to make sure that the beneficiary and their family are clear on what is the next step when they leave the hospital. We have had a lot of the beneficiaries be very willing and very appreciative of our efforts in calling the hospital and helping them find information. It doesn't always change the outcome of them staying an additional day in the facility, but we are able to make sure that everybody has the clarity they need to feel comfortable when it's time to discharge.

That's great. Thanks, Natalie. There's a couple of things as we draw towards a close that I just wanted to make sure that our audience is aware of. I know whenever we talk about Immediate Advocacy, we always describe the differences between Immediate Advocacy and our other appeal types. And if I misspeak here, please, both of you, either one of you let me know.

But I think one of the biggest things when I look at Immediate Advocacy is the fact that there is no medical record involved, is that correct? 

That is correct. We are strictly going on the communication from the beneficiary and their representative and then reaching out to the other entity, whether it's a hospital provider, home health, DME company, whoever we need to reach out to at that point.

Great. Thank you. And just one more thing that I always like to put into all of our information about Immediate Advocacy, and that is that since it's a newer and less formal type of approach, especially without having a medical record, if there is anything that the Medicare recipient or their family ever wants to stop Immediate Advocacy and move to a different approach to addressing concerns, that's available to them, correct? And how do they go about that? 

That's available in both a straight Immediate Advocacy or even the discharge assistance planning. And really going about it, it's just verbally say, you know what, this is not necessarily working for me, or this is not going to provide the outcome I'm looking for or however they want to verbalize it. 

We can stop the process and offer a different avenue for them to pursue. 

That's great. Thanks for the clarification, David. I appreciate it. Is there anything else that either one of you would like to add as we kind of wrap up? 

Not for me, Scott. I really appreciate the opportunity to speak with and reach out to our community and help continue to look forward to partnering with the beneficiary, Medicare beneficiaries, and assisting with any concerns they may have.

Absolutely. Natalie. 

I, again, want to say thank you for having us today. I think making sure that beneficiaries, their representatives as well as even the providers understand that when we are reaching out on behalf of the beneficiaries, it is truly to be a helping hand, to get everybody involved and get a resolution to everyone's concerns as quick as possible. So, thanks, Scott. 

Absolutely, Natalie, I couldn't agree anymore with what you said, 100%. So, I thank you both for your time today. And if you've enjoyed this podcast, this is just a reminder that we have several podcasts that we've done previously where we've mentioned Immediate Advocacy that's available to you in past podcasts.

And we also, of course, would encourage you to sign up for future podcasts for various elements as well as looking at our newsletter to sign up for that. And especially checking our website for greater amount of information. We do have, as I mentioned in the Show Notes, we do have our website, acentraqio.com and some mentions there. We have some links for phone numbers of how to reach us and different ways to sign up. But I would just say, if you have any questions about Immediate Advocacy, you have many opportunities to look. You can look to the website, you can contact us directly, you can check on previous podcasts, but we're more than happy to provide this information to our audience.

And again, I thank our two guests today, and we look forward to our next podcast. Take care everyone.