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TIP: Ensure Advance Directive form compliance

Patient Access Weekly Advisor, May 7, 2008

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Advance Directive forms most often are presented by patient access staff members. But any lack of communication among access, nursing, and case management staff members can lead to unnecessary confusion and headaches come compliance checks.

Mandatory requirements from CMS, including the Fair Patient Billing Act, are on the minds of access managers lately. The goal is to comply and present Advance Directive forms in the most patient-friendly, transparent way.

Tracy Walsh, LCSW, director of patient access and case management at Vail (CO) Valley Medical Center, says the most important part of handling the Advanced Directive form is ensuring that multiple entities are involved.

When she was the director of patient registration at Tahoe Forest Hospital in Truckee, CA, Walsh says, there were trigger points for different departments to become involved in the process-all the way from the beginning when the facility concocted the form. "All the different entities had to get together and agree on it," Walsh says.

It all began in patient access, which would establish with the patient what the form means.

"A lot of times people didn't know what it was," Walsh says. "We were making it simplistic enough for a registrar to explain it. That was the difficult part. You map out your process, then you try to find something that carries over to the other entities. You try to develop a simple one-page document that is easy for anyone to pick up and know their responsibilities."

After the form left access, it would trigger the ward clerk to get it from medical records. Then a social worker was contacted if necessary. And then comes case management.

"Case management needed a trigger because they review 100% of cases anyway," Walsh says. "They needed to know if there was something they needed to do."

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