A male worker was referred to Paradigm with acute-status post-urinary tract cancer, intra-abdominal fluid collection, bacteremia, mechanical ventilation and ilieus. We took on his case to manage his long-term care hospital course and other potential post-acute care services.
Our interdisciplinary clinical review team did an extensive health history including oncology, internal medicine, infectious disease and surgery services with active treatment underway prior to referral. We reviewed projected unbundled chargemaster scenarios for a long-term acute care (LTC) hospital, as well LTC-Diagnosis Related Group (DRG) payment comparables under the Centers for Medicare and Medicaid Services (CMS). To be comprehensive, we also consulted our own database of allowances for other providers locally and nationally to ensure our plan created the best care and the best value.
We proposed, and the provider accepted, an all-inclusive day rate with a minimum savings guarantee (from total provider billed charges). We worked with the long-term acute care hospital in New Jersey to develop the care plan, which included extensive infectious disease I.V. antibiotic treatment and respiratory therapy services.
This prospective referral achieved 59% below the jurisdiction’s workers compensation usual & customary allowed charges totaling $5,860/day.
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