Clinical Information

[Guest guest]

Hi ,

I would like to pose this to the group. Any one that cares to share with me how they work in conjunction with the nurse coordinators to obtain medical information, especially when there are unusual circumstances, or clinical questions from the insurance companies. I am not a clinician and we have a Renal and Liver program. I have more difficulty with the liver coordinators in getting assistance, which I ask for rarely. I have been here since July, and am the first official TFC this center has had. Previously a medical secretary learned the job when the program first started. They tell me "I" should "find" the information, and "learn" the terminology.

Sorry, I don't feel comfortable taking on that responsibility in all cases, I'm certainly not paid as a clinician and the director of TX who hired me, specifically stated that I would not be expected to understand and/or answer medical questions. [Aguiar, (Surgery)] I have to disagree w/this comment-if we, as a community, expect that RN case mgrs & Medical Directors should understand all the many nuances of tx, then we also need to be able to 'talk the talk', as one case mgr said to me once.

Having said that, your coordinators are out of line in their response to your request for help learning how to talk the talk (in my opinion anyway). As much as they might not wish to admit it, they were not born w/the knowledge the have now re: tx, nor, I suspect, did they gain much of it in nursing school-they learned on the job & by asking, I'm sure, numerous 'dumb questions'-heaven knows I've asked my share ( & then some!) in the 13+ yrs I've been doing this, as many of my coordinators can attest to!! Bottom line is the more YOU know, the less THEY will have to interact w/insurance companies & case mgrs, right? (Unless they actually like doing that?) I have always felt that a big part of my job is to keep the case mgrs away from my coordinators & /or, heaven forbid, one of my MD's-they have enough to do w/o having to deal w/repeated requests for colonoscopies or dental exams (anyone want to guess which company just called me?). Furthermore, I think it is this level of knowledge that, quite frankly, sets the TFC apart from the person in Admitting who just verifies ins coverage.

I think the TFC does need to have a good understanding of the tx process in gen'l & their own program specifically just as you need to be able to convey the gen'l process of what it is we do to your team along w/the specifics of the company you're dealing with @ the time.

W/re: to your question about how I interact w/my staff here re: clinical information, etc-I gather what is needed, either thru the electronic medical record we use here or from the paper chart for any testing that might have been done on the outside, depending on the ins involved, go thru it to make sure there are no red flags (especially in the MSW note) or pieces that didn't get done (such as getting a stress test or ID consult) & then send it off. If the MSW note in particular has information in it I don't think the ins company needs to know (especially w/re: to things that might have happened in childhood), then I will insist the MSW re-write a generic 'cleared for tx' note I can use just for this purpose. If I come up against something I don't understand or that just looks odd to me, I ask another of my patented stupid questions :-)

Probably not the answer you were looking for , but that's how I see it :-)

J. Aguiar

Beth Israel Deaconess, Boston