How Kepro’s Free Immediate Advocacy Services Help People Who Have Medicare

SUMMARY
As a contractor for Medicare, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Kepro 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. 

In Episode 3, host Scott Fortin, Senior Director, Communications and Outreach at Kepro, is joined by Kim McDonald, Clinical Review Supervisor. If you want to learn more about Immediate Advocacy, a free service for people who have Medicare, you should give a listen to this episode. Scott and Kim talk about what Immediate Advocacy is and give several examples of when to call Kepro and ask for Immediate Advocacy.

For more information about Kepro BFCC-QIO, please visit www.keproqio.com.

KEY TOPICS
00:28: Overview, introduction
01:40 What is Immediate Advocacy? How can it help people who have Medicare?
08:40 Examples of when to call Kepro about Immediate Advocacy
15:50 Resources

SUBSCRIBE
Subscribe to our newsletters: Case Review Connections, On the Healthcare Front

RESOURCES
Immediate Advocacy: www.keproqio.com/ImmediateAdvocacy
Information for stakeholders: Working with Our Partners and Stakeholders

Music: Motivational Upbeat Corporate by RinkevichMusic
https://soundcloud.com/rinkevichmusic
Video Link: https://youtu.be/U78mgVaM12M

Transcript

Welcome to Aging Health Matters, a podcast from Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. The 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.

Scott Fortin
Welcome everyone to another edition of our Aging Health Matters Podcast. I'm Scott Fortin, Senior Director of Communications and Outreach for Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization.

Hopefully you've had a chance to listen to some of our previous podcasts, but if you haven't, I'm going to give you a quick update about us and what we do. We represent Medicare beneficiaries in 29 states throughout the United States and the territories. We have three different services that we talk with people about and that is appeals, that is hospital discharge appeals, skilled service termination appeals, quality of care complaints, and Immediate Advocacy services. In some previous podcasts, we have talked about Immediate Advocacy services, but today I'm very pleased to say that that's going to be the focus of today's podcast. And I have the pleasure of having one of our supervisors in the customer service area, and that's Kim McDonald along with me today. I'm very excited to have you with us Kim, welcome.

Kim McDonald
Thank you, Scott. Thank you very much.

Scott Fortin
Kim, could you tell folks a little bit about yourself, how long you have been doing this kind of work at Kepro  and a little bit about the IA process that you and your team do each day?

Kim McDonald
Yes. Well, again, I'm Kim McDonald, one of the Clinical Review Supervisors, and I'm with the Immediate Advocacy department. And I've been with Kepro since about 2014, and with my background, I've worked in certain areas such as community mental health, substance abuse, HIV, AIDS arena as well as home health settings. With regards to the Immediate Advocacy process, we have clinical reviewers that work with Medicare beneficiaries and their families on a daily basis, trying to listen to the concerns that are brought forth within the call, and we try to see how best we can address the concern. 

So the great thing about Immediate Advocacy is that our team works to resolve the concern in a very quick fashion. We try to address the provider with the beneficiary or the family member’s permission, to try to get connected to the provider to have a discussion about the concerns that have been relayed to us and to see how best the issue can be addressed in real time, so not necessarily having to wait weeks or months. We are trying to address the issue right then and there so that we can get hopefully some resolution in a quick manner and have some satisfaction for all that are involved. So it's a very, very quick process. It is not something that takes a lengthy period of time to address, and the goal is to really  have a resolution within about four calendar days. That's the goal.

Scott Fortin
That's great, Kim. And one of the things that we've discussed relating to Immediate Advocacy and I've always talked about it as the term immediate as you just said. I think one of the biggest things that we want people to understand about this is that it can help people to quickly resolve that concern, that complaint, that gap, if you will, in areas such as medical care services, even things such as durable health equipment in various healthcare settings; this really kind of cuts across the various settings, and it really helps people to get those questions answered quickly without the need for medical records to be involved and without, as you stated, to have longer processes and conversations to occur. So really it is that goal to resolve that in a couple of business days within a 48-hour period. So Kim, can you maybe tell us a couple of examples just simple examples that people could understand that talks about some of the concerns you've seen or something along those lines?

Kim McDonald
Absolutely. Concerns can range from a patient feeling as though they're not getting good solid communication from their provider. Maybe they're in the hospital, and there's just really a lack of communication regarding their discharge plan. Maybe there is an issue you had brought up with durable medical equipment, someone is getting ready to go home, and there was an order for wheelchair, but they hadn't received it, and they're back home. You know, we can take some time to reach out and see what steps we can take to address that particular concern. There could also be an issue that a patient has where they were experiencing difficulties with scheduling a follow-up appointment to be seen, and the patient requires a prescription refill. So those are just some of those gaps. Some of those concerns that our team hears that we try to get working on rather quickly to address and resolve for the patient or the Medicare beneficiary, and it goes from acute settings, hospitals, or concerns relating to care in a skilled nursing facility or home with home health or provider’s office, doctor’s office. So, we get the gamut as far as concerns.

Scott Fortin
OK, great. And I know you know some of the other ones that Kim and I have talked about in the past and Kim and her team, each day deal with various aspects of the healthcare gap, as I always refer to it as, and that is things such as not getting questions answered by a nurse. So then they turn to us in that process or not receiving that piece of equipment that they really need because a lot of these issues happen, correct me if I'm wrong Kim, on discharge many times or somebody’s just getting settled back into their home or a different level of care where they haven't necessarily received what they've needed. I know that you mentioned a prescription refill. They haven't been able to get that or they may not have gotten some of the things they need to function, and that is really our true purpose. When it comes to Immediate Advocacy is to help the person get over that hill, if you will, to talk about these things with someone, to talk about these concerns that they have and sort of put their mind at ease a little bit. Would that be a correct assumption, Kim?

Kim McDonald
Absolutely and not only from the standpoint of the Medicare beneficiary, but the provider as well, we often time hear that they are not familiar, they were never informed that this was a concern, and they are very glad that our team members contact them to make them aware of the issues, so that they can be quickly addressed and resolved. So the providers as well, they truly appreciate our contacting them too.

Scott Fortin
Great. And now Kim and I both have mentioned her team. So what are these folks referred to as? What are your team members called each day, Kim?

Kim McDonald
Yes, they are clinical reviewers, so it's a team mixed with nurses as well as social workers, but they are clinical reviewers.

Scott Fortin
Great. So as you can tell from Kim's description, these are folks that have various backgrounds depending upon the need of the person that's going to have the immediate concern that they need taken care of. Whether you need someone to help recognize some of these social elements, to get these things taken care of or if you need a nurse for something clinical, both of those type of elements can be taken care of through this process. Correct. Kim?

Kim McDonald
That's correct.

Scott Fortin
OK, wonderful. And Kim, do you have any stories or examples that you can provide, you know, a little bit more for our audience to give them some sort of sense of what you see each day is working through, and how some of these services have helped people?

Kim McDonald
Oh, sure. We did have one family member of a beneficiary that called into Kepro to discuss concerns with lack of communication by hospital staff regarding the Medicare beneficiary being transferred to a different hospital. That was their request. There was also a lack of communication as to the reason why the beneficiary was losing so much blood. And they had not been receiving any updates regarding having an oncology consult.

And so after the Immediate Advocacy was agreed upon by the family member, or we call the beneficiary representative, the hospital case manager had been reached to discuss these concerns further by our clinical reviewer. And then as a result of the Immediate Advocacy or IA, a care plan meeting was arranged with the family and the beneficiary, and the oncologist was given the contact information of the family member, and the beneficiary was able to be transferred to a different hospital per their family member’s request; the family member was so grateful for Kepro’s assistance and had called back to speak with me about the efforts of the clinical reviewer. The family member stated that our clinical reviewer in quotes was magnificent and a life saver, and they stated what they had attempted to do in 10 days was done within a couple of hours by the clinical reviewer, and they were very, very grateful for the outreach efforts. So that was a good success story that we had.

Scott Fortin
Wonderful. That's amazing. And you know, that's one of the things that being in health care that we all realize, and that is many decisions that are made whether it's a discharge from a hospital to what we consider a lower level of care in a nursing home setting to rehab or to home health services; there's many times that a discharge, for example, will occur very quickly. I mean extremely rapidly in this process and let's pick a day. So today we're happening to record this on a Monday. If you have a loved one in the hospital or if you're in the hospital yourself, you may find out later today that you're being released tomorrow, or even at the end of the day today. So sometimes if a person is going to utilize other post-acute type of skilled services, many times those are something that the family can go to a nursing home, for example, or check out a home health agency. But many times, they are going to just be going off of the recommendations of the hospital case manager or even in a long-term care setting, the nursing home Social Services Director. So in those particular cases, Kim, I think that's another one maybe to point out that there's a concern sometimes on a family's aspect about the safety of that discharge or not being able to go out and tour a particular facility. Getting that time to put into actually feel at ease with that decision. Is that something that you all can help with on a daily basis as well?

Kim McDonald
Oh, absolutely. Yes, we can certainly bring forth that particular concern, and we hear that often, family members not having the opportunity to really go through the list exhaustively to figure out which one  facility that they're wanting to have their loved one in. And so we can certainly make the provider aware of that concern and see what other steps can be taken. It is time sensitive, of course, with regards to the discharge planning, but we can certainly make a call and express that to the provider and see what else can be done to assist the family. We want to make sure that they are as knowledgeable as possible with regards to the discharge and as comfortable as possible with all the decisions that are going to be made and so absolutely we can certainly make a call on that.

Scott Fortin
OK. That's great. Good to know. And one of the things we've talked about a little bit previously is Kepro's ability to do a discharge appeal, and one element that I wanted to bring out about Immediate Advocacy is just what Kim and I discussed, and that is the fact that a discharge appeal, which in the case of some of these families, they've already filed a discharge appeal trying to hold off on that appeal, to try to move ahead with a selection process for their loved one; the challenge here sometimes, obviously, is getting medical records and making a determination. Sometimes those appeals can be moved into Immediate Advocacy in order to further that, especially when the hospital is wanting to look further, to try and move someone out a little bit quicker to get them to that rehab facility to start that rehab. Is that a fair assessment as well, Kim?

Kim McDonald
Yes, with the appeals department, they will take a look, just as you stated, with the medical records and make a determination if the discharge is appropriate at that time. But while that appeal is in place, we are also going to address any other concerns that the family may have. Again, maybe there's still an issue with communication. Maybe there was an issue with regards to their stay that just hadn't been addressed. relating to their medications and so forth, we're going to take a look at those other pieces that the appeals department may not speak to necessarily, so that we can as a company fully address that family’s concerns all around.

Scott Fortin
Absolutely. And I always talk about gaps in the healthcare system. That is something that allows us to make sure that those gaps are taken care of, that a person doesn't have to wait and be nervous in their determination of the appeal to discharge. That way, we can get to someone quickly; we can help them with the resolution. So that's one aspect that I wanted to point out specifically about Immediate Advocacy and how it can partner with the discharge appeal, things that we've been doing for years, but with Immediate Advocacy being a newer process for the quality improvement organizations handling. It's something that we can do that ensures that folks are covered throughout the entire process.

Kim, this has been great information. Is there anything that you'd like to add for the sake of our audience or ways that they can find out more about Immediate Advocacy?

Kim McDonald
Yes, absolutely. I want to make sure that everyone is aware of our website. Please go to keproqio.com and under the information for people who have Medicare and their families, make sure to select Immediate Advocacy, and then they'll be able to see our page from there.

Scott Fortin
That's great information, Kim. And while we're talking about the website, I will also mention that we have many elements that will help both the Medicare beneficiary and their families. That is things such as our beneficiary newsletter. We have a YouTube channel. We have other elements of the website that explain the appeal process, quality of care concerns. All of these things, including our phone numbers, can all be found on the same website that was just mentioned by Kim, and that is keproqio.com, keproqio.com.

Scott Fortin
And you know Kim, I really have appreciated your time visiting with us here today. Any parting words for anyone before we sign off for the Immediate Advocacy part of our podcast.

Kim McDonald
I appreciate you having me, Scott on the podcast, and I just encourage those who are needing assistance, Medicare beneficiaries or their family members, representatives that are needing any assistance regarding clinical care and services, please, please do contact us.

Scott Fortin
Alright. Thank you, Kim and I would urge anyone who needs any assistance with Immediate Advocacy services to contact Kim and her team. They're a wonderful group of individuals, very understanding, caring people that can help you to determine your way navigating the system and taking the best care of your health that you can.

With this portion, I always talk about our upcoming podcasts and some of our previous. I would ask if you haven't listened to some of our previous podcast that you go back, and it'll give you a better sense of our discharge appeals and the various elements that Kepro does as well as outreach.

In our upcoming podcasts, we will be visiting with some of our stakeholders, and if you've listened to our podcast with our outreach person, Kia Weaver, you'll note that Kia and I defined what a stakeholder is and will take you through some of those folks as we talk about our partnerships, how we get information out into the environment, and also help those stakeholders to sort of copromote what they do.

So I would urge you to keep looking for some of our upcoming podcasts and again to visit our website if you have any questions or want to find out any additional information about our organization; that is keproqio.com. Thanks, Kim. You've been a wonderful guest. Really appreciate you being with us here today.

Kim McDonald
Thank you so much, Scott.

Scott Fortin
Alright. And we want to wish everyone a great day and hope to give you some information in an upcoming podcast that you can use to better your health. Everyone have a great day. Take care.