Veterans Health Administration Referral Coordination Initiative ...

Department of Veterans Affairs

Veterans Health Administration

Referral Coordination Initiative

Implementation Guidebook

Updated: March 10, 2021

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Table of Contents

1

Executive Summary ..................................................................................................................... 8

Referral Coordination Initiative Objective ............................................................................................. 8

Purpose of Referral Coordination Initiative Guidebook ........................................................................ 9

Future Updates to Referral Coordination Initiative Guidebook ............................................................. 9

2

Referral Coordination Initiative Introduction ........................................................................... 10

What is Changing and Why? ............................................................................................................. 10

Future State ...................................................................................................................................... 11

Team Composition ..................................................................................................................... 12

VAMCs with Limited or No On-site Specialty Care ............................................................................ 12

Ideal Process for VAMCs with Limited or No On-site Specialty Care .......................................... 13

What This Means for Veterans ................................................................................................... 13

What This Means for Staff .......................................................................................................... 14

Support.............................................................................................................................................. 14

3

Roles and Responsibilities of RCI ............................................................................................ 15

Executive Sponsors and Facility/VISN Leadership Support ............................................................... 15

Facility Executive Sponsors and Leadership .............................................................................. 15

VISN Executive Sponsors and Leadership ................................................................................. 16

RCT Oversight................................................................................................................................... 16

RCI Champions ................................................................................................................................. 17

Facility Champion ....................................................................................................................... 17

VISN Champion.......................................................................................................................... 17

Clinicians Related to the Referral Coordination Process .................................................................... 18

Referring Provider ...................................................................................................................... 18

Facility Clinical Specialty Care Service ....................................................................................... 18

Referral Coordination Team .............................................................................................................. 19

Minimal RCT Composition .......................................................................................................... 19

Clinical RCT Staff ....................................................................................................................... 19

Administrative RCT Staff ............................................................................................................ 20

Supplemental Role and Responsibilities Materials ............................................................................ 21

4

How to Get Started ..................................................................................................................... 22

RCI Implementation Checklist ........................................................................................................... 22

Develop the RCI Implementation Team ............................................................................................. 23

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Select Implementation Team Members ...................................................................................... 23

Develop Implementation Plan ..................................................................................................... 23

Monitor and Communicate ......................................................................................................... 23

Conduct Workload Analysis ............................................................................................................... 24

Workload Analysis ...................................................................................................................... 24

Prioritize RCT Implementation by Service Line/Specialty .................................................................. 24

Update CPRS Consult Menu ...................................................................................................... 25

Staffing, Reallocation of Resources, and Productivity Goals.............................................................. 26

Clinical Triage Recommendation ................................................................................................ 26

Scheduling Recommendation ..................................................................................................... 27

Staffing Structure Consideration ................................................................................................. 27

Alignment / Supervision of the RCT ............................................................................................ 27

Identify Optimal RCT Model............................................................................................................... 28

Centralized RCT Model .............................................................................................................. 28

Service Line/Specialty RCT Model ............................................................................................. 29

Form Referral Coordination Team ..................................................................................................... 29

Required RCT Tools: Consult Toolbox (CTB) and Consult Tracking Management (CTM/CTM+) 30

Local Facilitation of RCT Training ............................................................................................... 31

RCT Prerequisites: ¡°Getting to know your Specialties¡± Prior to RCT Go-Live ............................. 31

Socialize and Educate Facilities ........................................................................................................ 33

How to Get Started Supplemental Materials ...................................................................................... 33

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Optimizing Referrals .................................................................................................................. 34

Consult Directive 1232 ...................................................................................................................... 34

Developing Care Coordination/Service Agreements .......................................................................... 34

What Makes a Good Consult? ........................................................................................................... 35

Referring Perspective ................................................................................................................. 35

Example Consults ...................................................................................................................... 36

Update Consult Menu ........................................................................................................................ 37

Optimizing Referrals Supplemental Material ...................................................................................... 38

6

VISN Referral Coordination ....................................................................................................... 39

VISN Referral Coordination Program ................................................................................................. 39

VISN Oversight and Offering Limited Specialty Care Support ............................................................ 39

How to Put Together VISN Menu of Services ............................................................................. 40

How to Use VISN Resources...................................................................................................... 40

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How to Hand-off Referrals (IFCs) Between Facilities .................................................................. 41

VISN RCT ......................................................................................................................................... 41

Strong Practice/Brief History VISN Care Routing/Referral Coordination ............................................ 42

VISN Referral Coordination Roles and Responsibilities .............................................................. 43

How to Get Started ............................................................................................................................ 44

Assess Need ¨C What Makes Sense at VISN and What Can Stay Local ..................................... 44

Identify Key Stakeholders ........................................................................................................... 44

Complete Current State Assessment .......................................................................................... 44

Develop Business Case ............................................................................................................. 45

Develop and Plan .............................................................................................................................. 45

Identify VISN Leadership Team .................................................................................................. 45

Identify VISN Steering Committee or Overseeing Body .............................................................. 45

Identify Individual Workgroups.................................................................................................... 45

Workgroups ....................................................................................................................................... 46

Pre-Work .................................................................................................................................... 46

Develop Performance Monitoring Plan in Line with RCI Expectations ............................................... 47

Implement and Monitor ...................................................................................................................... 48

Monitor and Improve.......................................................................................................................... 49

VISN Referral Coordination Supplemental Materials ......................................................................... 49

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RCT Operations .......................................................................................................................... 50

Receive/Review Consult/Referral ...................................................................................................... 50

Clinical Triage.................................................................................................................................... 50

Overview .................................................................................................................................... 50

Medical Record Review .............................................................................................................. 51

High Risk and Complex Veteran Considerations ........................................................................ 51

Eligibility ..................................................................................................................................... 52

Tools to Use (Required and Optional) ........................................................................................ 52

Documentation ........................................................................................................................... 52

#RCT# ........................................................................................................................................ 53

Clinical Triage Tool ..................................................................................................................... 54

Contact Veteran ................................................................................................................................ 55

Determining Who Should Contact the Veteran ........................................................................... 56

Solutions for Transportation........................................................................................................ 56

Coordinate/Schedule ......................................................................................................................... 58

RCT Promising Practices .................................................................................................................. 59

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RCT Operations Supplemental Material ............................................................................................ 59

8

Scripts for Discussing Care Options ........................................................................................ 60

Referring Provider Scripting............................................................................................................... 60

Veteran Has No Specific Questions............................................................................................ 60

Veteran Requests Community Care Referral Based on Eligibility ............................................... 60

Veteran Requests Community Care Referral Based on Best Medical Interest ............................ 60

Referral Coordination Team: Administrative and Clinical Scripting Framework .................................. 61

Referral Coordination Team: Administrative and Clinical Scripting .................................................... 61

Administrative RCT or Staff with Scheduling Keys ¨C Veteran Engagement ................................ 61

Clinical RCT or Administrative RCT Do Not Have Scheduling Keys ¨C Veteran Engagement ...... 63

Referring Provider or RCT Team: Veteran Needs Can Be Addressed via E-Consult ......................... 64

MISSION Act Information .................................................................................................................. 64

Veteran Does Not Answer the Phone ................................................................................................ 65

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Data and Measuring Success .................................................................................................... 66

Impact Measures ............................................................................................................................... 66

Analyzing Data to Monitor Progress .................................................................................................. 66

Data and Measuring Success Supplemental Material ........................................................................ 68

10

Appropriate Use of Decision Support Tool (DST) ................................................................ 69

DST Checklist for RCT ...................................................................................................................... 69

Best Medical Interest General Information ......................................................................................... 71

Types of BMI ..................................................................................................................................... 71

BMI Definitions .................................................................................................................................. 72

Supplemental Materials ..................................................................................................................... 73

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Community Care Scheduling ................................................................................................. 74

Community Care Referral Checklist ................................................................................................... 74

Veteran Community Care Scheduling Preferences ............................................................................ 74

Types of Preference Information to Capture ............................................................................... 75

Accessing the Consult Toolbox to Capture Scheduling Preferences........................................... 75

Entering Veteran Preferences .................................................................................................... 78

Options for Community Care Scheduling ........................................................................................... 79

VA Scheduling ............................................................................................................................ 79

Veteran Self-Scheduling ............................................................................................................. 79

Community Care Scheduling Supplemental Material ......................................................................... 80

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Use of Electronic Consults (E-Consults) .............................................................................. 81

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