Care Management

Care Management

Prior to Surgery and Post-Op

About two weeks before your surgery, you should plan the following:

Select a Support Person
We encourage patients to select a reliable support person. It is very important that your support person be available to assist you throughout this experience. They will need to assist with transportation, preparing and assisting with meals, and assisting with mobility around your home. If you live in a multi-level home, you may need to consider rearranging your home or staying with someone while you recover.

Advance Directives
The law requires that everyone being admitted to a medical facility have the opportunity to make advance directives concerning future decisions regarding their medical care. If you already have advance directives, please bring copies to the hospital on the day of your surgery. If you don’t, you can obtain your copy from the clinic, or PAU, and bring it to the hospital for notarization the day of surgery.

Contact Your Insurance Company
Before surgery you should contact your insurance company and confirm if pre-authorization, pre-certification, or a second opinion is required. Depending on your post-operative needs, you may need a Skilled Nursing Facility, Home Health, Outpatient Therapy, or Durable Medical Equipment. Contact your insurance company or Medicare provider before surgery to find out what benefits are provided with your particular plan and if there are any certain agencies or rehabilitation facilities that you would need to use. Call these preferred agencies to make initial contact and discuss their ability to cover services for you in your area.

To Guide You in Discharge Planning Options
Based on information you have obtained from your insurance company and the assessments by your therapists and doctor, one of the following will be arranged:

Home Health
A number of home health services will be arranged for you while you are in the hospital. Medicare criteria for home health coverage require the patient to be homebound.

  • Home health physical therapist and occupational therapist, if available, will visit you at home to help with exercises.
  • If you are sent home with Coumadin, a home health nurse will be sent to your home to draw blood samples. They will come twice a week for three weeks then once a week.

Rehabilitative Services
Occasionally, a stay in a rehabilitation facility is helpful for your recovery. If this is the case, you will be given a choice of appropriate facilities based on your specific needs.

A case manager will discuss these options with you while you are in the hospital. There are two levels of rehabilitation care:

  • Skilled Nursing Rehab provides a less aggressive program. This requires insurance approval for admission.
  • Outpatient/therapy labs – You will be given a prescription for outpatient labs and outpatient therapy. You will be able to choose the closest facility to where you live and that is covered by your insurance.
  • Inpatient Rehab – This requires you to be able to participate in three hours of intense daily therapies. You must meet insurance criteria for admission, which will be determined based on your progress after surgery.

Caring for Yourself at Home
Your care manager will meet with you for a post-op interview and will be in charge of coordinating your hospital discharge. The Clinical Care Coordinator, physical therapist and occupational therapist works with your physician to help you decide on the best discharge plan. They will assist you in obtaining any equipment before you leave the hospital. All equipment must be prescribed by your doctor in order for Medicare, Medicaid, and insurance companies to pay for it. However, Medicare, Medicaid, and many insurance companies DO NOT cover the cost of shower benches, elevated toilet seats, bedside commodes, grab bars, or other bathroom items. If you choose to obtain the equipment, it will become your responsibility to pay for it yourself.

Post-Discharge Questions
Within the first seven days of discharge, contact your Care Manager about questions related to any services arranged. After seven days, or if you have questions related to pain and other medical concerns, contact the orthopaedic clinic.