CHRISUS Health Quality Care Alliance

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CHRISTUS Health Quality Care Alliance Physician Request for Information
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General Agency Information
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Type of PAC




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Please provide the name and contact information for the following
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Star Rating
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Please tell us the reason for and results of your most recent licensure/regulatory inspection. (If completing for multiple facilities, Please attach licensure/regulatory status per location).
Regular Accreditation:




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For Cause Inspection



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Does your PAC Provider admit patients 24/7 and perform visits 365 days/year?

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Please check the percentage, by payor type, you are willing to accept for each patient population:
Medicare





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Health Insurance Exchange




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Charity




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Quality
Does your PAC provider offer Swing Bed programs?


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For each PAC provider type, please provide the average length of stay for the timeframe noted below
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For each PAC provider type, please provide the average length of stay for the timeframe noted below
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Skilled Services - Patient Volume Census
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Specialized Programs
Please check if you have any of the below programs











Hospice Only - Are the following addressed, please answer yes or no and explain your answer:
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Please indicate if the following information is obtained/confirmed the day the patient arrives at your PAC Provider
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Do you allow the referring acute care facility staff (i.e., Care Transitions Nurse, Home Health Case Manager) to participate in interdisciplinary rounds?





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On average, how frequently does your PAC Provider staff conduct a discharge/transition conference with patients and family members and the home health agency prior to discharge? (Select one).



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What percentage of patients were discharged with home healthcare services during the last six months? (Select one)




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Patient Satisfaction
Does your PAC Provider conduct a patient satisfaction survey?


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Interoperability – What system does your agency use to manage referrals?



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Additional Information
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