Harbor:Options for follow-up (peds)

Start

First determine whether the patient can be seen at Harbor

• Patients who have LA Care DHS 644 or Health Net DHS 615 are followed by us and can be seen in our clinics
• Patients with no insurance at all, straight or emergency Medi-Cal, or CCS can be seen in our clinics

"OOP" (Out-of-plan)

The patient cannot come to any Harbor clinics, except for subspecialty clinics as a continuation of their ED visit within 24 hours of the ED visit

• Subspecialty service care as a continuation of the ED visit within 24 hours of the ED visit
  • For patients seeing subspecialty service immediately (eg ortho in cast room, ophtho/ENT in clinic), discharge the patient from the ED to go to appropriate location
  • Patients seeing the subspecialty service the next morning (still within 24 hours of ED visit) can be discharged home to follow up in the appropriate subspecialty clinic
  • OOP patients may NOT follow up in subspecialty clinics > 24 hours after the ED visit, even ortho patients that have been casted
• It is sometimes possible to get authorization from an OOP patient's insurance plan for them to be seen in subspecialty clinics at Harbor
  • Utilization review may be trying to get authorization for select patients
    • IF you have authorization at the time of ED discharge, then you can make an appointment for an OOP patient in an authorized Harbor clinic
• OOP patient's health plan information and primary physician assigned / contact information is available from registration
  • It is on the Cerner ED Summary page under Additional Patient Information
  • It often is printed automatically as part of the patient's discharge summary
  • We no longer have orange and green sheets from registration
• If subspecialist referral is needed, consider giving the patient/parent a copy of the subspecialist's consult note to take to their PMD
• For patients with imaging studies, ask the nurse/clerk to please have them placed on a CD to give to the patient/parent

Can be seen at Harbor

• For subspecialty clinics where the patient needs to be seen in < 2 weeks
  • Page the appropriate subspecialist for approval (get their name)
    • Put in for the appointment using "Follow-up Date" on the Depart Process: free text the clinic needed, put the approving doctor in the comments section
    • Click "Schedule Follow-up Appointment" to make the star appear on the track so the clerk knows to schedule an appointment
• For subspecialty clinics where the patient can wait > 2 weeks
  • If empaneled to DHS, refer patient back to their PMD to get subspecialty referral, including for MRI
    • Patients empaneled to Harbor Dept of Pediatrics can call 222-1225 or 222-1227 for an appt within 1-5 days
    • Patients empaneled to Harbor Dept of Pediatrics who want to schedule an appt > 5 days can call 222-1220
    • Patients empaneled to Lomita FM can call 310-534-7600
  • If DHS eligible but not empaneled to a DHS provider, give patient a Community Health Partners handout to obtain a PMD and then a referral
• For short term follow-up of a specific condition (eg abd pain recheck, wound check, asthma or pneumonia recheck, suture removal)
  • If empaneled to DHS, have patient call for a same day appointment to follow up
  • If DHS eligible but not empaneled to a DHS provider, must advise patient to return to ED for follow-up
  • There is no longer an Acute Care Follow-up Clinic
• For pregnant patients
  • OB intake appointment can be given to establish OB care if there are no significant medical issues
    • This will NOT be an MD/NP visit; it will only be an administrative intake visit
  • Else, call OB/Gyn for f/u or send to Gyn urgent care within a few days
• For regular pediatric well-child care
  • If DHS empaneled but no PMD, have patient call 222-1220
  • If DHS eligible but no PMD, give Community Health Partners handout
  • For adults 18yo and older needing primary physician, go to pemsource.org, Harbor only page, Patient handouts, and print the appropriate page of "PCP Referral 18-20 years" handout