20 years of dedicated service to over 70 facilities in twelve states.
ACI recruits exceptional physicians and mid-level providers to enhance quality medical care.

Physicians practicing with ACI in your Emergency Department will be board certified or eligible in a primary care specialty such as Emergency Medicine, Family Practice, or Internal Medicine and have significant Emergency Department experience at a comparable volume and acuity practice. The physician interview process for full-time physicians would preferably involve hospital medical staff, administration, and nursing staff as part of the ultimate decision-making process. It is the policy of ACI that we place all physicians on a probationary status so that both parties have an adequate opportunity to review the practice opportunity before committing themselves. This provides opportunity for both parties to receive a preview of a potential long term medical staff relationship. This has been very effective in minimizing any mismatches in the appointment process.

Recruitment is performed via a full-time recruitment team that preferentially targets the region the practice is located in. We have found it more effective to recruit regionally in regard to long-term retention and compatibility of expectations and lifestyles. Site orientation begins the day that the physician accepts assignment and the hospital concurs. There will be a written Physician Orientation Manual designed to be specific to your facility that will be shared with each physician. The Chief Medical Officer and/or Recruitment Coordinator, working with the on-site Medical Director, orient each physician to your facility. We also request orientation assistance from members of hospital administration, medical, and nursing staffs. It is expected that your loc

Many of our affiliated facilities have elected Critical Access Hospital status and, in keeping with our commitment to an active partnership, ACUTE CARE, INC. has developed specific expertise in reimbursement for essential services in a cost-based environment.

One of the key advantages in becoming a Critical Access Hospital is the opportunity to access revenues through cost-based reimbursement from Medicare. The hospital continues to provide the same core inpatient and outpatient services and function under the same hospital licensure standards and Medicare Conditions of Participation, including an explicit requirement for 24-hour emergency services. After approval as a Critical Access Hospital, payment for services provided to Medicare patients is changed from a prospective to a cost-based basis.

A significant but often unrecognized, reimbursable expense is classified as availability or otherwise known as stand-by time. In all ACUTE CARE, INC. staffing models, Emergency Department physicians are required to be on premises during their service at the facility. Patients with a variety of injuries and illnesses arrive in Emergency Departments any time of day or night. Medicare recognizes that there is a value to the community and the nation in maintaining these readiness capabilities. As a result of the unscheduled nature of emergency medicine, Emergency Physicians may spend a portion of their time in an availability status awaiting the arrival of patients. There is substantial economic cost for this "down-time" which may account for a significant portion of the shift. Paying physicians for this "standby time" is a significant overhead expense for the hospital.

ACUTE CARE elected to build a system specifically designed for Critical Access Hospital ED Physician clinical time measurement. Our goals for the ACUTEtrack project included ease of installation, system simplicity and reliability, accurate and timely report generation, and use of industry standard and widely available components.

To learn more about ACUTEtrack please see the summary and diagram, or contact your Client Services Director.

Though Critical Access Hospitals now receive equitable compensation for inpatient care, many of these facilities are witnessing a drop in admissions. Primary Care physicians serving these hospitals are seemingly deemphasizing inpatient care in favor of a clinic-based practice and transfers to larger medical centers, causing an outflow of patients.

Our investigation has revealed that Primary Care physicians request support in the admission process and overnight management of their patients.

Our affiliated Emergency Department physicians are capable of these tasks. Most of our affiliated Emergency Physicians are board certified in Family Practice and have substantial hospital medicine experience.

In our rural practices, the Emergency Department volume is modest enough to allow for additional responsibilities. ACUTE CARE, INC. is willing to work with your facility to expand the duties of the ED Physicians to include selected hospitalist responsibilities and recruit physicians capable of this new hybrid position.

We have decided to call the new program AdmitED.

With this new program, the ED physician would serve in the Emergency Department, and would admit patients to the inpatient floors. S/he would maintain accessibility for physician-specific inquiries and care associated with patients admitted to acute and skilled inpatient care.

           For more information contact your Client Services Director.

ACUTE CARE, INC. is well versed in the coding and billing aspects of the Emergency Department professional Services. We have been involved in the coding aspect of the business for the last seven years and involved in the billing aspect for the last four years. We partnered with EPBS of Oklahoma City, Oklahoma several years ago due to their superior background, compliance controls, and process management in the billing and coding business.

We are well versed in the process of starting a fee for service contract and the up front needs that are required to expedite the processing to allow billing with the various payors. We work closely with our hospitals to make sure we work with every payor already contracted with the hospital.

• ACI receives patient's chart via electronic media
• ACI receives ED's daily log via electronic media
• Patient charts are coded with the appropriate ICD-9, CPT and other relevant codes
• Third-party payer claims are filed.
• Insurance claims are generally submitted within 1-7 days from the date of receipt provided that all appropriate physician authorizations, provider number, etc. are in place.
• Electronic submissions for Insurance claims are used whenever possible.
• We follow a compliance program which is setup in accordance to the Federal and State laws and guidelines with HIPPA.

ACI is a Category 1 approved provider of Continuing Medical Education and offers a wide array of customized educational programs including subjects such as, but not limited to EMTALA, ACLS, PALS, and BLS.

Early in the development of our group practice, Dr. Menadue recognized the value of developing an educational resource specific to the practice of emergency medicine. Using experienced independent contractor educators and coordinators, as well as selected members of the company's leadership, he assembled a team worthy of the organization and of substantial value to ACI's affiliated facility and physicians.

As a result, ACI has an impressive history of comprehensive educational support for emergency and primary care physicians, as well as hospital ancillary personnel. Our organization is the only private Midwest physician organization to be awarded the distinction of being an accredited provider of Continuing Medical Education (CME).

ACUTE CARE, INC. also is a leader in individualized American Heart Association Advanced Cardiac Life Support training (a key requirement for all ED physicians), is a provider of education programs through an instructor trained by the Bayer Institute of Health Care Communication, and offers a wide array of customized educational programs including medicolegal subjects like the Emergency Medical Treatment and Active Labor Act (EMTALA). Recently our firm has ventured into Internet-based CME, using browser-based versions of an EMTALA PowerPoint presentation accompanied by streaming Real Audio audio narration.

Our full-time credentialing department will present a JCAHO modeled credentialing packet to the hospital administration in a timely manner. Physicians recruited by ACI will participate in educational in-services and in hospital and community activities related to the promotion of emergency services. The final decision to accept or reject any applicant rests with the administration and medical staff or your facility. See the services we provide as a Credentialing Verification Organization (CVO).

The hospitals in ACI's market niche are continually challenged to recover payment for their services from the agencies ("payors"), governmental and private, which provides insurance for their patients. Medicare and Medicaid insure a disproportionately large segment of the patient population in this market and the payment systems are complex and seemingly biased against the smaller facilities. Providing assistance to its partner facilities with the challenges specific to the Emergency Department reimbursement effort (coding and billing) is a natural outgrowth of the ACI philosophy.

Dr. Menadue, is a past member of the Reimbursement Committee of the American College of Emergency Physicians, and keeps abreast of national changes in documentation, coding and reimbursement, their expected impact, and time of implementation in the Central United States. Dr. Menadue recognizes the impact of these challenges on the hospitals in the market segment and has tailored ACI's value added services portfolio to provide support and counseling for its contracted facilities.

The newest addition to our service portfolio, ACUTEdoc, is a template documentation system for the physician and nurse's record of the Emergency Department patient encounter. The system encourages compliant physician documentation, coding and reimbursement. The physician and nurse charting tools are associated with a computer-based set of discharge instructions that completes the system. The integrated elements dramatically enhance quality of care, patient (customer) satisfaction and the peer review process.

Our organization offers a wide-array of coding and documentation solutions to partner facilities. ACUTE CARE, INC. currently provides physician coding services to several of our current clients. This department utilizes the services of experienced coders with risk management experience to enable accurate documentation, coding and billing in a timely ACUTE CARE, INC. is fortunate to also have available the services of a full-time coding and reimbursement staff, experienced professionals that review each facility's current documentation and coding process, and serve as a partner and resource in creation of an optimal reimbursement and risk management system for the affiliated facilities. These services are of substantial practical and financial value, and are provided as a distinctive feature of the contractual relationship. This is one of ACI's more remarkable "internal consultant" capabilities. We are exceedingly well versed in the specific requirements of Emergency Department documentation and the rigors of extracting fair compensation from payers like Medicare and insurance companies.

Given the essential role of documentation in both quality assurance and reimbursement, ACI has chosen to provide facilities with a preferred system designed to facilitate achievement of those goals. The ACUTEdoc product is a template documentation system used for the physician and nurse to record the Emergency Department patient encounter. Based on the government's own guidelines for compliant physician documentation, the system encourages continuous quality improvement and patient care, proper coding (transferring the patient encounter into the accepted categories of the billing process), and enhanced reimbursement. The physician and nurse charting tools are connected with a computer-based set of discharge instructions. This complete system of integrated elements dramatically enhances quality of care, customer (patient) satisfaction and the peer review process.

The ACUTEdoc documentation system benefits the facility by reducing hospital expenses associated with medical records transcription and increasing the efficacy of coding professional fees for the Emergency Department physician

ACUTE CARE, INC. has successfully partnered with our affiliated facilities to provide them with a medical director who provides a multitude of services to the Emergency Department, including chart review and helping to create ED policies and procedures. For a listing of all the medical director options please contact one of our Client Services Director.

24/7
60 Hour Weekend
48 Hour Weekend
Flexible Staffing Models Available

1. MD or DO from accredited medical school.
2. A current state license in good standing.
3. ACLS certification.
4. Complete credential packet.
5. Excellent communications/public relations skills.
6. Proof of adequate insurance coverage.
7. Documentation of a history of good standing in provision of services (minimum 500 hours of unsupervised Emergency Department experience).
8. Be able to meet the requirements outlined in the facility's Medical Staff By-Laws.
9. Board certified in an appropriate specialty.

In addition, we recommend that all full-time physicians become certified in Advanced Trauma Life Support via the auspices of the American College of Surgeons within six months of their full-time appointment (subject to class availability). Physicians recruited by ACI will participate in educational in-services and in hospital and community activities related to the promotion of emergency services. The final decision to accept or reject any applicant rests with the administration and medical staff.

Our services include Locum Tenens, Exclusive and Permanent Placement

See a sample of the credentialing guidelines our Physician Credentialers utilize in preparing a physician's credentials file.

Our professional liability insurance carrier is ProAssurance. This company has served as one of the "gold standards" in medical professional liability insurance since its inception. ACUTE CARE, INC.'s Performance Improvement department works closely with our carrier and has developed an extensive investigative process for dealing with both incidents of concern and actual claims.

It is our group policy to investigate every incident and claim and provide a privileged report to our legal counsel. This process has proven very effective in recognizing potential and real claims, and has led to early and favorable settlements in the past. We believe that this malpractice insurance partnership is distinctive in the field of Emergency Medicine and has contributed significantly to our ability to maintain an industry leading loss record and favorable terms of coverage.

Professional liability coverage for each physician working in our affiliated facilities' Emergency Departments is one million per claim and three million aggregate of claims per physician (or per state limits, if higher). Insurance is written on a claims-made basis with an unlimited tail. Our insurance carrier is licensed to provide service in all states in which we practice.

The Emergency Department represents the main interface between the community and hospital. This department serves as the "front door" of the hospital, and a large portion of both patients and visitors connect their perception of the care delivered by the hospital with the care that they receive in the Emergency Department.

An important element of any marketing program is an ongoing public relations effort. ACUTE CARE, INC. will work with your organization to assess the marketing needs of your facility and assist in developing and implementing a Strategic Marketing Plan specific to the Emergency Department. In many cases, we will work with your in-house public relations staff to create advertisements for local media outlets.

ACUTE CARE, INC. has chosen to set itself apart from its competitors by committing to direct participation of the firm's leadership team in Emergency Department committee and medical staff meetings. Most of the other firms finalize a sale with a signed agreement and then conduct the large majority of the contracted services by telephone. ACUTE CARE, INC. prides itself on a frequent physical presence at and meaningful interpersonal interaction with its contracted facility partners. Our monthly on-site visits enable our management to build relationships not only with our contracted physicians, but the administrative members of your organization.

In partnering with ACUTE CARE, INC. you will have access to a facility schedule that is updated daily. You can access this information via our secure website. When you choose ACUTE CARE, INC. your password will be provided.

ACUTE CARE, INC. will utilize the survey data already instituted at your facility in guiding our performance improvement partnership. We also provide customized survey resources designed to supply additional detail for our analysis of the Emergency Department practice.

While the hospital typically surveys the patients' perceptions of their Emergency Department care, we feel it is our responsibility to gather patient satisfaction impressions from hospital administration, medical and ancillary staff. Our emphasis is on the physician component of the patient interaction, and we have developed sophisticated tools to collect this information and share it with your facility. Each physician is evaluated after his or her first shift at your facility through phone interviews with the hospital staff and, via feedback from clinical and administrative personnel at the facility, on a continual basis. The physician is evaluated in the following areas:

• Competence and medical ability
• Communication ability with hospital staff
• Patient rapport
• Documentation: Content of record
• Documentation: Completion of record

ACUTE CARE, INC. believes that all of these criteria influence the Emergency Department Physician's ability to provide a positive patient encounter. This evaluation provides a mechanism for praise of worthy performance and as a guide for education, counseling, and support if the physician's practice is in need of improvement.

Our experience provides evidence that a proactive Performance Improvement plan and attention to training and support leads to improvement in patient satisfaction. This continual monitoring and direct feedback to the physician yields a positive outcome for our joint practice in your Emergency Department.

Should you desire, ACI will assist the hospital with the implementation of an Occupational Health Program, Urgent Care, or Hospitalist services. These services are facets of a progressive Emergency Department and can prove to be both effective marketing tools and a source of additional revenue. In our experience, we find that these service extensions are effective in fostering an increase in outpatient visits and providing optimal utilization of your Emergency Department. In addition to affiliations your hospital may have with network hospital organizations; your facility will have access to a network of similar volume facilities with the same needs for their Emergency Services.

ACUTE CARE, INC. achieves Continuous Quality Improvement (CQI) through an aggressive corporate quality initiative that is integrated into each hospital's plan. The ACI CQI effort is administered through the Performance Improvement department. This division of ACI, led by Barbara Moats, DO, Chief Medical Officer, includes two board certified, experienced Emergency Physicians and two similarly experienced Registered Nurses. These professionals provide peer review, physician mentoring, and local Medical Director education and support.

The Performance Improvement department was an early addition to ACI's array of services and has grown rapidly. As concerns or compliments regarding the performance of any of the more than 400 independent contractor physicians are brought to the notice of ACI (typically via a phone call from the Emergency Department manager), the Performance Improvement department conducts the information gathering and analysis associated with the report and makes recommendations regarding an appropriate course of action.

Dr. Moats is a key leader in the organization and is actively involved in medical peer review, physician mentoring and performance improvement. She brings a wealth of experience to the practice, having served as a staff physician in Emergency Department at Iowa Methodist Medical Center in Des Moines, Iowa for 23 years. Dr. Moats also served as the Medical Director for Life Flight, the helicopter air-medical service based at the hospital. An aspect of the CQI effort is decentralized, with ACI identifying one Emergency Department physician at each location as a Local Medical Director. This physician is provided a monthly stipend and in return, ACI provides a list of responsibilities and expectations and designates this individual as a primary ACI CQI contact at the hospital. The local Medical Director reviews, investigates and responds to all patient care concerns, whether generated from patients, medical staff or administration. Usually, the Local Medical Director can resolve concerns specific to a particular facility and the results of each investigation are then provided to the Des Moines office in a monthly report.

ACUTE CARE, INC. believes it is our organization's responsibility to gather patient satisfaction impressions from hospital administration, medical staff and ancillary staff. The emphasis is on the Emergency Department physician component of the patient interaction, and ACI has developed sophisticated tools to collect this information and share it with the facility. Each physician is evaluated after his or her first shift at a facility and on a continual basis thereafter. Through phone interviews and on-site visits with hospital staff, the physician is evaluated in competence and medical ability, communication ability with hospital staff, professional appearance, patient rapport, and documentation ACUTE CARE, INC. has come to understand that adherence to standards of clinical practice and interpersonal communication significantly influences the Emergency Department physician's ability to provide a positive patient encounter. ACUTE CARE, INC.'s evaluation provides a mechanism for praise of worthy performance and as a guide for education, counseling and practice support by the ACI's Performance Improvement department staff. Our firm's experience shows that a proactive quality improvement plan with attention to training and support leads to improved patient satisfaction. This continual monitoring and direct feedback to the physician has been proven to yield a desirable outcome for the ED practice in each affiliated Emergency Department and enhance the relationship between the facility and ACI.

Our organization is currently internally regionalized to service our 70 plus practices. The operational concept divides those practices into four regional teams. Each regional team consists of a dedicated physician recruiter, two physician schedules and physician credentialer. Each team is managed and assisted by a regional coordinator. These coordinators report to a Operations Director, Assistant Vice President and Vice President that oversee operations. Each team is uniquely set up to handle new business and increased capacity within our current book of business.

The current regions have capacity for more contracts. Within our strategic planning process this year, we elected to plan to allow for continued, controlled growth. In short, we have the capacity to recruit and grow anywhere in the country, without adding additional stress to our operations staff and current physician pool – and still maintain quality.

Our organization handles all of our scheduling in the corporate office and each region is assigned a scheduler to handle the day-to-day operations for the facility. If an emergency takes place after normal business hours, we instruct the facility personnel to contact our 24-hour line (800.729.7813) where a scheduler is always on call. Should a physician not show for his or her scheduled shift, the scheduler on call will begin the process of replacing that physician by calling other physicians on the current ED staff, while keeping in constant communication with member a of the ED team. We have filled every hour of contracted coverage throughout the 19 years of our existence. We would encourage full-time emergency physicians to reside in the community so we have depth in emergencies. Physicians are required to have the next month's availability to our organization by the 10th of each month, with the finalized scheduled published by the 15th. Both our physicians and facilities may access current and future calendars through a secure website.