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Care@rhombusmedicalssolution.com
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OUR CARE MODEL

REDEFINING MEDICAL DIRECTORSHIP WITH

A COMPREHENSIVE APPROACH

Our Physician-led clinical pods create higher clinical standards for Post-Acute providers and improved outcomes for patients.

GAPS Medical Director

  • Extensive post-acute and executive healthcare experience
  • Collaboration with primary care, hospitals, ACOs and Payers
  • Subject matter experts in medication management, palliative care, hospice, managed care, nursing home and assisted living clinical services

    • Census Management

  • Improving Hospital Partnership Channels
  • Integrating patient care flow with ACOs
  • Creating or supporting speciality programs to drive community provider relations
  • Improve quality measures and elevate star ratings

    • PDPM Readiness

  • Expertise in PDPM Documentation and Billing
  • Physician driven rehab support
  • Aiding in Coding Optimization -
  • Mock PDPM review and preparation
  • Ensuring appropriate PDPM patient classification and case mix documentation

    • GAPS Clinical Pharmacist

    Medication Optimization Management -eliminating unnecessary medications, adverse drug events and reducing unplanned hospitalizations

    Cost Containment - improving pharmacy efficiency and utilization

    Collaboration with nursing staff, physicians and GAPS Medical Director

    Post-discharge After Care

  • Continuous monitoring and after-hours coverage
  • Identify and help manage clinical gaps and care needs during transitions from acute and post-acute settings and services
  • Support for CMS -sponsored case management programs (AWV, CCM, TCM programs)

    • Physician oversight and communication

  • Extensive post-acute and executive healthcare experience
  • Collaboration with primary care, hospitals, ACOs and Payers
  • Subject matter experts in medication management, palliative care, hospice, managed care, nursing home and assisted living clinical services

    • Physician oversight and communication

  • Improving physician/nurse collaboration and communication pathways
  • Ensure patients will be seen and examined in a timely/compliant manner
  • Collaborate with physicians to improve patient outcomes

    • Patient and Family Experience

  • Overly medicated patients don`t progress. Our appropriately treated patients SIMPLY FEEL BETTER
  • Reducing unnecessary hospitalizations improves both patient and family experience

    • Quality Improvement and Advance Care Planning

  • Ensuring all patients have appropriate advance care planning especially when there is change in condition
  • Improve QAPI process and ensure regulatory compliance

    • ALF Care-Management

  • We integrate our medical model into the existing social and community models enhancing the communities length of stay and improving patient outcomes