The Care At the Right Location
(CARL) Tool: FAQs

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General CARL Questions:

+ What market void does CARL fill?
  • BPCI partners now have responsibility for post-acute outcomes. Inhospital next site of care decision making is not quantified or well understood.
  • Assessing and optimizing the discharge planning process is a critical element of success in the BPCI program.
  • CARL falls into the category of “Clinical Decision Support Systems” designed to support clinicians’ next site of care decision making.
+ Why is there no substantial academic research for this kind of tool?
  • Hospitals have traditionally not been responsible for postdischarge care outcomes such as readmissions. This is changing. An important first step in academic research for the clinical responsibility is to understand your population across key domains at the time of discharge.
+ What testing has been performed on the CARL Tool?
  • Remedy Partners has completed a retrospective Evaluation1 that analyzed 1537 completed BPCI episodes using the Tool, comparing its performance against the Episode Initiator’s historical discharge site recommendations. This retrospective evaluation also assessed the risk-adjusted readmission rate for postacute facilities, HHA, and home.
  • Results from the evaluation were positive. Risk adjusted readmission rates were roughly equivalent between PAC facilities and HHA. CARL proposed HHA twice as often as care teams and reduced proposals to postacute facilities.
+ How is the CARL Tool different from Interqual and Milliman?
  • The CARL Tool is a clinical decision support tool that uses information about key patient characteristics solely for the purpose of next site of care decision support. Interqual and Milliman are designed to provide hospitals with medical necessity information to support billing practices.
+ Where else is the CARL Tool being utilized?
  • The CARL Tool is being deployed at Remedy’s BCPI anchor facilities representing roughly 40% of all BPCI patients nationwide.
+ Why is the CARL Tools logic hidden?
  • It is a proprietary algorithm developed by Remedy Partners and thus a key piece of intellectual priority.

Why Use CARL?

+ Why should I use the CARL Tool?
  • BPCI partners now have responsibility for post­acute outcomes. Specifically, CARL was designed to identify, structure and simplify essential information for successful discharge planning and to propose an appropriate next site of care for consideration at IDT rounds.
  • This type of consideration and discussion should allow the care team to identify the patient’s discharge goals and services needed, to maximize available resources (including caregivers) to meet those needs, to support a safe transition and to prevent unnecessary readmissions.
+ How does using this tool improve on case management expertise and experience in discharge planning?
  • The CARL Tool will introduce a rubric to structure your evaluation process and record your decisions. In the beginning this will lead to more in depth discussions and consistent dialogue. Over time, the tool will yield insights into your decision making process and help refine next site of care decision process at your organization.

How to use CARL

+ If the Care Team’s NSOC decision is different than the proposal from the CARL Tool, which NSOC should
   be recommended to the patient?
  • Never allow CARL’s NSOC proposal to override the care team’s clinical judgment or patient choice. CARL’s NSOC proposal is meant to be considered at IDT rounds to promote meaningful discussion– it is a proposal not a mandate.
+ Should I discuss the CARL Tool’s proposed NSOC with the patient or caregiver?
  • No. Do not reference the CARL Tool NSOC proposal with the patient. You may discuss domains, i.e. answers to the questions for the tool because those impact the ultimate NSOC decision and service needs. Never reference the CARL Tool when referring to the information in CARL’s domains.
  • E.g. What not to say: “The CARL Tool says you have to go home, so you have to go home.”
  • E.g. What to say: Based on your service needs and the fact that you have a capable caregiver available 24 hours a day we feel that home is the best option for your recovery.
+ What if I can’t find the ambulatory or ADL status of the patient to fill in the Tool?
  • Look in the EMR for the most recent RN or nursing assistant note.
  • If no RN or nursing assistant note located, obtain verbal report from RN or nursing assistant on ambulation and ADL status.
  • Refer to physical therapy as well.
+ Can I use the ambulatory status and ADL status of the patient before they came into the hospital?
  • No. Those factors may have changed since the patient has been admitted.
+ What if physical therapy has documented a recommendation of SNF or home?
  • You should still fill out the CARL Tool and present CARL’s NSOC proposal for consideration at IDT rounds. There are components of the tool other than physical therapy that are important to the patient’s discharge that should be taken into consideration when determining their NSOC.
+ What if the patient wants to go to a certain NSOC that is different than what the Care Team recommends?
   (E.g. The patient wants to go to SNF and the Care Team thinks they would be better off at Home with
   Home Health.)
  • The Care Team should ask the patient why they think that NSOC is best for them and address any concerns they have.
  • The Care Team should communicate the reasoning behind their NSOC recommendation to the patient, such as various post acute service needs and available resources that led to their NSOC decision.
  • Ultimately, if patient choice is the reason that the final NSOC disagrees with the CARL proposal indicate that reason for disagreement in the CARL Tool.
+ If the patient has not had a physical therapy evaluation, what do I select for Therapies?
  • Refer to PT for an evaluation.
  • If PT unable to perform an evaluation before discharge, request recommendation from PT if the patient should have PT after hospital discharge.
+ Which members of the Care Team provide information in the patient record used in completing the
   CARL Tool?
  • Any member who is currently part of your hospital’s interdisciplinary rounds team.
  • Case/care management staff.
  • Physical therapists, occupational therapists, speech and language pathologists.
  • Unit nurses
  • Certified Nursing Assistants, or their equivalent.
  • Attending physicians.
+ Who should be completing the CARL tool in Episode Connect?
  • Typically the dedicated case manager, care manager or patient navigator will be responsible for completing CARL in Episode Connect and presenting the CARL proposal at IDT rounds.
  • In a less than typical case, refer to specific workflows provided by Remedy that will specify the responsible party.
+ Who should consider the CARL Tool’s NSOC proposal?
  • All members of the care team should consider the CARL NSOC proposal at IDT rounds. One member of the care team should be responsible for presenting the CARL proposal at rounds.

Download the CARL Tool Overview 


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