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Adequate CM staff is vital as reimbursement models change
Case managers can’t do what is necessary to help their hospital succeed under the new global payment models if they are busy juggling care coordination for 25 or 30 patients.
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New payment models require a shift in thinking
Under the DRG payment system, case managers have been pressured to get patients out of the hospital as quickly and safely as possible, but that’s not the case in bundled payment arrangements.
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Get ready: Bundled payments are in your future
The Centers for Medicare & Medicaid Services’ mandatory bundled payment pilot project makes clear that the agency intends to reform Medicare reimbursement.
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Decision not to operate on 2-year-old results in death and $6.25 million jury award
A 2-year-old girl died after her stomach ruptured from a recurring and treatable symptom. The girl had stomach issues in July 2009. After being sent to a second hospital, an examination of the gastrointestinal tract revealed the girl suffered from gastric volvulus, which can cause the stomach to twist on its axis.
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Failure to update a patient’s EHRs leads to $35.4 million verdict against hospital
In 2004, a female Boston Marathon runner became dizzy after completing the race. The dizziness became so severe that the woman went to the hospital seeking treatment.
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Hospitals sued over claims they limited marketing
The DOJ sued four hospital systems that it says for years unlawfully agreed to allocate territories for marketing, which it says denied consumers and physicians important information about competing providers and other benefits of unfettered competition.
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Study: Aggressive med mal increases LOS and costs
Patients who undergo spine surgery in a community known to be an aggressive malpractice environment are likely to be hospitalized longer and incur higher charges, according to a study published recently in The Spine Journal.
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243 people arrested for $712 million in false billing
In a case involving the most defendants charged and largest alleged loss amount in the history of the federal fraud task force, a nationwide sweep has led to charges against 243 individuals, including 46 doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.
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OSHA promises closer scrutiny of staff injuries
OSHA is cracking down on injuries to nurses and other healthcare staff members.
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Never events usually are traced to multiple human factors, not just a root cause
Researchers at the Mayo Clinic confirm what many risk managers note from their own root cause analyses: Most never events can be traced back to human factors rather than just a root cause.