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I will never forget my biggest ethical dilemma. It happened when I was a director of case management at a large medical center in New York City. It was the day after Thanksgiving.
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When case managers think about ethical dilemmas, they are thinking about much more than when to discontinue a ventilator, or to stop treatment, or any of the myriad of clinical ethical decisions that must be made every day in hospitals throughout the United States.
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More often, registrars are finding themselves in the difficult position of educating patients about their insurance coverage, according to Steph Collins, manager of patient access at Fairview Northland Health Services in Princeton, MN.
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The Medical Center of Central Georgia in Macon was an early adopter of registration kiosks, says Jane Gray, CPA, FACHE, FHFMA, assistant vice president for the revenue cycle.
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As part of Memorial Health System's adoption of the Toyota Lean Processes, the case management department at Saddleback Memorial Hospital in Laguna Hills, CA, has standardized work flow for discharging patients and is piloting the process on one unit.
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Arm yourself with data before approaching the administration about establishing an emergency department case management department, increasing staff, or changing hours.
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The case management department at Lee Memorial Health System in Fort Myers, FL, has been able to demonstrate a savings of $4.5 million as a result of having case managers in the emergency department.
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If you have the emergency department volume and the staffing, covering the emergency department 24 hours a day, seven days a week is optimal, according to Joanna Malcolm, RN, CCM, BSN, consulting manager, clinical advisory services for Pershing, Yoakley & Associates in Atlanta.
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When patients are admitted to the hospital inappropriately, the paperwork involved to correct the error brings to mind the saying "an ounce of prevention is worth a pound of cure."
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Today's hospitals are facing a shrinking pool of healthcare dollars along with increased scrutiny from Medicare, Medicaid, and commercial payers and strong penalties for fraud and abuse.