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In preparation for the Recovery Audit Contractors (RACs) and to improve patient flow, Durham Regional Hospital redesigned its case management department and moved to a triad model of patient care.
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By redesigning its case management program and beefing up technology, Saint Thomas Health Services reduced the average length of stay systemwide by 0.20 days and saved more than $6 million in just two years.
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In an effort to ensure that the patients most vulnerable for readmission stay safe at home after discharge, Lutheran Medical Center is developing a pilot program with a local home care agency to provide at least one home care visit for the majority of congestive heart failure patients going home with no services.
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If you haven't started analyzing your hospital's readmission rates and the role case managers can play in reducing readmissions, it's time to start so your hospital can avoid penalties from the Centers for Medicare & Medicaid Services (CMS).
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As part of the ongoing education to prepare for Medicare's Recovery Audit Contractors (RAC) program, Cynthia Lawson, RN-BC, MBA, CPHQ, director of case management at North Hills (TX) Hospital is teaching her case management staff to think innovatively when reviewing charts.
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As of January 2010, The Joint Commission has incorporated into its Quality Check web site (www.qualitycheck.org/consumer/searchQCR.aspx) the Centers for Medicare & Medicaid Services' (CMS') 30-day readmission rates for heart attack, heart failure, and pneumonia Medicare patients.
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Although the Centers for Medicare & Medicaid Services (CMS) made several minor modifications to the Outpatient Prospective Payment System (OPPS) for 2010 with impact on the emergency department, none result in a significant change in ED facility coding. However, there are references to several planned projects required to provide data to be used in future reporting and/or rate changes.
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A new process for managing radiological discrepancies in the ED at Catawba Valley Medical Center in Hickory, NC, has significantly improved the efficiency with which notifications are received and acted upon.