Hospital Case Management – February 1, 2011
February 1, 2011
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Don't leave money on the table: Take proactive approach to denials
As reimbursement shrinks and health care providers tighten their belts, hospitals need to take a proactive approach to denials to make sure they get paid appropriately for the care they provide, experts say. -
Real-time management keeps denials rate low
By conducing real-time concurrent denials management, Jewish Hospital and St. Mary's Healthcare, a not-for-profit health care system in Louisville, KY, keeps its average denials rate below 1%, consistently exceeding the hospital's goal of a denials rate of under 2% for commercial patient days, including Medicare managed care patients. -
Checks and balances keep denials low
By taking a proactive approach to patient status and instituting a series of checks and balances, Good Samaritan Hospital in Dayton, OH, keeps denials at a minimum. -
Critical Path Network: CM beyond hospital walls supports chronically ill
Recognizing that chronically ill patients benefit from care management beyond the walls of the hospital or their physician's office, Middlesex Hospital in Middletown, CT, has created The Center for Chronic Care Management, which offers four National Committee for Quality Assurance- (NCQA) accredited disease management programs to help patients manage their conditions. -
Critical Path Network: Childbirth at Evergreen seen as family experience
Childbirth at Evergreen Hospital Medical Center in Kirkland, WA, is viewed as a family experience, rather than a medical event. -
Model decreases LOS, less revenue lost to denials
By redefining the roles of case managers and social workers and working with physicians on patient throughput and length of stay, Fauquier Hospital in Warrenton, VA, significantly reduced its Medicare length of stay by almost a day and decreased the revenue lost because of denials by medical necessity by 70%. -
'No-wait' ED a five-year success
A true test of the success of a process improvement initiative is whether the results can be sustained, and the ED at Hudson Valley Hospital Center in Cortlandt Manor, NY, has just celebrated the fifth anniversary of its "no wait" process. Most patients skip the waiting room entirely and go right to registration, and then to triage. -
Improved flow aids patient safety
If there are any doubts that improving patient flow also enhances patient safety, the recent experience of the ED at Enumclaw (WA) Regional Hospital should dispel them.