Centers for Medicare and Medicaid Services (CMS)
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Price Transparency Now a Reality; Not All Hospitals Fully on Board
Some hospitals were holding off, hoping courts would overturn the requirements. Other facilities still are contending with operational challenges caused by COVID-19. Nevertheless, expectations have changed — and the consequences of noncompliance are real.
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The Basic Elements of Healthcare Reimbursement, Part 2
This month will continue the discussion of healthcare reimbursement by third-party payers. We began last month with a review of the diagnosis-related groups (DRGs) and associated terminology. We will continue by reviewing how medical records are coded followed by the new MS-DRGs implemented in 2007.
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The Four C’s of Patient Care
Every day, case managers face pressure to achieve optimal outcomes in a multitude of scenarios. At the core of each case is the patient’s understanding of medical care, their ability to think critically, make decisions about their care, and use good judgment. Capacity, competency, coping, and choice are the core considerations every case manager should examine with each patient.
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New Research Suggests More Data on Readmissions Can Help
A recent study of Medicare data revealed facilities have many opportunities to improve readmissions — to either a medical or psychiatric hospital — after psychiatric hospitalization.
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Methods for Case Managers to Build and Enhance Resilience
Hospital case management departments can anticipate increased levels of stress among their staff as the COVID-19 pandemic continues. This could cause employees to burn out and leave their jobs. But before things reach a crisis point, there are practical and evidence-based steps leaders can take to help their employees shore up their resiliency to deal with pandemic-related stressors.
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Case Management Leaders Can Help Staff Weather Ongoing Crisis
Research on the effects of the COVID-19 pandemic on nurses, physicians, and other healthcare workers across the world shows disturbing levels of anxiety, depression, stress, burnout, and suicide. The authors of one study estimate the prevalence of burnout among registered nurses in the United States to range from 35% to 45%.
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The Basic Elements of Healthcare Reimbursement — Part 1
Changes in healthcare reimbursement have occurred with lightning speed over the last two decades. Providers billed for services rendered and were reimbursed — with no checks, balances, or control over costs of care. Case management, as a care delivery model, followed a similar course. But as reimbursement changed, so did case management. This month we will begin our discussion of reimbursement, including the changes to case management as it evolved with reimbursement.
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Nurse Navigator Role Helps Reduce 30-Day Readmissions
A program that used nurse navigators with heart failure patients cut its 30-day readmission rate in half and provided more thorough follow-up care in transitioning patients home.
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CHECK Program Works to Solve Problems Brewing Beneath Surface
The CHECK program prevents rehospitalizations by employing a team of community health workers and licensed behavioral health professionals to help people with chronic diseases deal with the social determinants of health that hinder their disease management.
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CHECK Program Addresses Chronic Illnesses with a Holistic Approach
A program created to help children and young people, from birth to age 25 years, with chronic illnesses has evolved into a way to prevent emergency department visits and rehospitalizations for any population, including at-risk, older adults.