Centers for Medicare and Medicaid Services (CMS)
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Person-Centered Case Management Tool Improves Discharge
A patient-centered, collaborative case management tool can help hospital case managers anticipate patients’ needs and ensure an appropriate discharge and transition of care. Inadequate care coordination can lead to rehospitalizations and expensive care.
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Boards of Directors on Notice With Recent Caremark Decisions
Two recent court rulings indicate courts may extend a corporate board’s duty to monitor further than the previous norm. Healthcare corporate directors could be at an increased risk of shareholder lawsuits and personal liability.
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The Conditions of Participation for Discharge Planning: Current Rules and 2020 Updates
In 2015, CMS introduced proposed rules for discharge planning. These proposed rules were to be used to update the current rules under the Conditions of Participation for Discharge Planning. In 2019, CMS provided the elements of the proposed rules that would be adopted in November 2019. This month, we will discuss the current rules, the proposed rules, and the final rules published in 2019.
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How to Initiate Serious Illness Conversations With Patients
Patients with serious and life-threatening illnesses are faced with choices on the treatments they receive or elect not to receive. The treatment for a patient with advanced cancer is different than the treatment for a patient with advanced heart failure or chronic obstructive lung disease. However, the essence of a serious illness conversation is the same: What are the patient’s goals, values, and preferences? How do those inform their plan of care?
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Getting Involved: Case Managers Go to Washington
Legislation and regulatory changes do not always seem in patients’ best interests. Insurance coverage issues have made news headlines. In skilled nursing facilities, physical therapy time has been limited by CMS, which has also triggered concerns. What can a case manager do? How can one influence state legislators/regulators, and public policy? Advocacy for patients is integral to the case manager’s role.
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Health System Makes Utilization Review Paperless, More Efficient
As health systems update and revamp their electronic health records, they might want to consider adding a case management module. An electronic health record that includes an acute case management module with robotic process automation can create seamless efficiency.
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Ensure Adherence by Addressing Patients’ Social Needs
If a patient fears he or she will get robbed leaving the pharmacy, he or she is less likely to buy the medication. The patient may be homeless, or simply cannot afford the medication. He or she may struggle with literacy and reading the prescription information. The patient may be depressed, or may not believe the medication will help. These all are realities for patients, especially those living in inner cities. The result is medication nonadherence, which can pose serious consequences for a patient’s health — and lead to billions of dollars in excess healthcare costs in the U.S. annually.
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Use Data-Driven Dashboard, Other Tools to Assist ED Navigation Team
ED navigation teams can connect patients to primary care providers, psychosocial programs, and community-based organizations to help keep people out of hospital beds and the ED.
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ED Care Transition Teams Can Address Behavioral, Social Needs
Health systems that employ care coordination/case management teams in the ED can save hundreds of thousands of dollars, and improve the health of some of their most vulnerable patients. The results of a recent study showed that frequent ED users experience higher death rates and greater health-related social needs. One solution is care coordination and communication.
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Population Health Program Extends Continuum of Care
Valley Health System’s population health program employs post-acute navigators who help coordinate care transitions to skilled nursing facilities, home health, and community providers.