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Centers for Medicare and Medicaid Services (CMS)

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  • How Case Managers Can Help Victims of Trafficking

    Case managers can learn skills and tactics for helping patients who have been trafficked. For example, investigators used an online training module to educate ED staff about human trafficking. Participants reported more confidence in identifying a possible human trafficking victim, noting they were more likely to screen patients for human trafficking.

  • Stroke Patient Navigator Prevents 30-Day Readmissions

    A stroke nurse navigator team can prevent 30-day readmissions in stroke patients treated with thrombolysis, investigators found. A health system’s 30-day readmission rate was 13.6% before it began to use a stroke nurse navigator. The rate declined to 6.9%. Patients with the stroke nurse implementation were 67.6% less likely to be readmitted within 30 days compared to patients without the navigator.

  • International Discharges Create Chaos and Inspire Creativity for Case Managers

    Case managers and discharge planners in every state sometimes encounter the most challenging and frustrating of cases: the international discharge. Hospital Case Management asked Judith R. Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, a clinical consultant and author of Home Hospice Navigation: The Caregiver’s Guide, to answer a few questions about best practices in handling these unique care transition cases.

  • Care Coordination and Communication Needed Between Transplant Providers and Primary Care

    Cirrhosis affects a small percentage of the U.S. population. But it is a highly complex disease that leads to high hospital readmission rates and a higher cost per patient than found in heart failure and COPD. Investigators found care coordination and efficient communication between providers can optimize care. Telehealth can help patients, particularly for return visits.

  • Case Management Challenges in the Emergency Department

    Hospital case management already is unique. But carrying out this role in the ED brings even more challenge and intensity to bear. It also affects operations and well-being in the rest of the hospital.

  • For Clinicians, Discharge Safety Is a Growing Ethical Concern

    More often, clinicians are asking ethicists questions such as, “Is this discharge plan ethical?” It seems clinicians are distressed over what they consider to be unsafe decisions. Clinicians create a treatment plan based on what they believe is in the patient’s best interest. For various reasons, sometimes the plan is just not feasible.

  • Nurse Care Coordinators Are Valuable in Federally Qualified Health Centers

    A Federally Qualified Health Center that invested in a registered nurse care coordination program in a primary care setting found the position provided a valuable service and was cost-effective.

  • How to Fight Denials

    Case managers do not have to settle for denials. In fact, they can use their skills to overturn denials. There are certain tactics that can help in this process, and some case management professionals even specialize in this.

  • Hispanic Patients with Diabetes Need Better Care Transition Models

    About one in 10 Americans are diagnosed with diabetes, and the Hispanic/Latino population is disproportionately affected. Their risk is higher — and their outcomes are worse — than the white, non-Hispanic population. Researchers designed a transition of care model and pilot to see if they could improve outcomes.

  • Care Transitions Through ACHIEVE Study Score Points with Patients

    Care transitions across organizations and the community require better collaboration and communication among providers and social service organizations, according to recent research. Patients benefited from improved collaboration. They reported feeling better supported and cared for by providers involved in a care transition project.