Centers for Medicare and Medicaid Services (CMS)
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Tips for Reducing Long Length of Stay Cases
Long length-of-stay patients can cost hospitals hundreds of thousands of dollars in unreimbursed care each year. Hospital case managers can help reduce these cases through consistent care management and team support.
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Hospital Case Managers Can Learn From Lean
One effective way for hospitals to improve patient care and reduce rehospitalizations and longer lengths of stay (LOS) is to take a Lean approach. Lean and Lean Six Sigma principles can help a healthcare organization eliminate waste and improve quality, and outcomes. For example, after employing Lean principles, Mid Coast-Parkview Health in Brunswick, ME, shortened patient stays of 30 or more days by more than 20%, saving $124,000.
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Centralized Utilization Review: Key Considerations for Successful Implementation
As hospitals grapple with ever-changing utilization review (UR) guidelines from CMS and consolidate with other facilities, many are centralizing their UR operations. Under a centralized model, an offsite UR nurse or case manager is alerted when a new patient is admitted and sees all the documentation necessary to determine whether the medical record supports the patient’s status. Centralized UR establishes a standardized common process across facilities, which is a key benefit for multihospital health systems.
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CMS Update: Outpatient Total Knee, Hip Arthroplasty
To provide patients with better value and results, CMS has issued a final rule regarding the inpatient-only list of surgical procedures. This list includes procedures that typically are only provided in the inpatient setting and not paid under the Outpatient Prospective Payment System. Criteria for removing procedure from the inpatient-only list includes determining that the procedure is performed in numerous hospitals on an outpatient basis. For example, total knee arthroplasty moved from the list starting in 2018. Total hip arthroplasty is expected to be removed from the list in 2020.
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CMS 2020 Final Rules: Infection Control in Inpatient and Long-Term Acute Care
Antimicrobial resistance represents a serious risk for Medicare beneficiaries and for the public overall. CMS is finalizing an alternative new technology add-on payment pathway for antimicrobial products designated by the FDA as Qualified Infectious Disease Products (QIDPs). Under this policy, a QIDP will be considered new and will not need to demonstrate that it meets the substantial clinical improvement criterion; it will only need to meet the cost criterion. CMS also is increasing the new technology add-on payment to 75% for an antimicrobial designated as a QIDP.
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CMS Issues 2020 Final Rules for Inpatient and Long-Term Acute Care
The Centers for Medicare & Medicaid Services issued its final rule in August to update the Medicare payment policies for hospitals under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System for fiscal year 2020. Changes were made to the rural hospital wage index, all-cause readmissions, and interoperability.
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Bundled Payments, Population Health Fuel Move to New Healthcare Models
A health network with more than a dozen acute care hospitals has developed teams with advanced care providers to work with Medicare at-risk patients to improve care and reduce costs. The case management-style teams also work with some privately insured patients. The team approach has resulted in a 9.5% reduction in 30-day readmissions, according to a healthcare organization’s internal data.
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Healthcare Organizations Use Different Approaches to Reducing Readmissions
Two different techniques highlight success in reducing healthcare costs and readmissions. What they have in common is a focus on teams. Developing the right skills and putting the right team in place are key to success.
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Ethical Issues and Standards in Case Management, Part 1
This month, we will discuss principles related to ethics and how they affect one’s role as an RN case manager or a social worker. These principles include patient advocacy, which applies to all the roles and functions that case managers perform.
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Intensive Inpatient Rehabilitation: Optimal Path for Stroke Patients
After acute care, a stroke patient’s discharge plan should include an inpatient rehabilitation facility (IRF) when they meet specific medical criteria, according to the 2016 American Heart Association/American Stroke Association guidelines. Stroke also tops the CMS 13 list, which designates 13 medical conditions that 60% of an IRF’s patients must have for the IRF to qualify. IRFs provide hospital-level care to stroke patients who need intensive, interdisciplinary rehabilitation care provided under the direct supervision of a physician.