Centers for Medicare and Medicaid Services (CMS)
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Compliance Measures for the Case Manager’s Daily Practice — Part 3
In the last two issues, we reviewed the areas of compliance in the Conditions of Participation for utilization review and began our discussion on the CoP for discharge planning. In this issue, we will continue our discussion of the areas of compliance for discharge planning.
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EDs Confront Surge in Hospitalizations and Deaths From Flu-related Complications
With flu widespread in every state except Hawaii, frontline providers have been busy this year trying to stay ahead of what is shaping up to be a robust flu season.
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AHA Requests Delay of Application Deadline for Bundled Payments Program
The American Hospital Association has asked CMS to delay the March 12 deadline for hospitals to apply for the Bundled Payments for Care Improvement Advanced program and to furnish more detailed information on how the program would work.
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Don’t Do the ‘Same Old Thing’ When It Comes to Bundled Payments
Case managers can’t just keep doing the same old thing when bundled payments arrangements begin. Because the hospital is taking a financial risk by participating, case managers must ensure patients receive everything they need in a timely manner and move through the continuum quickly and safely.
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Improve Your Outcomes by Reducing Variations in Care
With bundled payments and other quality initiatives, hospitals should constantly improve their processes. A multidisciplinary team from the hospital works with community physicians and post-acute providers to develop protocols.
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Use Data to Identify Opportunities, Monitor Progress to Make Bundled Payments Work
Success under bundled payments requires using past data to identify opportunities for improvement and analyzing current trends to uncover problematic situations and make changes in real time.
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It Takes Collaboration and Consistency for Success in Bundled Payments
It takes a lot of planning and oversight for hospitals to succeed financially under bundled payment initiatives, which work best when representatives from all levels of the healthcare continuum work together.
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Get On the Bundled Payments Bandwagon — Even if Your Hospital Isn’t Participating
Even though the latest rounds of bundled payments are voluntary, the shift toward value-based reimbursements continues — meaning hospitals and their case management staffs still should focus on improving patient care, reducing readmissions, and containing costs at the same time.
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PAs Provide More Patient Contact, Reduce LOS, and Maintain Quality
Physician assistants have helped one hospital improve care in its observation unit without increasing costs, partly by providing more contact with patients than physicians can. The hospital also has optimized its observation unit model.
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App Pushes Patient Education to New Level
Not so long ago, case managers relied primarily on paper brochures and tip sheets when supplementing in-person patient education. Many might still use paper in addition to web-based information, but the newest frontier involves apps that bring education to a patient’s fingertips at precisely the moment he or she needs it.