Centers for Medicare and Medicaid Services (CMS)
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Hospitals Without Walls Transitions Reach New Level
As the pandemic continues, some healthcare facilities worldwide are providing acute care to patients in their homes. This is a necessity in places where the health systems have been overwhelmed. In other places, it is a way to provide care that might even be safer for certain medically stable patients. -
Hospital Attains QCDR Status, Improves Quality Metrics
Alteon Health, a physician-owned and physician-led acute care medical group based in Germantown, MD, recently became a Qualified Clinical Data Registry (QCDR), a Centers for Medicare & Medicaid Services-approved vendor that is in the business of improving healthcare quality. QCDRs may include specialty societies, regional health collaboratives, large health systems, or software vendors working in collaboration with one of these medical entities.
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A Tribute to a Case Management Pioneer: Karen Zander
In August 2020, we lost Karen Zander, one of the true pioneers in hospital case management. Karen’s name is synonymous with acute care case management. She spent a large part of her professional career advancing case management roles, models, and the measurement of case management outcomes. -
Patient-Centered Care Can Improve Transitions
Patient-centered care is a simple, evidence-based way to improve care transitions and patient outcomes. Hospital case managers can benefit from learning more shared decision-making tactics.
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Target Low-Hanging Fruit in Preventing, Overturning Denials
The keys to preventing and overturning payer denials are to collect data to identify problem areas and to train staff in best practices. The case management team should understand the information each payer wants and how best to share those data.
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Develop Best Practices for Shared Decision-Making
Case managers are learning more about how to include patients in their care transitions, as part of shared decision-making. The first step in shared decision-making is to assess the patient’s situation, followed by educating the patient about all facets of their self-care and health management. -
The Balancing Act: Patient Satisfaction and the Hospital Bottom Line
In some ways, it seems that it is nearly impossible to please both the hospital administration and the patients and their families, especially in times of crisis. However, the case manager is in a unique position to bring both along — assuming they have the right tools to do so. Without the help of a wise and invested hospital case manager, the chances of a positive experience for the patient are lower, and hospital spending is more likely to be higher.
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The Basic Elements of Healthcare Reimbursement, Part 3
In this month’s issue, the conversation on healthcare reimbursement turns to the additional prospective payment systems found across the continuum of care. Prospective payment remains a way in which the Centers for Medicare & Medicaid Services can determine the rates for care based on predetermined amounts rather than on billing. The processes are similar to the use of the diagnosis-related groups in the acute care setting, with some differences.
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Care Transition Program Shows Success with Long-Term Outcomes
A hospital’s Care Transitions Clinical Coordinators program provides patients and caregivers with care transition support. The program focuses on assessment and identification of the root cause of readmission, as well as other key interventions.
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Discharge Algorithm Improves Transitions, Results
Decision support technology can help case managers improve transitions of care and more easily access patient information necessary for an optimal discharge. The algorithm can collect data on patients’ functional status, cognition, caregiver status, and other important characteristics.