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Faced with high readmission rates and patients who made multiple visits to the emergency department and were hospitalized frequently, a multidisciplinary team at Lehigh Valley Health Network began analyzing the cases of frequent utilizers one at a time, getting to the root cause of the readmissions, and developing a plan to keep them out of the hospital and emergency department.
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The Centers for Medicare & Medicaid Services (CMS) proposed rule for the 2014 Inpatient Prospective Payment System (IPPS) is subject to change, but hospital case managers still should familiarize themselves with the rule and determine the impact, says Ralph Wuebker, MD, MBA, chief medical officer for Executive Health Resources, a Newton Square, PA, physician advisor company.
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At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.
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The continuing shift toward basing hospital reimbursement on quality emphasized by the Centers for Medicare & Medicaid Services in the Inpatient Prospective Payment System (IPPS) proposed rule for 2014 raises the stakes for hospitals, especially those that treat a lot of Medicare patients.
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In the Inpatient Prospective Payment System proposed rule for fiscal 2014, the Centers for Medicare & Medicaid Services (CMS) clarified its long-standing policy on how Medicare contractors review inpatient admissions for payment purposes and continued its emphasis on basing reimbursement on quality.
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When two bombs went off near the finish line of the Boston Marathon, hospital clinicians had one thought: I have to get to work. A surgeon who had just run 26 miles came into Beth Israel Deaconess Medical Center and prepared to operate. Nurses and doctors treating the wounded wondered about their own family and friends.
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The administration at Scottsdale (AZ) Healthcare System thinks it so important for the Important Message from Medicare (IM) to be delivered correctly that all case managers go through extensive training on when and how the IM should be given to patients.
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The role of the hospital case manager has taken many twists and turns over the past two decades. Case management started out as a sectioned-off role of utilization review without any relationship to the direct care providers or interdisciplinary care team.
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In the newly revised Discharge Planning Interpretive Guidelines, the Centers for Medicare & Medicaid Services (CMS) includes what it calls "blue boxes" that advise hospitals on best practices in discharge planning and care transitions.
