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The final rule for the fiscal 2013 Inpatient Prospective Payment System (IPPS), effective Oct. 1, 2012, continues the Centers for Medicare & Medicaid Services' (CMS) move to tie reimbursement to quality, rather than merely quantity, and makes it more important than ever for case managers to ensure that documentation in the medical record is complete and clearly reflects the patient's severity of illness, says Susan Wallace, MEd RHIA, CCS, CDIP, CCDS, director of compliance/inpatient consultant for Administrative Consultant Service, LLC, a healthcare consulting firm based in Shawnee, OK.
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By collaborating on a case management program for uninsured and underinsured patients who overuse the emergency department, two hospitals in Lincoln, NE, have reduced the number of emergency department visits by patients in the program by 56% and cut emergency department costs related to non-emergent care by 67%. In 2011, the initiative saved the two hospitals about $700,000 in uncompensated care costs.
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As a hospital case manager, you may think your job is done when you ensure that your patients have a discharge plan and have left the hospital.
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When UConn Health Center/John Dempsey Hospital in Farmington, CT, first proposed meetings with post-acute providers to improve transitions, only two skilled nursing facilities and a few home health agencies agreed to participate.
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Every now and then at Sunnybrook Health Sciences in Toronto, Canada, there was talk about getting ventilated patients up and about even if they were still intubated.
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In an effort to reduce readmissions, University Hospital in Newark, NJ, partnered with the Visiting Nurses Association Health Group and developed a program that uses intensive case management to reduce readmissions for patients with multiple chronic conditions.
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By improving processes within the hospital and collaborating with post-acute providers in the community, Charles Cole Memorial Hospital in Coudersport, PA, decreased its 30-day readmission rate for all patients by 15.9% in a one-year period.
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Nine hospitals in southern Texas have joined with the area's Agency on the Aging and formed the Rio Grande Valley Readmission Coalition to follow at-risk patients after they are discharged from the hospital in an effort to prevent readmissions.
