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Healthcare reform initiatives such as value-based purchasing and readmission reduction, and a growing emphasis on quality have heightened awareness of case management, says Toni Cesta, RN, PhD, FAAN, senior vice president, operational efficiency and capacity management at Lutheran Medical Center in Brooklyn, NY, and partner and consultant in Dallas-based Case Management Concepts.
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After years of being frustrated by the Centers for Medicare & Medicaid Services Recovery Audit Contractor (RAC) program and other audit programs, the hospital industry is taking action. Heres the latest:
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Your influenza vaccination campaign is coming into the public spotlight, and that means more pressure than ever on the logistics of administering and tracking those vaccinations.
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Before Kootenai Medical Center in Coeur d'Alene, ID, began its pain care management program, emergency department physicians were spending 36% of their work day seeing patients whose primary complaint was pain, excluding orthopedic patients and those experiencing chest pain.
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By centralizing the patient transfer process, Baylor Health Care System, with headquarters in Dallas, has made it easier for patient to transfer from one hospital to another and facilitates communication between clinicians.
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[Editor's note: Last month in Case Management Insider, we started our discussion on the case management process. We reviewed the first two steps in the process which were "selection and screening" and "patient assessment and diagnosis." In this month's edition we will continue to review the steps that case manager's use in their daily work to achieve positive outcomes for their patients and their organizations.]
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The Centers for Medicare and Medicaid Services (CMS) instructed state Medicaid agencies to develop a RAC program by Jan. 1 of this year but the program is not expected to be in full swing until well into 2013.
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Many hospital associates believe that registration staff simply sit at their desk and greet patients, reports Barbara Blum, director of access, admitting, and registration at MedStar Health in Columbia, MD. "They have no idea what the registration staff's responsibilities include," Blum says.
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The U.S. Department of Health and Human Services (HHS) has delayed the implementation of the ICD-10 procedure and diagnostic coding set, but that doesn't mean that hospitals can forget about preparing for the conversion to the new system, says Deborah Hale, CCS, CCDS, president and chief executive officer of Administrative Consultant Service, a healthcare consulting firm based in Shawnee, OK.
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Before North Broward Medical Center in Deerfield Beach, FL, re-engineered its discharge process two years ago, 29% of patients were being readmitted within 30 days. Now, the figure has dropped to 15%.
