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At Montefiore Medical Center in the Bronx, NY, a complex care case manager coordinates appropriate post-discharge options for uninsured and under-insured patients who are likely to need complex care after discharge.
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In Lee County Florida, providing healthcare for the uninsured and under insured is a community-wide effort, according to Chris Nesheim, RN, MS, CMAC, system director, case management, Lee Memorial Health system with headquarters in Ft. Myers, FL.
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Faced with an increasing number of patients who have no insurance and can't afford to pay for their own care, the University of Iowa Hospitals and Clinics in Iowa City, has developed a multi-pronged approach to identify indigent patients early in their stay and help them get access to community providers who can provide ongoing care.
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Frail elderly patients are able to stay in their homes, thanks to home visits by an interdisciplinary team from Boston University's Geriatric Service at Boston Medical Center.
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As the Centers for Medicare and Medicaid Services (CMS) continue to increase its focus on discharge planning, case managers need to pay more attention than ever to ensuring that patients have the information they need to make informed choices about their discharge destination, says Jackie Birmingham, RN, MSN, MS, nurse educator/consultant in discharge planning and vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.
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As part of the efforts to ensure that admissions are appropriate, Covenant Health System, with headquarters in Knoxville, TN, is conducting a pilot project to test the effectiveness of having utilization managers review patients admitted to the hospital, and work with the admitting physician to decide whether the patient should be admitted or receive observation services as an outpatient.
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In the last two issues of Case Management Insider, we reviewed the roles and functions most often associated with the work of case managers in the acute care setting.
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By identifying community resources for homeless and near-homeless patients, Montefiore Medical Center in the Bronx, NY, is cutting down preventable admissions.
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As part of its efforts to cut improper payments, the Centers for Medicare and Medicaid Services (CMS) has launched a three-year Recovery Audit program prepayment review demonstration project in 11 states.
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