Discharge Planning
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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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Leaders Plot How They Will Leverage the Lessons of COVID-19
While healthcare leaders continue to battle a global pandemic, many also are plotting how they will use the lessons of this emergency to make their health systems better. Several shared their ideas during the Institute for Healthcare Improvement’s annual forum.
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Opioid Use and the Role of the Case Manager
Regardless of whether they know it, many case managers are faced with patients and clients each day who are struggling with opioid use disorder (OUD). As rates of OUD continue to increase, it is essential for case managers to hone their skills of confidently recognizing and addressing the disorder.
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Occupational Therapy and Hospital Readmissions
Occupational therapy is a bit like case management. In both vocations, the greater healthcare community (and population in general) is not entirely familiar with their purpose. Both positions often are all-encompassing, diverse, and necessary as they consider the whole person. Both occupational therapists and case managers often play a role in helping control hospital spending.
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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.
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Hospital-SNF Partnership Brings Better Care for Complex Patients
Coordinating post-acute services for patients has been an ongoing challenge during the COVID-19 pandemic. One solution is for hospitals to form partnerships with local skilled nursing facilities. These partnerships can help hospitals find adequate care for complex patients. Hospital case managers and other staff can help the skilled nursing facility with difficult problem-solving and care coordination.
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Tools Keep Tabs on Patients Remotely, Predicting Outcomes and Conserving Resources
Researchers developed an automated text messaging approach that can monitor patients who have been discharged from the ED. Other investigators have leveraged artificial intelligence to train an algorithm to help emergency clinicians better predict outcomes and manage resources.
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Post-Acute Care Transitions Were Problematic in Pandemic-Ravaged Areas
The continuum of care hit roadblocks in some U.S. cities as the COVID-19 pandemic made post-acute care transitions extremely challenging. In New York City, the epicenter of the pandemic in March and April 2020, case managers needed to transition patients from acute care beds quickly, but had to adjust to surge obstacles to their usual post-acute options, according to the results of a recent study.
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Knowing More About Super-Users Prevents Unnecessary ED Visits
Frequent ED visitors account for 10% to 26% of all ED visits, and are responsible for a growing proportion of healthcare expenditures. The risk of ED super-use is more likely for older patients and those in poorer health. The most common diagnoses were low back pain, nausea and vomiting, chest pain, headache and migraine, urinary tract infection, and abdominal pain.