Discharge Planning
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Centralized Utilization Management: The Good, the Bad, and the Best Practices
Challenged with employing enough staff in case management departments, the need for expertise in every role, and the increased requirements from payers, case management leaders are evaluating centralizing utilization review. This centralization carries both benefits and challenges, some of which are amplified because of the current healthcare climate.
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Home Devices Expand Telemedicine Options
As telemedicine use increases, case management professionals can harness its benefits to improve outcomes and provide a better experience for patients and physicians. COVID-19 played a large part in the increase as providers worked to minimize exposure to the virus. However, many patients still need proper monitoring.
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Q&A: CM Leadership During Pandemic Surge
Case management leaders have been navigating another COVID-19 case surge. Angie Roberson, MSN, RN, ACM-RN, director of case management at Spartanburg Regional Healthcare System in Spartanburg, SC, works in one of the worst-hit counties in one of the worst-hit states during the late 2020 and early 2021 surge of COVID-19 that swept across the United States.
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Case Management Is Critical to Bundled Payment Programs
A healthcare organization’s Medicare Bundled Payments for Care Improvement Advanced (BCPI Advanced) program resulted in lower hospital readmission rates. The program reduced readmission rates from 30% to 19%.
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As COVID-19 Vaccine Rolls Out, Leaders Need to Roll Up Sleeves
The new COVID-19 vaccine provide good news for a pandemic-weary healthcare world, offering case managers and other hospital professionals an opportunity to become vaccinated against COVID-19. Case managers should expect uncertainty about how the first vaccines are distributed.
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Acute, Hospital-Level Care in the Home: A Glimpse of the Future
Emergency providers can provide hospital-level acute care to patients at home under Advanced Care at Home, a new program from the Mayo Clinic that leverages technology and in-person services. The approach has been introduced in Jacksonville, FL, and Eau Claire, WI.
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Hospital Cuts COPD Readmission Rates with Bundle Checklist
A Maryland hospital’s COPD readmission average rate was 16.09%. Rates higher than 10.8% resulted in a penalty. Leaders set a target goal of 10.7%, and a stretch goal of 10.2%. The hospital surpassed both goals within a year. Read on to learn how they pulled it off.
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Substance Abuse and Suicidal Ideation Commonly Coexist in ED Patients
Appropriate discharge planning, including tracking patients and measuring outcomes of follow-up tactics, is a key aspect of the emergency management of this population.
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The Basic Elements of Healthcare Reimbursement, Part 2
This month will continue the discussion of healthcare reimbursement by third-party payers. We began last month with a review of the diagnosis-related groups (DRGs) and associated terminology. We will continue by reviewing how medical records are coded followed by the new MS-DRGs implemented in 2007.
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The Four C’s of Patient Care
Every day, case managers face pressure to achieve optimal outcomes in a multitude of scenarios. At the core of each case is the patient’s understanding of medical care, their ability to think critically, make decisions about their care, and use good judgment. Capacity, competency, coping, and choice are the core considerations every case manager should examine with each patient.