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Healthcare reform mandates, new reimbursement requirements from the Centers for Medicare and Medicaid Services (CMS), and pressure from payers to keep patients out of the hospital and emergency department all mean that hospitals need to do a better job of transitioning patients to another level of care.
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After Summa Health System and Akron, OH, area nursing facilities formed the Care Coordination Network to improve communication throughout the continuum of care, lengths of stay and readmissions for patients transferred to facilities in the network dropped.
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A pilot project providing coaching and follow up for heart failure (HF) patients who are readmitted frequently resulted in a 50% drop in the readmission rate at Indiana University (IU) Health Ball Memorial Hospital in Muncie, IN.
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The recruitment and retention of good case managers has never been more important than it is today. In the early years of hospital case management, many case managers transitioned into the role from utilization review or discharge planning positions.
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Where will we find the new case managers and what will the new candidate look like? They might not be the seasoned clinician as you would hope for. As we need more and more case managers and social workers, some of us might need to look even more broadly for our candidates.
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At Pennsylvania State University (Penn State) Milton S. Hershey Medical Center in Hershey, PA, a long-term acute care liaison evaluates patients with complex needs for potential placement in a long-term acute care hospital (LTACH), coordinates a comprehensive plan for transition with the treatment team, and works with the accepting facility and the patients' insurers to ensure a smooth transition.
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No matter what model of accountable care organization (ACO) the Centers for Medicare and Medicaid Services (CMS) settles on, case managers are sure to be key players as providers focus on managing care efficiently and effectively across the continuum.
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Sumner Regional Medical Center in Gallatin, TN, offers good evidence that quick-turnarounds are indeed possible when you have motivated staff.
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A social work presence in the emergency department (ED) is critical to the effectiveness of the case management process.
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At Cheyenne (WY) Regional Medical Center, recovery audit contractor (RAC) determined that a significant number of surgical one-day inpatient stays should have been billed as observation.
