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A program that provides support for uninsured patients has saved $4.56 million over 18 months at Memorial Hermann Healthcare System in Houston.
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Not only is the emergency department (ED) not just for admissions, but it has become a key and strategic element of today's case management departments. A primary route of entry for many patients across the United States, it can make or break a hospital in today's highly audited environment.
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The emergency department (ED) case manager has four principal roles that should be observed. Those role are as follows:
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Recognizing that hospital readmissions are costly for providers and insurers alike, Blue Cross and Blue Shield of Illinois and the Illinois Hospital Association are collaborating on a quality initiative to reduce the rate of hospital readmissions.
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When it comes to ensuring that patients are receiving high-value, cost-effective care, case managers are where the rubber hits the road, says Michael Taylor, MD, vice president of operations at Executive Health Resources, a Newton Square, PA, healthcare consulting firm.
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After Bassett Medical Center in Cooperstown, NY, began a multidisciplinary program to reduce readmissions, the 30-day readmission rate for high-risk patient diagnoses dropped 70% from 13.4% in 2009 to 0.7% 2010. The initiative earned the medical center a Pinnacle Award for Quality and Patient Safety from the Hospital Association of New York State.
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A pilot program in which parents or caregivers of patients were screened for health literacy reduced healthcare costs and emergency department use for patients at Cook Children's Medical Center in Fort Worth, TX.
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Systems will need to be remediated if they will be used to check medical necessity for ICD-10 standards when they are implemented in October 2013, says Jeffrey Smith, RN, MBA, CPC, a New York City-based manager at Accenture Insight Driven Health, a management and technology consulting company.
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As the clock ticks down toward the implementation of ICD-10, case managers should start learning about the new coding requirements and how they are going to affect what they do on a daily basis.
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As case management leaders, you will be looking for the next generation of case managers to come from the bedside. The following information will review the process you might consider using to facilitate recruitment of staff to your department.
