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Examples of financial outcomes measures include length of stay (LOS), cost per day, cost per case, and third party payer denials.
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Quality outcome metrics, compiled for the entire organization, include readmissions, discharge/disposition delays, delays in service/turnaround time, patient satisfaction, and inappropriate admissions.
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Beginning with discharges on Oct. 1, 2012, your hospital's reimbursement could be affected by its performance on quality measures as the Centers for Medicare & Medicaid Services (CMS) implements the value-based purchasing program mandated by the Patient Protection and Affordable Care Act.
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A new regulation from the Centers for Medicare & Medicaid Services (CMS) will have a far-reaching impact on Medicare patients and their providers, including hospital-based case managers, says Jackie Birmingham, RN, BSN, MS, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group.
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Faced with an influx of patients following Hurricane Katrina, North Oaks Health System in Hammond, LA, placed case managers in the emergency department, an initiative that ultimately led to 24-7 coverage by emergency department case managers.
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Since case management's entry into the acute care setting in the mid-1980s, most of the significant changes in health care delivery have been associated with changes in health care's reimbursement structure.
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As part of its transition to becoming an accountable care organization, Cheyenne (WY) Regional Medical Center has redesigned its case management model and implemented a transfer center, a single point of entry for all patients whether they are transfers from smaller hospitals, direct admits from provider offices, or patients admitted by emergency department physicians.
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How's this for a turnaround? A few years ago, patient satisfaction levels in the three EDs of the Cambridge (MA) Health Alliance were in the lowest decile in Massachusetts, and now they are consistently in the top quartile.
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The dramatic improvements achieved in patient flow at Cambridge (MA) Health Alliance could not have been possible without culture change, says Assad Sayah, MD, FACEP, chief of emergency medicine for the system.
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By taking a proactive approach to patient status and instituting a series of checks and balances, Good Samaritan Hospital in Dayton, OH, keeps denials at a minimum.
