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Care guides who work with patients at Minneapolis-based Allina Hospitals & Clinics primary care clinics wear business casual clothes and sit in cubicles in the clinic waiting areas, which makes them accessible to the patients who come to see their doctor.
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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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Orientation should be geared to the experiential level of the new staff. The novice case manager will require a different orientation than the experienced case manager. You will need to determine this based on an assessment of the new staff member.
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Your job descriptions should clearly define the minimum amount of education that you require for the role of case manager or social worker.
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Most of the items in in the box "Characteristics and Core Competencies of Potential Candidates" (below) are inherent and/or learned over time.
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When the Inpatient Prospective Payment System (IPPS) final rule for 2012 was issued, the Centers for Medicare and Medicaid Services (CMS) stated that its goal is to encourage hospitals to provide higher quality of care at a lower cost and to promote greater efficiencies across all care settings and throughout the entire health system.
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A year after Saint Joseph-London Hospital in London, KY, began a heart failure readmissions program, 30-day readmissions dropped from 27.7% to 15.9%. A similar program for patients admitted for acute myocardial infarctions (AMI) reduced the readmissions rate from 23% to 10% in a short time.
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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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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.