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The Centers for Medicare & Medicaid Services (CMS) has announced a pause in the Recovery Auditor program while it develops new contracts with the auditors, and so the auditors can complete all claims reviews before the current contracts expire.
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After St. Rose Hospital in Hayward, CA, started its readmission reduction program, the community hospitals 30-day readmission rate for all diagnoses dropped by 37% and the 90-day readmission rate declined by 43%.
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In the past, the highest-cost Medicaid patients often received care from a variety of different entities that did not always coordinate with each other and often provided duplicative services, says Deirdre Astin, health program administrator, New York State Department of Health. The health home model aims to change all of that, she says.
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The care managers at St. Vincents Hospital and Saint Josephs Medical Center never know what the day may bring, says John Francis, LSCW, who oversees the care managers.
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Sometimes the best lessons come when things do not work out as planned. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, learned that in the aftermath of a project for his masters degree three years ago. At the time, he was assistant manager in a neuro intensive care unit.
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It is not always easy to get people to change behaviors. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, experienced that when he tried to get nurses on a neuro intensive care unit to start giving report in the room with patients and their families. There was always a reason why some nurses just couldnt do it.
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In the last few months of 2013 and the beginning of this year, some ED administrators around the country observed a curious variation in their data.
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The Centers for Medicare & Medicaid Services Probe and Educate initiative to determine hospitals compliance with the two-midnight rule makes it clear that case managers must review physician documentation as well as medical necessity.
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Case managers have been an integral part of the discharge planning process for decades. Typically this process has involved an in-depth assessment of the patient, which has included their clinical as well as psychosocial, financial and living situations
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When BK Kizziar, RN-BC, CCM, was in the hospital following surgery, a case manager walked into her room the day before discharge and asked whether she wanted to go to an acute rehab facility or have physical therapy sessions at home.
