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With the increase in uninsured and underinsured patients, hospitals face the challenge of finding post-acute care for unfunded or underfunded patients, or keeping them in a bed when they no longer need the acute level of care.
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Case management follows a process, not unlike the clinical nursing process or social work process. By following a process, case managers can function more effectively and efficiently.
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As part of its efforts to cut improper payments, the Centers for Medicare and Medicaid Services (CMS) has launched a three-year Recovery Audit program prepayment review demonstration project in 11 states.
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By identifying community resources for homeless and near-homeless patients, Montefiore Medical Center in the Bronx, NY, is cutting down preventable admissions.
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In the last two issues of Case Management Insider, we reviewed the roles and functions most often associated with the work of case managers in the acute care setting.
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As part of the efforts to ensure that admissions are appropriate, Covenant Health System, with headquarters in Knoxville, TN, is conducting a pilot project to test the effectiveness of having utilization managers review patients admitted to the hospital, and work with the admitting physician to decide whether the patient should be admitted or receive observation services as an outpatient.
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As the Centers for Medicare and Medicaid Services (CMS) continue to increase its focus on discharge planning, case managers need to pay more attention than ever to ensuring that patients have the information they need to make informed choices about their discharge destination, says Jackie Birmingham, RN, MSN, MS, nurse educator/consultant in discharge planning and vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.
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Frail elderly patients are able to stay in their homes, thanks to home visits by an interdisciplinary team from Boston University's Geriatric Service at Boston Medical Center.
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Knowing how to develop an individualized teaching plan for patients is a skill each newly hired nurse must know at Massachusetts General Hospital in Boston.
