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As part of Cigna's Collaborative Accountable Care initiative, physician practices hire care coordinators who work with patients on following their treatment plan and link them to Cigna resources when needed.
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Case managers are working long hours and most get only cost-of-living raises.
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Mountain State Health Alliance opened a free heart failure clinic after determining that patients' inability to get a timely follow-up appointment and financial issues were the cause of many readmissions.
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When hospitals determine after discharge that a patient did not meet inpatient criteria, they can file a provider liable claim using Condition Code W2 and be reimbursed for all services as if the patient were an outpatient, according to Deborah Hale, CCS, CCDS.
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At The Nebraska Medical Center in Omaha, pharmacists are part of a multidisciplinary team and see many patients in person starting on Day 1.
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Having pharmacists on the multidisciplinary team can help ensure that patients progress well in the hospital and that they follow their medication plan at home and avoid emergency department visits or readmissions.
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The pharmacy at Strong Memorial Hospital in Rochester, NY, fills about 75% of the prescriptions that patients are given at discharge.
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Hospitals are running the gamut of possible solutions as they struggle to interpret the provisions of the the Health Insurance Portability and Accountability Act (HIPAA) privacy rule, says Tony Mogavero, director of physician services for St. Petersburg, FL-based John Putnam International, a company that provides web-based and teacher-led education for access personnel.
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One of the major challenges facing case managers is what to consider when selecting comparative performance data. But that is just the first of several questions that must be addressed, says Patrice Spath, BA, RHIT, a consultant in health care quality with Brown-Spath & Associates in Forest Grove, OR. It also is important to identify and correct serious flaws in utilization and outcome data, she adds.
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Every year, Hospital Case Managements reader survey asks case managers what they like most and least about the newsletter. And every year, readers variously compliment and criticize us for the extent to which we cover clinical pathways.