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Hospital Case Management

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  • Case Managers See an Influx of Elderly Patients in the ED

    As baby boomers shift into their senior years, hospital EDs are seeing increasing numbers of older patients, a trend noted by a care coordinator at the Cleveland Clinic. These older, at-risk patients need case management services.

  • Pulmonary Maintenance Programs Reduce Readmissions, Lower Costs

    A hospital-based pulmonary maintenance exercise program can help patients with chronic lung conditions improve their exercise tolerance and regain some lung function, while reducing readmissions, according to the authors of a recent study. The potential cost savings are significant as well.

  • An Escalation Team Can Improve Care for Complex Cases

    Patients with complex needs can stretch the resources of even the most experienced case manager. These tend to be patients who have been admitted via the ED, not elective admissions. They are ready for discharge, but various barriers can cause complications.

  • Person-Centered Case Management Tool Improves Discharge

    A patient-centered, collaborative case management tool can help hospital case managers anticipate patients’ needs and ensure an appropriate discharge and transition of care. Inadequate care coordination can lead to rehospitalizations and expensive care.

  • The Conditions of Participation for Discharge Planning: Current Rules and 2020 Updates

    In 2015, CMS introduced proposed rules for discharge planning. These proposed rules were to be used to update the current rules under the Conditions of Participation for Discharge Planning. In 2019, CMS provided the elements of the proposed rules that would be adopted in November 2019. This month, we will discuss the current rules, the proposed rules, and the final rules published in 2019.

  • How to Initiate Serious Illness Conversations With Patients

    Patients with serious and life-threatening illnesses are faced with choices on the treatments they receive or elect not to receive. The treatment for a patient with advanced cancer is different than the treatment for a patient with advanced heart failure or chronic obstructive lung disease. However, the essence of a serious illness conversation is the same: What are the patient’s goals, values, and preferences? How do those inform their plan of care?

  • Getting Involved: Case Managers Go to Washington

    Legislation and regulatory changes do not always seem in patients’ best interests. Insurance coverage issues have made news headlines. In skilled nursing facilities, physical therapy time has been limited by CMS, which has also triggered concerns. What can a case manager do? How can one influence state legislators/regulators, and public policy? Advocacy for patients is integral to the case manager’s role.

  • Health System Makes Utilization Review Paperless, More Efficient

    As health systems update and revamp their electronic health records, they might want to consider adding a case management module. An electronic health record that includes an acute case management module with robotic process automation can create seamless efficiency.

  • Ensure Adherence by Addressing Patients’ Social Needs

    If a patient fears he or she will get robbed leaving the pharmacy, he or she is less likely to buy the medication. The patient may be homeless, or simply cannot afford the medication. He or she may struggle with literacy and reading the prescription information. The patient may be depressed, or may not believe the medication will help. These all are realities for patients, especially those living in inner cities. The result is medication nonadherence, which can pose serious consequences for a patient’s health — and lead to billions of dollars in excess healthcare costs in the U.S. annually.

  • Use Data-Driven Dashboard, Other Tools to Assist ED Navigation Team

    ED navigation teams can connect patients to primary care providers, psychosocial programs, and community-based organizations to help keep people out of hospital beds and the ED.