Hospital Case Management
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ED Case Managers Can Help Improve Transitions and Outcomes
Case managers in the ED can perform more than utilization reviews. In a newer model for their role, case managers can help put ED patients in touch with resources, helping them avoid readmissions and improve outcomes. Cleveland Clinic realized that with the changing landscape of healthcare, there is a way care management can put patients in touch with the community services they need to stay out of the hospital and ED. Case managers based in the ED can help patients with whatever they will need when they are well enough to leave.
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Case Management Dashboard Can Improve Patient Outcomes
Hospitals and other healthcare organizations can improve patient navigation, quality, and efficiency by creating goals and a plan through data collection and a dashboard. Health systems are successfully using analytics to engage with electronic medical records and in creating roadmaps for patients. Electronic data collection helps health systems predict roadblocks more accurately. It also helps facilitate faster transitions.
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Centralized Utilization Review: Key Considerations for Successful Implementation
As hospitals grapple with ever-changing utilization review (UR) guidelines from CMS and consolidate with other facilities, many are centralizing their UR operations. Under a centralized model, an offsite UR nurse or case manager is alerted when a new patient is admitted and sees all the documentation necessary to determine whether the medical record supports the patient’s status. Centralized UR establishes a standardized common process across facilities, which is a key benefit for multihospital health systems.
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CMS Update: Outpatient Total Knee, Hip Arthroplasty
To provide patients with better value and results, CMS has issued a final rule regarding the inpatient-only list of surgical procedures. This list includes procedures that typically are only provided in the inpatient setting and not paid under the Outpatient Prospective Payment System. Criteria for removing procedure from the inpatient-only list includes determining that the procedure is performed in numerous hospitals on an outpatient basis. For example, total knee arthroplasty moved from the list starting in 2018. Total hip arthroplasty is expected to be removed from the list in 2020.
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CMS 2020 Final Rules: Infection Control in Inpatient and Long-Term Acute Care
Antimicrobial resistance represents a serious risk for Medicare beneficiaries and for the public overall. CMS is finalizing an alternative new technology add-on payment pathway for antimicrobial products designated by the FDA as Qualified Infectious Disease Products (QIDPs). Under this policy, a QIDP will be considered new and will not need to demonstrate that it meets the substantial clinical improvement criterion; it will only need to meet the cost criterion. CMS also is increasing the new technology add-on payment to 75% for an antimicrobial designated as a QIDP.
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CMS Issues 2020 Final Rules for Inpatient and Long-Term Acute Care
The Centers for Medicare & Medicaid Services issued its final rule in August to update the Medicare payment policies for hospitals under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System for fiscal year 2020. Changes were made to the rural hospital wage index, all-cause readmissions, and interoperability.
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Ethical Issues and Standards in Case Management, Part 1
This month, we will discuss principles related to ethics and how they affect one’s role as an RN case manager or a social worker. These principles include patient advocacy, which applies to all the roles and functions that case managers perform.
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Intensive Inpatient Rehabilitation: Optimal Path for Stroke Patients
After acute care, a stroke patient’s discharge plan should include an inpatient rehabilitation facility (IRF) when they meet specific medical criteria, according to the 2016 American Heart Association/American Stroke Association guidelines. Stroke also tops the CMS 13 list, which designates 13 medical conditions that 60% of an IRF’s patients must have for the IRF to qualify. IRFs provide hospital-level care to stroke patients who need intensive, interdisciplinary rehabilitation care provided under the direct supervision of a physician.
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Children With Chronic Illness: When Compliance Is Complicated
Children living with chronic illness often struggle with their treatment regimen. Depression and anxiety may be involved, as the child likely cannot cope. But that is just one component of the noncompliance picture. Psychological and medical trauma, as well as family issues, may be involved.
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Case Studies Offer Clues to How Team Case Management Model Worked
West Virginia University's team case management approach to diabetes management has led to positive outcomes with patients.