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ED Coding Update: This quarterly column is written by Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC,President of Edelberg Compliance Associates,Baton Rouge, LA.
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To address declining volumes and suboptimal patient satisfaction in the ED, administrators at North Adams Regional Hospital used lean techniques to eliminate waste and streamline the triage process.
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Since Optima Health began its Mission Health wellness and disease management program five years ago at a large employer group, 84% of the 450 participants with diabetes have taken their medication as ordered, compared with just 55% when the program began.
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Faced with a growing population with diabetes and soaring costs for managing the disease, payers and providers are focusing on preventing and managing the disease that costs the American economy an estimated $245 billion a year a 41% increase over the $174 billion estimated cost in 2007, according to a report by the American Diabetes Association.
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How can you make sure that your nurses make a difference to the outcomes of your patients? According to a study in the January issue of Medical Care1, all it takes is a good patient/nurse ratio and good leadership.
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For the past few years, the ED at St. Mary Medical Center in Langhorne, PA, has seen double-digit increases in patient volume. The surging demand has been difficult, to say the least. And by early 2012, administrators realized it was time for a change in course.
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Instead of waiting until members develop diabetes to intervene, Molina Healthcare is offering members with pre-diabetes a chance to participate in the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program, a prevention program that encourages moderate weight loss, exercise, and lifestyle changes.
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In addition to providing health coaching and care coordination for members who already have developed diabetes, Independence Blue Cross, with headquarters in Philadelphia, provides coaching for members at high risk for developing the disease.