Hospital Management
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The Pushback to Burdensome Authorization Requirements Has Begun
It is hard to dispute the fact that prior authorization requirements place a heavy burden on both patients and providers. Yet the number of services and medications requiring auths continues to increase. Read on to learn about several trends.
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Patient Care Goes Forward as Planned: ‘You’re Good to Go’
Patients tend to become anxious when scheduled care is cancelled due to authorization holdups. This happened so often in one system that a decision was made to change the process. If the payer takes too long to give an answer one way or the other, things go forward as planned anyway.
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Automation, Artificial Intelligence Future of Patient Access Authorizations
A revenue cycle operator explains how his department is breaking free from old-fashioned practices and moving toward automation.
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Evidence Shows Prior Auth Requirements Hurt Patient Care
Complying with health insurance companies’ prior authorization requirements is demanding ever-increasing resources from patient access. The authors of multiple recent studies found these requirements also stop patients from receiving needed — and sometimes life-saving — medical care.
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The Case Manager’s Toolbox: The Essential Skills of an Effective Case Manager, Part 1
RN case managers and social workers are key advocates in the delivery of quality healthcare. Their broad skills and training allow them to assess patients’ needs and work well with families and other members of the healthcare team. Negotiating, collaborating, communicating, team-building, precepting, educating, and consulting are the basis of what a successful case manager brings to the care setting each day. This month will begin a discussion of the skill sets every case manager and social worker should possess to be as effective in the role as possible.
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Program Tailored to Reducing Senior Patient Readmissions
A program in the Chicago area is demonstrating the value of tailoring discharge plans to the particular needs of elderly patients with little support outside the hospital. These “solo seniors” often face complex medical challenges after discharge and can experience high rates of readmission without help from family and friends. With hospitals facing significant penalties from 30-day readmissions, the program could be a model for hospitals to emulate.
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Case Managers Can Help Patients With Autism Spectrum Disorder
A hospital’s strange sounds, sights, and people can be overwhelming for a child with autism. But a case manager who watches for behavioral cues — and listens carefully to parents — can help that child cope more easily.
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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.
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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.
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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.