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Millions of Americans live with chronic conditions: diabetes, hypertension, arthritis, pain, and myriad other illnesses and injuries. When chronic conditions worsen or unrelated acute episodes occur, hospitalization may become necessary.
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Instead of handing patients piles of papers during the discharge planning process, case managers and social workers at The Valley Hospital in Ridgewood, NJ, simply refer them to the hospital's Valley C.A.R.E.S. web site, a resource with links to more than 2,000 agencies, facilities, organizations, and informational sites.
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When a patient is admitted to the hospital with a chronic condition such as pain, one of the key elements of assessment is to determine what medications including prescriptions drugs and nonprescription medications and supplements the individual is taking. It is not uncommon for some patients, particularly older adults, to take 10 or more prescription medications a day.
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Unnecessary hospital readmissions can be avoided by a "whole-family" approach to discharge planning. Medicare requirements and The Joint Commission focus on evaluating and meeting the patient's needs, yet engagement and active participation of the family or lay caregivers also is central to improving the patient's transition from hospital to home.
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If your case management department isn't involved in the business side of health care, you're missing opportunities to affect your hospital's bottom line and to ensure that your patients get the most effective, cost-efficient care.
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Faced with an audit that eventually revealed millions of dollars in Medicare overpayments for short-stay patients placed in the wrong admission status, Saint Joseph's Hospital in Atlanta began a series of proactive steps to correct the problem, educate staff, and assure that InterQual criteria are applied correctly.
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By reviewing the discharge dispositions of patients whose hospital stay was covered by the Medicare post-acute transfer rule, Jupiter (FL) Medical Center in Florida was able to generate an additional $108,000 in reimbursement in just one year.
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Three years ago, the management team at Orlando Regional Healthcare System took a hard look at managed care denials, recalls Craig Pergrem, CHAM, MBA, corporate director of patient business, and asked, "What can we do to stop the bleeding?"
