Hospital Management
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Hospitals push back against reimbursement cuts due to Two-Midnight rule
Hospitals across the country have filed lawsuits challenging the decision by CMS to reduce Medicare reimbursement by 0.2% to compensate for the financial effect of the Two-Midnight rule.
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Case management’s role in the new proposed bundled payment program
As we have discussed in prior editions of Case Management Insider, the 2010 Affordable Care Act was a game changer for the healthcare system. The payment reforms it introduced began the process of requiring health systems to communicate across the continuum of care and to reduce and/or eliminate existing silos. This across-the-continuum integration required sharing of accountability for cost and quality of care among providers.
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Ensure that services observation patients receive are necessary and timely
The move by CMS to change the payment methodology for patients receiving observation services means it’s more important than ever for case managers to ensure that patients receive the services they need in a timely manner and that they receive only the care they need while they are in an acute care setting, says Amy M. Smith, RN, MSN, CCM, director of case management at Dartmouth-Hitchcock Medical Center, a 421-bed academic medical center in Lebanon, NH.
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Ensure that patients meet criteria, documentation supports it
If you’ve got a system for getting patient status right up front and it works, don’t change anything but make sure that the documentation is detailed and complete, advises Linda Sallee, RN, MS, CMAC, ACM, IQCI, director for Huron Healthcare with headquarters in Chicago.
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Who’s in observation? The treatment team needs to know instantly
Patients receiving observation services can fall through the cracks and stay in the hospital longer than necessary if there’s not a way for the treatment team to easily distinguish between them and admitted patients.
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Review patients at every entry point to ensure patient status
The solution to getting patient status right is to have case managers in the right places to review the cases of patients who are coming into the hospital, says Beverly Cunningham, RN, MS, consultant and partner at Oklahoma-based Case Management Concepts.
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Inpatient or observation: Will the difference ever be clear?
CMS has been trying for several years to clear up the confusion about which patients should be admitted as inpatients and which should receive observation services as outpatients, but the new rules seem to make it more difficult to understand.
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Unnecessary blood tests are common prior to low-risk surgery — high variation among facilities
Depending on which facility patients go to for their low-risk surgical procedure, they may be 2.4 times more or less likely to be sent for unnecessary blood tests.
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High rate of office visits and cumulative costs prior to colonoscopies for colon cancer screening
Kevin R. Riggs, MD, MPH, instructor at the Johns Hopkins University School of Medicine, Baltimore, and colleagues analyzed billing data to determine the proportion of colonoscopies for colon cancer screening and polyp surveillance that were preceded by office visits.
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Are flexible resident duty hour policies safe for surgery patients?
Allowing residents the flexibility to work longer shifts than allowed in the United States and to take less time off between shifts to provide continuity of patient care is not associated with a greater risk to patients of early serious postoperative complications or death, according to study results involving 117 U.S. general surgery residency programs and 151 hospitals.