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When Sarasota (FL) Memorial Hospital began experiencing a big spike in emergency department diversion, the hospital created a multidisciplinary committee to determine why the diversion was occurring.
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Having a dedicated team responsible for following up on denied claims has generated an average of $2 million or more in recovered revenue for United Health Service Hospital every year since the first full year of the initiative in 2001.
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The functions that case managers perform in your hospital can have a big effect on the caseload they can comfortably handle, says Toni Cesta, RN, PhD, FAAN, vice president for patient flow optimization at the North Shore-Long Island Jewish Health System.
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It's happening all the time at hospitals across the nation. When a new initiative, like DRG assurance or clinical documentation improvement is developed, it's turned over to the case managers "because they're already in the charts."
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Finding, motivating, and retaining qualified case managers and support staff can be a challenge. The reasons for employee turnover are many low unemployment, a more mobile work force, promises of higher wage and benefit levels, and feelings of not being recognized or appreciated.
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When a representative from the case management department began attending the daily meeting of a large hospitalist group at St. Vincent's Medical Center, the Jacksonville, FL, hospital began to see an improvement in patient throughput almost immediately.
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Thanks to an intensive program monitoring the core measures requirements throughout the hospital, Methodist Medical Center has been ranked among the top three hospitals in the state of Tennessee for compliance with the core measures for two years in a row.
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Following a successful pilot project that decreased the patient-case manager ratio, Our Lady of the Lake Medical Center in Baton Rouge, LA, hired additional staff, reducing the caseload of case managers on the medical unit and giving them more time to interact with the patients and concentrate on discharge planning needs.
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Garnering patient satisfaction scores in the 95th percentile is impressive, but doing it for 10 consecutive years really makes people sit up and take notice.