-
As part of its efforts to reduce readmissions, WellStar Health System, based in suburban Atlanta, is meeting with post-acute providers to collaborate on ways to make transitions between levels of care smoother. It is piloting a program in which a transition coach works with heart failure patients in the hospital and follows them for four weeks following discharge.
-
Case management follows a process, not unlike the clinical nursing process or social work process. By following a process, case managers can function more effectively and efficiently.
-
With the increase in uninsured and underinsured patients, hospitals face the challenge of finding post-acute care for unfunded or underfunded patients, or keeping them in a bed when they no longer need the acute level of care.
-
In its efforts to ensure that the uninsured and homeless receive the healthcare services they need, Carondelet Health Network in Tucson, AZ, has developed a list of community resources and partnered with community agencies to provide care for patients underserved patients.
-
In order to provide consistent post-acute care for uninsured or under insured patients, hospitals need to think like payers and develop a payment assistance policy so that at admission or registration, a financial counselor can do a quick assessment and determine who qualifies and who doesn't, according to Matt Boettcher, LSW, MSW, vice president for continuum of care for Scott and White Healthcare, with headquarters in Temple, TX, and consultant for the Center for Case Management, a patient care management consulting firm based in Wellesley, MA.
-
At Montefiore Medical Center in the Bronx, NY, a complex care case manager coordinates appropriate post-discharge options for uninsured and under-insured patients who are likely to need complex care after discharge.
-
In Lee County Florida, providing healthcare for the uninsured and under insured is a community-wide effort, according to Chris Nesheim, RN, MS, CMAC, system director, case management, Lee Memorial Health system with headquarters in Ft. Myers, FL.
-
Faced with an increasing number of patients who have no insurance and can't afford to pay for their own care, the University of Iowa Hospitals and Clinics in Iowa City, has developed a multi-pronged approach to identify indigent patients early in their stay and help them get access to community providers who can provide ongoing care.
-
Frail elderly patients are able to stay in their homes, thanks to home visits by an interdisciplinary team from Boston University's Geriatric Service at Boston Medical Center.
-
As the Centers for Medicare and Medicaid Services (CMS) continue to increase its focus on discharge planning, case managers need to pay more attention than ever to ensuring that patients have the information they need to make informed choices about their discharge destination, says Jackie Birmingham, RN, MSN, MS, nurse educator/consultant in discharge planning and vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.
