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With increasing scrutiny on medical necessity and cuts in reimbursement, along with a growing emphasis on care coordination and transitions in care, case management's position as a major player in the hospital should be assured. But that's not always the case.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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As part of its efforts to cut improper payments, the Centers for Medicare and Medicaid Services (CMS) has launched a three-year Recovery Audit program prepayment review demonstration project in 11 states.
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By identifying community resources for homeless and near-homeless patients, Montefiore Medical Center in the Bronx, NY, is cutting down preventable admissions.
