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A proposal by the Centers for Medicare & Medicaid Services (CMS) to include nearly half of the existing diagnosis-related groups (DRGs) covered by the post-acute care transfer rule will cut Medicare payments to hospitals by $880 million a year, or approximately 1.1% of Medicare payments, according to the Chicago-based American Hospital Association (AHA).
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In much the way 401k investment plans forever changed retirement benefits and led to the realignment of the financial industry in the 1980s, a concept called consumer-directed health care (CDH) appears poised to transform the way health care is delivered.
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By modifying its automated case management system to identify patients with barriers to discharge, enabling the clinical staff to set priorities, Good Samaritan Hospital in Baltimore was able to decrease the percentage of denied days by more than 50% in just six months.
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Hospital case management should be a team approach, with everyone on the team looking at what needs to be done for the patients and making sure it gets done, says Judith Martin, RN, CCM, director of medical management for Regional Medical Center, a division of Trover Foundation, a nonprofit health care organization in Madisonville, KY.
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Commissioners with the Commission for Case Manager Certification (CCMC) frequently are asked in many forums, such as conferences, how applicants can study and prepare for the Certified Case Manager (CCM) certification exam.
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Case management directors struggle daily with how best to assign caseloads to their staff, but its not enough to rely on benchmarks of caseload statistics. Many other factors can affect how many patients a case manager can manage adequately, experts say.
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Collaboration between key hospital departments is crucial to making sure discharge planning starts at the earliest possible point in the patient encounter, and the latest advances in technology certainly can facilitate the necessary interdepartmental communication.
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A pilot project under way at Arnot Ogden Medical Center in Elmira, NY, is assessing how likely patients are to adhere to their prescribed medication regimen, with the ultimate goal of helping them to become more compliant, says Tina Davis, RN, MS, CNS, senior director of continuum of care.
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When the case management department at University of Wisconsin Hospitals and Clinics implemented a series of initiatives to improve the throughput of patients, the average length of stay for surgical patients dropped from 7.9 days to 4.6 days and overall length of stay dropped from 6.3 days to 5.1 days including all the outliers.