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[Editor's note: Last month in Case Management Insider, we started our discussion on the case management process. We reviewed the first two steps in the process which were "selection and screening" and "patient assessment and diagnosis." In this month's edition we will continue to review the steps that case manager's use in their daily work to achieve positive outcomes for their patients and their organizations.]
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The Centers for Medicare and Medicaid Services (CMS) instructed state Medicaid agencies to develop a RAC program by Jan. 1 of this year but the program is not expected to be in full swing until well into 2013.
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Many hospital associates believe that registration staff simply sit at their desk and greet patients, reports Barbara Blum, director of access, admitting, and registration at MedStar Health in Columbia, MD. "They have no idea what the registration staff's responsibilities include," Blum says.
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The U.S. Department of Health and Human Services (HHS) has delayed the implementation of the ICD-10 procedure and diagnostic coding set, but that doesn't mean that hospitals can forget about preparing for the conversion to the new system, says Deborah Hale, CCS, CCDS, president and chief executive officer of Administrative Consultant Service, a healthcare consulting firm based in Shawnee, OK.
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Before North Broward Medical Center in Deerfield Beach, FL, re-engineered its discharge process two years ago, 29% of patients were being readmitted within 30 days. Now, the figure has dropped to 15%.
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The Agency for Healthcare Research and Quality (AHRQ) has created a website with a wealth of tools to help hospitals set up the Comprehensive Unit-based Safety Program (CUSP). (www.ahrq.gov/cusptoolkit) Frontline users that have implemented CUSP say they not only reduced infections, but dramatically transformed their overall patient safety culture.
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Operating a small hospital doesn' t mean you can' t think big. Ellenville Regional Hospital (ERH), a 25-bed rural hospital in Wawarsing, NY, is enjoying success with a medication reconciliation and patient safety project that would be the envy of any large teaching institution by reducing medication-related events to a very low 0.1 occurrences per 1,000 doses dispensed.
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By revamping the discharge process and working with post-acute providers, UConn Health Center/John Dempsey Hospital, Farmington, CT, reduced 30-day heart failure readmissions from 25.1% in August 2010 to 17% in March 2012.
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Helping your hospital optimize reimbursement and avoid losing money in today's healthcare audit environment starts with ensuring that the patient is in the right level of care from the beginning and this means making sure that observation services are ordered only when they are appropriate.
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If patients are admitted to the hospital when outpatient services were appropriate, the level of care can be changed, but there's a lot of paperwork involved to correct the error.
