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Every case manager encounters challenging patients and family members those who are angry, provocative, depressed, or just plain ornery. That's because people in the hospital are sick, under stress, and often fearful about their situation.
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After Good Samaritan Hospital Medical Center in West Islip, NY, began a comprehensive process to reduce readmission rates for heart failure patients, readmission rates dropped from 21.1% to 15.3% in just a few months.
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Getting an entire staff of physicians, nurses, and techs to do things differently is never easy, but you can clear away hurdles by giving them the ability to formulate some of their own solutions. That, at least, has been the experience of Swedish Medical Center in Issaquah, WA, in its quest to implement a more efficient, no-wait ED concept. The approach appears to be sitting well with patients, too.
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A Hartford (CT) Physician Hospital Organization's program to reduce the rate of readmission for patients discharged with a primary diagnosis of heart failure has kept the readmission rate at between 11% and 13% for the last year, according to Linda Conroy, RN, BSN, clinical integration case manager for the Hartford Physician Hospital Organization, a partnership between Hartford Hospital and Hartford Physicians Association.
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The role of the social worker in the acute care setting has been evolving for the last two decades.
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Healthcare reform makes processes for insurance verification a top priority for patient access areas, says Sebrena Johnson, manager of insurance verification and precertification in the Admission Services Department at Cone Health System in Greensboro, NC.
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The publics awareness of the U.S. Senate investigation of Accretive Health, a debt collection company hired by a Minnesota hospital to do registration and upfront collections, has important implications for patient access departments, says Jessica Curtis, director of Boston-based Community Catalysts Hospital Accountability Project.
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Hospitals are left in an untenable position due to changes in policy by the Centers for Medicare and Medicaid Services (CMS) that are causing hospitals to place patients in observation status for more than 48 hours instead of admitting them, according to an April 27, 2012, amicus brief filed by the American Hospital Association (AHA).
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Have community advisory groups give feedback not only on clinical processes, but also the revenue cycle, advises Richard L. Gundling, FHFMA, CMA, vice president of healthcare financial practices for the Healthcare Financial Management Association (HFMA).
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Patient access departments need to prepare for a “great increase” in the volume of patients who are eligible not only for Medicaid, but also private insurance policies, as a result of the Patient Protection and Affordable Care Act (PPACA) according to Luis Guerrero, director of patient access services at Ochsner Baptist Medical Center in New Orleans.
