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The Centers for Medicare & Medicaid Services (CMS) continues to move at a rapid pace toward value-based purchasing, proposing expansion in hospital quality reporting requirements and increasing the number of hospital-acquired conditions for which Medicare won't reimburse.
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Case managers should be involved in their hospitals' efforts to ensure compliance with the Centers for Medicare & Medicaid Services (CMS) regulations that require documentation of conditions that are present on admission and deny payment for certain conditions acquired during the hospital stay, experts say.
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When a patient discharged on a Friday is back in the hospital the following Monday, there can be many reasons.
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As the Centers for Medicare & Medicaid Services (CMS) moves to strengthen the tie between quality of care and hospital reimbursement, hospitals should take a systematic and universal approach to identifying patients at risk and preventing hospital-acquired conditions for all patients and not just those covered by Medicare, says Leslie Schultz, RN, NEA-BC, PhD, CPHQ, director, knowledge transfer for Premier Inc.
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As the result of an initiative in which the entire hospital staff collaborate to improve length of stay, Spartanburg (SC) Regional Healthcare System's average severity-adjusted length of stay has dropped from an average of 5.40 days in 2007 to an average of 5.18 days so far in 2008.
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At Loma Linda (CA) University Medical Center, ED nurses have decreased door-to-EKG time to 11 minutes from almost an hour a year ago, reports Teri D. Reynolds, RN, BSN, clinical educator in the department of emergency services.
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Case managers act as the safety net in making sure that patients receive appropriate evidence-based care interventions and ensuring safety protocols and preventive measures are in place at Baystate Medical Center in Springfield, MA.
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A clinical documentation improvement program at Moses Cone Health System in Greensboro, NC, has resulted in a 6.43% increase in the case mix index and a 7.5% rise in the severity of illness weight.
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Ongoing education between the clinical documentation improvement specialists, the coders, and managers of each department is essential to the success of Moses Cone Health System's clinical documentation improvement initiative, says Mary Beth Brown, RN, BSN, CPHM, manager of utilization review of clinical documentation improvement.
