Hospital Case Management – June 1, 2005
June 1, 2005
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Take the lead to ensure patients are placed in the right status
Hospitals tread a fine line when it comes to placing patients in observation status. If patients dont meet criteria for observation, your claim probably will be denied. -
Front-end process avoids problems with observation
Hospital case management departments should take the lead in making sure patients are placed in the right status by establishing a front-end process to make sure that problems in observation status vs. admission status dont occur. -
PEPPER can identify areas where denials may occur
If its not currently doing so, your case management department should make use of your Program for Evaluating Payment Patterns Electronic Report (PEPPER) to identify areas where you may be overcoding or undercoding, medical necessity of admissions is questionable, or readmissions are too frequent. -
Talk directly to patients about beliefs, practices
When Sonja Boone, MD, director of diversity for Northwestern Memorial Hospital in Chicago, talks to case managers about how they can provide patient-centered care to people from other cultures, she encourages them to talk directly to the patients about their beliefs and practices and about how the hospital can meet their needs. -
Ambulatory Care Quarterly: ED screening changes put pressure on competitors
When Ocala (FL) Regional Medical Center announced a new screening initiative that would involve counseling nonurgent patients to seek alternative care, a funny thing happened: Local competitors Monroe Regional and Timber Ridge became involved when they heard about our initiative, because they felt they would be inundated by patients who were not having their treatment here, says Susan Atkin, RN, emergency department (ED) director. -
Ambulatory Care Quarterly: To ease overcrowding, delay elective surgeries
No one is claiming its a cure-all for emergency department (ED) overcrowding, but a number of facilities have turned to postponing elective surgeries that require admissions as an important part of a multifaceted plan to ease the burden on their harried ED staff. And when they do, many give the ED manager a key role in the decision-making process. -
Ambulatory Care Quarterly: Attention: ED manager now in the huddle
An administrative huddle at Latter Day Saints (LDS) Hospital in Salt Lake City has been tremendously helpful in determining when to postpone elective surgeries, but it has had a much broader impact on patient flow in the emergency department (ED) and the hospital as a whole. -
Ambulatory Care Quarterly: Do EDs need a policy for e-communications?
While your facility, no doubt, has a Health Information Portability and Accountability Act (HIPAA)-compliance policy, which, among other things, covers electronic communications, it might be a good idea to craft one that is specific to your ED, experts say. -
Critical Path Network: ‘Predicting the future’ helps cut LOS by 50%
Emergency department (ED) managers may not possess a crystal ball, but the ability to predict future events is nonetheless critical to their success, notes Bonnie Coalt, RN, MS, director of nursing at Miami Valley Hospital in Dayton, OH. -
Critical Path Network: ICU reduces mortality of critically ill ICU patients
When reading a New England Journal of Medicine article1 describing intensive monitoring of blood glucose levels for surgical intensive care unit (ICU) patients on ventilators, which resulted in decreased mortality rates, James Krinsley, MD, director of critical care at Stamford (CT) Hospital, had a revelation. -
Critical Path Network: You can save money with supplies and equipment
Two of your surgeons want you to purchase an expensive piece of technology, but youre wary because youre unsure how much they will use it. What should you do? -
Critical Path Network: Journal Review: In-room registration affects ED LOS
In-room registration reduces patients total length of stay significantly, says this study from the Childrens Hospital and Health System in Milwaukee.