Hospital Case Management – August 1, 2009
August 1, 2009
View Issues
-
Case management affects bottom line, quality of care, regulatory compliance
Hospital reimbursement is being squeezed from all sides. In the proposed Inpatient Prospective Payment System rule for fiscal year 2010, the Centers for Medicare & Medicaid Services (CMS) has proposed slashing the Medicare reimbursement update to account for improvements in documentation and coding and limiting reimbursement for readmissions. -
ED gatekeepers essential to financial health
A robust emergency department case management program is becoming essential as hospitals struggling with capacity and payer sources clamp down on inappropriate admissions, says Toni Cesta, RN, PhD, FAAN, senior vice president, operational efficiency and capacity management at Lutheran Medical Center in Brooklyn, NY. -
Extra diagnostic testing can cost hospitals big
Hospitals are losing large amounts of money on extra and inappropriate diagnostic testing and procedures, as well as outpatient procedures performed in the inpatient setting because third-party payers frequently are denying the claims, says Brenda Keeling, RN, CPHQ, CPUR, of Patient Response, a Milburn, OK, health care consulting firm. -
Claims data analysis helps hospital recoup revenue
By analyzing claims data to assure that the hospital was reimbursed appropriately and aggressively appealing all denials and underpayments of claims, DCH Health System in Tuscaloosa, AL, was able to generate a 1.25% increase in net patient revenue. -
Critical Path Network: Throughput initiatives lower discharge time by two hours
Through a series of initiatives aimed at increasing patient throughput, Bay Medical Center in Panama City, FL, has lowered its average discharge time by two hours. -
Critical Path Network: Special discharge area frees up beds
Faced with a high census and backups in the emergency department, Bay Medical Center in Panama City, FL, created two discharge areas where patients who were waiting for transportation to home or a nursing home could wait, freeing up much-needed beds on the units. -
Critical Path Network: Patient-, family-centered care helps decrease LOS
By involving patients and family members in the treatment plan and discharge process before they are admitted to the hospital for treatment, the staff at Moffitt Cancer Center in Tampa, FL, within a five-month period of time decreased length of stay by almost two days and achieved a 7% increase in the number of admissions involving hematology patients. -
ED CM facilitates appropriate care level
As emergency department case manager, Janeice Garrison, RN, MSN, BC, sees herself as the "point guard" for the hospital in a large, mostly rural area where the population is growing by an average of 22.4% a year and the percentage of uninsured, undocumented, and homeless patients is increasing. -
Access Management Quarterly: Identify uncollectible accounts early
Is a patient's account uncollectible? Is your self-pay patient eligible for financial assistance? Both of those scenarios are becoming more common due to the recession and if the answer to either of those questions is "yes," you should know sooner rather than later.