Hospital Case Management 2012-07-01

If you haven't expanded your readmission reduction projects beyond heart failure, pneumonia, and acute myocardial infarction, your hospital may find itself with reduced reimbursement in the future, warns Toni Cesta, RN, PhD, FAAN, senior vice president, operational efficiency and capacity management at Lutheran Medical Center in Brooklyn, NY, and partner and consultant in Dallas-based Case Management Concepts.

Extend the discharge plan beyond hospital walls

Instead of thinking of case management as a hospital model, start thinking about case management as a continuum model, which transcends where people receive care, advises Toni Cesta, RN, PhD, FAAN, senior vice president, operational efficiency and capacity management at Lutheran Medical Center in Brooklyn, NY, and partner and consultant in Dallas-based Case Management Concepts.

Involve caregivers in discharge planning

When providers bring the family caregiver into the discharge process early, there is a better chance that the caregiver will be prepared to care for the patient at home, says Carol Levine, director of the Families and Health Care Project for the United Hospital Fund, a non-profit health services research organization based in New York City.

Look beyond the illness to create discharge plan

Case managers are more likely to develop a discharge plan that works if they look beyond the reason for hospitalization and take into consideration everything that has been going on in the patient's life, says Jackie Birmingham, RN, MSN, MS, vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.

CMS continues emphasis on quality, efficiency

In the Inpatient Prospective Payment System (IPPS) proposed rule, the Centers for Medicare & Medicaid Services reiterates its intention to shift Medicare reimbursement from a system based on volume to one based on quality of care.

CM program keeps high utilizers out of hospital

A care management program that concentrates on high-cost and high-utilizing patients with complex medical and psychosocial needs has reduced the overall readmission rate at the University of Michigan Hospitals and Health Centers to 17.4%, down from 20% when the initiative began.

Initiative cuts readmission rate to 15%

When Valley Baptist Medical Center in Brownsville, TX, began a project to reduce readmissions in the fall of 2009, the overall 30-day readmissions rate was 23.3%.

Hospital, post-acute providers collaborate on transitions

When an analysis of readmissions indicated that a significant number of patients being readmitted within 30 days had been discharged to a post-acute provider, TMF Health Quality Institute, the Texas Medicare Quality Improvement Organization (QIO) established regular meetings with hospitals in the community, including Valley Baptist Medical Center in Brownsville, TX, and downstream providers including skilled nursing facilities, long-term acute care facilities, home health agencies, dialysis units, hospice providers, and rehab hospitals in the Brownsville area.

Case Management Insider: The Role of Case Management in an Era of Healthcare Reform Part 1

Healthcare reform has been discussed for many years, at the federal, state and local levels. While its parameters have been unclear until recently, they are now coming into focus.

Stakes Rise on Hospital Readmissions

Include all diagnoses, payers in readmission projects