Hospital Case Management 2011-08-01

Today's hospitals are facing a shrinking pool of healthcare dollars along with increased scrutiny from Medicare, Medicaid, and commercial payers and strong penalties for fraud and abuse.

Improper admissions equals paperwork

When patients are admitted to the hospital inappropriately, the paperwork involved to correct the error brings to mind the saying "an ounce of prevention is worth a pound of cure."

Staff ED at peak times for admissions

If you have the emergency department volume and the staffing, covering the emergency department 24 hours a day, seven days a week is optimal, according to Joanna Malcolm, RN, CCM, BSN, consulting manager, clinical advisory services for Pershing, Yoakley & Associates in Atlanta.

ED case managers save $4.5 million

The case management department at Lee Memorial Health System in Fort Myers, FL, has been able to demonstrate a savings of $4.5 million as a result of having case managers in the emergency department.

Use data to justify adding staff in the ED

Arm yourself with data before approaching the administration about establishing an emergency department case management department, increasing staff, or changing hours.

Provider-preventable conditions face cuts

Now that the Centers for Medicare and Medicaid Services (CMS) has launched a program that adjusts Medicaid payments for provider-preventable conditions, including healthcare-acquired conditions, it's essential for case managers to work with physicians to make sure all conditions that are present on admission are clearly documented on a patient's chart.

Pilot project to improve discharge process

As part of Memorial Health System's adoption of the Toyota Lean Processes, the case management department at Saddleback Memorial Hospital in Laguna Hills, CA, has standardized work flow for discharging patients and is piloting the process on one unit.

Ambulatory Care Quarterly: Registration kiosks 'intuitive' for patients

The Medical Center of Central Georgia in Macon was an early adopter of registration kiosks, says Jane Gray, CPA, FACHE, FHFMA, assistant vice president for the revenue cycle.

Ambulatory Care Quarterly: Patients want registrars to educate them

More often, registrars are finding themselves in the difficult position of educating patients about their insurance coverage, according to Steph Collins, manager of patient access at Fairview Northland Health Services in Princeton, MN.

Case Management Insider: Every day, the case management department faces multiple dilemmas over ethics

When case managers think about ethical dilemmas, they are thinking about much more than when to discontinue a ventilator, or to stop treatment, or any of the myriad of clinical ethical decisions that must be made every day in hospitals throughout the United States.

Case Management Insider: An ethical dilemma found in a case study

I will never forget my biggest ethical dilemma. It happened when I was a director of case management at a large medical center in New York City. It was the day after Thanksgiving.

Case Management Insider: Solution: Committees on organizational ethics

One solution to perennial problems such as ethics issues might be the formation of an organizational ethics committee. Different from a clinical ethics committee, an organizational ethics committee deals with organizational dilemmas that should be solved in a formalized manner.

Case Management Insider: The process of ethical decision-making

The ethical decision-making process is similar to the case management process and the nursing process. The steps include:

ED CMs improve throughput, reduce denials

ED case managers are crucial to help maximize reimbursement