Hospital Case Management 2006-10-01

Brace yourself for changes in the DRG model with more on the way

The Centers for Medicare & Medicaid Services (CMS) has announced significant changes in the inpatient prospective payment system, including interim steps toward a comprehensive revision of the DRG model to tie reimbursement more closely to the severity of the patient's condition.

Initiative focuses on eliminating roadblocks

At Edward Hospital in Naperville, IL, advanced practice nurses take the lead in meeting the hospital's goals of being in the top 10% of the core measures and other performance measures.

Critical Path Network: Team approach to improving documentation pays off

A team approach to documentation enhancement has resulted in a reduction in accounts receivable days, more accurate billing, and dramatic decreases in the number of queries to physicians for clarification about documentation at the Catholic Health System of Buffalo, NY.

APNs ensure patients move through the continuum

Case management is a collaborative process at Edward Hospital in Naperville, IL, with advanced practice nurses leading a team that includes utilization managers, social workers, and staff nurses.

Critical Path Network: Geriatric CMs collaborate on discharge planning

When an elderly patient is hospitalized at Lee Memorial Hospital in Fort Myers, FL, the case managers on the unit may call in a geriatric care manager who already has been working with the patient and has additional information that will be useful in creating the discharge plan.

Critical Path Network: CMS unveils planned changes to EMTALA

In its final inpatient prospective payment system (PPS) regulations for fiscal year 2007, the Centers for Medicare & Medicaid Services (CMS) has included some "modest" changes to the Emergency Medical Treatment and Labor Act (EMTALA) regulations, says M. Steven Lipton, an attorney with Davis Wright in San Francisco.

Be vigilant when it comes to fraud/abuse compliance

With the Office of the Inspector General (OIG) announcing its intention to cut down on Medicaid and Medicare fraud, it is more important than ever for case managers to make sure that they report any fraudulent conduct and carefully document it to avoid being held responsible, Elizabeth Hogue, Esq., suggests.

Discharge Planning Advisor: 'Basics' may be pushed aside in rush to trendier remedies

Discharge planning starts at admission. It's one of the most basic tenets of the discipline, notes Jackie Birmingham, RN, MS, CMAC, but one that is increasingly brushed aside as hospitals focus on utilization review (UR) and bed management in an effort to enhance patient throughput.

Discharge Planning Advisor: Maryland facility begins 'discharge by appointment'

This month, St. Joseph's Medical Center in Towson, MD, will begin discharging patients by appointment, in the latest phase of a three-year effort toward capacity maximization, says Jackie Connor, RN, MS, CCS, director of case management.

Hospital Case Management – October 1, 2006

October 1, 2006