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Have community advisory groups give feedback not only on clinical processes, but also the revenue cycle, advises Richard L. Gundling, FHFMA, CMA, vice president of healthcare financial practices for the Healthcare Financial Management Association (HFMA).
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Hospitals are left in an untenable position due to changes in policy by the Centers for Medicare and Medicaid Services (CMS) that are causing hospitals to place patients in observation status for more than 48 hours instead of admitting them, according to an April 27, 2012, amicus brief filed by the American Hospital Association (AHA).
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The publics awareness of the U.S. Senate investigation of Accretive Health, a debt collection company hired by a Minnesota hospital to do registration and upfront collections, has important implications for patient access departments, says Jessica Curtis, director of Boston-based Community Catalysts Hospital Accountability Project.
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A pilot program at MetroHealth Medical Center in Cleveland resulted in significant drops in emergency department visits among Medicaid recipients who were "ultra-users" of emergency care and participated in the one-year study.
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For years, the Centers for Medicare & Medicaid Services (CMS) state operations manual has had guidelines for surveyors to assess issues related to patient safety at hospitals. But there is such a wide range in size and scope of hospitals, says Marilyn Dahl, CMS director of the division of acute care services, that the organization decided it would be a good idea to create some sort of prompt for surveyors to use.
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To prevent readmissions when patients are transitioning from the acute care hospital to an inpatient rehabilitation center, case managers should make sure the patients are appropriate for acute rehab, that their medical conditions are stable, and that they can tolerate three hours of physical therapy every day.
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As we discussed last month, healthcare reform has changed the landscape of healthcare and of case management. Emerging trends and changes related to reimbursement, readmissions, pay for performance, outcomes and newly contracted reviewer agencies such as the Recovery Audit Contractors (RACs), have changed familiar payment methods and audits to new and different ones in a short amount of time.
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At St. Joseph's Hospital in Tampa, a multidisciplinary team collaborates with clinicians throughout the continuum to manage the care of heart failure patients.
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As reimbursement adjustments under the Centers for Medicare & Medicaid Services' (CMS) Value-based Purchasing (VBP) Program start to kick in this October 1, it's more important than ever for case managers to be pay attention to overall quality improvement and not just concentrate on particular patients or conditions, says Danielle Lloyd, MPH, vice president for policy development and analysis for the Premier healthcare alliance, with headquarters in Charlotte, NC.
