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Hospital Case Management

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  • Patient Transitions — It’s Not Just Discharge Planning Anymore

    Prior to the advent of the inpatient prospective payment system (IPPS), the discharge planning process was simpler and slower. Patients generally stayed in the hospital until they were well and then went home.
  • Are you ready for ICD-10 implementation?

    Implementation of ICD-10 has been postponed until Oct. 1, 2015, and all claims submitted after that point must use the new coding system.
  • CMS calls a temporary halt to the RA program

    The Centers for Medicare & Medicaid Services (CMS) has announced a pause in the Recovery Auditor program while it develops new contracts with the auditors, and so the auditors can complete all claims reviews before the current contracts expire.
  • Program cuts 30-day readmit rate to 10.6%

    After St. Rose Hospital in Hayward, CA, started its readmission reduction program, the community hospitals 30-day readmission rate for all diagnoses dropped by 37% and the 90-day readmission rate declined by 43%.
  • Health homes focus on needs in, out of system

    In the past, the highest-cost Medicaid patients often received care from a variety of different entities that did not always coordinate with each other and often provided duplicative services, says Deirdre Astin, health program administrator, New York State Department of Health. The health home model aims to change all of that, she says.
  • Never a dull moment in a health home

    The care managers at St. Vincents Hospital and Saint Josephs Medical Center never know what the day may bring, says John Francis, LSCW, who oversees the care managers.
  • Checklists come to nursing

    Sometimes the best lessons come when things do not work out as planned. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, learned that in the aftermath of a project for his masters degree three years ago. At the time, he was assistant manager in a neuro intensive care unit.
  • Common reasons against in-room report

    It is not always easy to get people to change behaviors. Nathan Rozeboom, RN, MPH, CCRN, a nurse manager at Harborview Medical Center in Seattle, experienced that when he tried to get nurses on a neuro intensive care unit to start giving report in the room with patients and their families. There was always a reason why some nurses just couldnt do it.
  • Unexpected drop-offs in demand cause worry

    In the last few months of 2013 and the beginning of this year, some ED administrators around the country observed a curious variation in their data.
  • Audits highlight need for documentation

    The Centers for Medicare & Medicaid Services Probe and Educate initiative to determine hospitals compliance with the two-midnight rule makes it clear that case managers must review physician documentation as well as medical necessity.