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As the Centers for Medicare & Medicaid Services (CMS) moves to strengthen the tie between quality of care and hospital reimbursement, hospitals should take a systematic and universal approach to identifying patients at risk and preventing hospital-acquired conditions for all patients and not just those covered by Medicare, says Leslie Schultz, RN, NEA-BC, PhD, CPHQ, director, knowledge transfer for Premier Inc.
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As the result of an initiative in which the entire hospital staff collaborate to improve length of stay, Spartanburg (SC) Regional Healthcare System's average severity-adjusted length of stay has dropped from an average of 5.40 days in 2007 to an average of 5.18 days so far in 2008.
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At Loma Linda (CA) University Medical Center, ED nurses have decreased door-to-EKG time to 11 minutes from almost an hour a year ago, reports Teri D. Reynolds, RN, BSN, clinical educator in the department of emergency services.
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Case managers act as the safety net in making sure that patients receive appropriate evidence-based care interventions and ensuring safety protocols and preventive measures are in place at Baystate Medical Center in Springfield, MA.
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A clinical documentation improvement program at Moses Cone Health System in Greensboro, NC, has resulted in a 6.43% increase in the case mix index and a 7.5% rise in the severity of illness weight.
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Ongoing education between the clinical documentation improvement specialists, the coders, and managers of each department is essential to the success of Moses Cone Health System's clinical documentation improvement initiative, says Mary Beth Brown, RN, BSN, CPHM, manager of utilization review of clinical documentation improvement.
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Everyone in the health care field has heard horror stories about patients' needs falling through the cracks when they transition from one level of care to another.
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"We need to do the same thing to empower patients and their families with information so they can be active participants in every transition of care," adds Skinner, a case manager for more than 20 years, principal consultant for Whitwell, TN-based Riverside Healthcare Consulting and a member of the National Transitions of Care Coalition.
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It will be several years before the Centers for Medi-care & Medicaid Services (CMS) will require hospitals to use the Continuity Assessment Record and Evaluation (CARE) tool, but hospital case managers can start now to prepare for its implementation and to give CMS feedback on the tool and its use in various settings.
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In its proposed rule for the Outpatient Prospective Payment System, issued July 3, 2008, the Centers for Medicare & Medicaid Services (CMS) continued its efforts to tie reimbursement to quality of services, adding four new outpatient quality measures that hospitals must report on and asking for public comments on an additional 18 measures being considered for future years.
