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Finding, motivating, and retaining qualified case managers and support staff can be a challenge. The reasons for employee turnover are many low unemployment, a more mobile work force, promises of higher wage and benefit levels, and feelings of not being recognized or appreciated.
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It's happening all the time at hospitals across the nation. When a new initiative, like DRG assurance or clinical documentation improvement is developed, it's turned over to the case managers "because they're already in the charts."
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The functions that case managers perform in your hospital can have a big effect on the caseload they can comfortably handle, says Toni Cesta, RN, PhD, FAAN, vice president for patient flow optimization at the North Shore-Long Island Jewish Health System.
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Having a dedicated team responsible for following up on denied claims has generated an average of $2 million or more in recovered revenue for United Health Service Hospital every year since the first full year of the initiative in 2001.
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When Sarasota (FL) Memorial Hospital began experiencing a big spike in emergency department diversion, the hospital created a multidisciplinary committee to determine why the diversion was occurring.
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Garnering patient satisfaction scores in the 95th percentile is impressive, but doing it for 10 consecutive years really makes people sit up and take notice.
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Is your organization's process for obtaining informed consent in compliance with both the Centers for Medicare & Medicaid (CMS)'s Conditions of Participation and the Joint Commission's accreditation standards? Would it surprise you to know that in this case, CMS' requirements are stricter?
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Most quality professionals are well-versed on the importance of learning from "near misses" and medical mistakes made at their organizations. But a growing number are now learning from errors made at other hospitals as well.
