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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.
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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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Many medical conditions aren't possible to diagnose without appropriate cardiorespiratory monitoring, vital sign reassessments, and diagnostic testing, and these are "disasters waiting to happen," warns Andrew Garlisi, MD, MPH, MBA, VAQSF, medical director for Geauga County Emergency Medical Services (EMS) and co-director of University Hospitals Geauga Medical Center's chest pain center in Chardon, OH.
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Lawsuits related to treatment delays in EDs aren't limited to patients in the lobby who are waiting to be seen, says Andrew Garlisi, MD, MPH, MBA, VAQSF, medical director for Geauga County EMS in Chardon, OH.
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Is your ED considering screening out non-critical patients by giving medical screening examinations (MSEs), as required by the Emergency Medical Treatment and Labor Act (EMTALA), then giving patients a choice of seeing a primary care doctor or paying a fee?
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EPs may try to put off intervening on admitted patients waiting for inpatient beds to become available to avoid confusion about what was already done for the patient and what the inpatient care plan is, says William C. Gerard, MD, MMM, FACEP, chairman and professional director of emergency services at Palmetto Health Richland in Columbia, SC.
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"This is a new electronic record, and it does not work very well." If an emergency physician (EP) didn't review the nursing notes because these couldn't be located within the ED's electronic medical record (EMR), this statement could very well be the EP's only defense in the event a medical malpractice suit occurs, says Michael Blaivas, MD, FACEP, FAIUM, professor of emergency medicine at Northside Hospital Forsyth in Atlanta, GA.
