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Expensive Deductibles Bringing Many Changes to Revenue Cycle

Patients with high deductibles often need an expert’s help. Registrars can pave the way for the eventual discussion with a financial counselor.

Many People Put Off Medical Care Because They Cannot Pay High Deductibles

Patients often find out about a high deductible not from their insurer or employer, but from a registrar — and many of these high-dollar accounts go unpaid. Now, multiple recent studies show that people are avoiding care because they cannot pay their high deductibles.

The Conditions of Participation for Discharge Planning: Current Rules and 2020 Updates

In 2015, CMS introduced proposed rules for discharge planning. These proposed rules were to be used to update the current rules under the Conditions of Participation for Discharge Planning. In 2019, CMS provided the elements of the proposed rules that would be adopted in November 2019. This month, we will discuss the current rules, the proposed rules, and the final rules published in 2019.

How to Initiate Serious Illness Conversations With Patients

Patients with serious and life-threatening illnesses are faced with choices on the treatments they receive or elect not to receive. The treatment for a patient with advanced cancer is different than the treatment for a patient with advanced heart failure or chronic obstructive lung disease. However, the essence of a serious illness conversation is the same: What are the patient’s goals, values, and preferences? How do those inform their plan of care?

Getting Involved: Case Managers Go to Washington

Legislation and regulatory changes do not always seem in patients’ best interests. Insurance coverage issues have made news headlines. In skilled nursing facilities, physical therapy time has been limited by CMS, which has also triggered concerns. What can a case manager do? How can one influence state legislators/regulators, and public policy? Advocacy for patients is integral to the case manager’s role.

Health System Makes Utilization Review Paperless, More Efficient

As health systems update and revamp their electronic health records, they might want to consider adding a case management module. An electronic health record that includes an acute case management module with robotic process automation can create seamless efficiency.

Ensure Adherence by Addressing Patients’ Social Needs

If a patient fears he or she will get robbed leaving the pharmacy, he or she is less likely to buy the medication. The patient may be homeless, or simply cannot afford the medication. He or she may struggle with literacy and reading the prescription information. The patient may be depressed, or may not believe the medication will help. These all are realities for patients, especially those living in inner cities. The result is medication nonadherence, which can pose serious consequences for a patient’s health — and lead to billions of dollars in excess healthcare costs in the U.S. annually.

Use Data-Driven Dashboard, Other Tools to Assist ED Navigation Team

ED navigation teams can connect patients to primary care providers, psychosocial programs, and community-based organizations to help keep people out of hospital beds and the ED.

ED Care Transition Teams Can Address Behavioral, Social Needs

Health systems that employ care coordination/case management teams in the ED can save hundreds of thousands of dollars, and improve the health of some of their most vulnerable patients. The results of a recent study showed that frequent ED users experience higher death rates and greater health-related social needs. One solution is care coordination and communication.

More Young Adults Receiving HPV Vaccination, but There Is Room for Improvement

Results of a new report indicate that the percentage of adults ages 18-26 years who received one or more doses of human papillomavirus (HPV) vaccine nearly doubled between 2013 and 2018. The percentage of adults in the same age category who received the recommended number of doses of HPV vaccine increased from 13.8% to 21.5%.