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When Lori Dempsey talks to health care professionals around the country about her experiences with the Recovery Audit Contractors (RACs) demonstration project, she opens her presentation by saying: "Are you nervous? Are you frustrated? Are you anxious about the RACs? Well, I'm here to legitimize all of those concerns."
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When challenged to increase efficiency and decrease length of stay, a multidisciplinary task force at Mercy St. Vincent's Medical Center in Toledo, OH, made the decision to have case managers on duty on every unit 24 hours a day, seven days a week.
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By focusing on discharge on Day 1 and during daily multidisciplinary rounds, Scott & White Healthcare in Round Rock, TX, has maintained an average length of stay for Medicare patients of just 3.2 days and achieved a 30-day readmission rate of just 3%.
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When the Recovery Audit Contractor (RAC) demonstration project began, the RACs began sending out chart requests slowly in the initial months, then increased the volume as the project went on, sometimes issuing requests for as many as 500 records at one time.
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The ED at the University of Kansas Hospital in Kansas City, KS, has virtually eliminated ambulance diversion; there were two diversions in June. It also has reduced its rate of patients leaving without being treated from 12% to 4%.
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The electrocardiogram (ECG) and X-ray of a chest pain patient in his mid-50s were both normal when examined by the treating ED physician. However, the physician's shift ended before the patient's lab results were back.
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Stephen A. Frew, JD, vice president and risk consultant with Johnson Insurance Services, a Madison, WI-based company specializing in risk management for health care professionals, says shift changes or "handoffs" in care often are associated with malpractice claims, typically for these three reasons:
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After the Recovery Audit Contractor (RAC) demonstration project ended, participating hospitals began looking for ways to minimize their risk and resources when the permanent RACs are rolled out.
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Before the Recovery Audit Contractor (RAC) issued its first requests for data, Sharp HealthCare in San Diego assembled a committee of stakeholders to determine what the process would probably be like, how to track requests, how to ensure that the health system responded in a timely manner, and what the appeals process should be.
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When its population of uninsured patients increased as more people lost their jobs, Ingham Regional Medical Center in Lansing, MI, developed a program to provide medication for people who can't otherwise afford it.
