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When patients benefits have been maxed out or are close to being maxed out, case managers need to be creative with discharge planning, experts say.
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After Southeast Alabama Medical Center in Dothan began a heart failure readmission prevention program, its 30-day readmission rate dropped to an average of 13%. In January, the hospital discharged 62 heart failure patients and only 8% were readmitted.
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At Good Samaritan Medical Center in West Palm Beach, FL, a throughput initiative that uses colored magnets to indicate anticipated discharges has cut emergency department holding time and increased the number of discharges by 2 p.m.
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As outbreaks continue to be reported due to unsafe injection practices and improper use of medication vials, the Centers for Medicare & Medicaid Services (CMS) is telling its surveyors to contact public health departments immediately if they see such flagrant breaches of infection control.
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Case managers should know their patients insurance benefits and out-of-pocket expenses when they develop a discharge plan to make sure the patient can afford the plan they are putting in place.
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Readmissions are not just a hospital problem. They are a problem that extends across the continuum of care, and providers at all levels of care must work together to solve it, says Tania Daniels, PT, MBA, vice president of patient safety for the Minnesota Hospital Association.
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With the dual goals of increasing operational efficiency and promoting patient-centered care, Northwest Community Hospital in suburban Chicago revamped its care delivery model, adding a new role of clinical care coordinator to facilitate smooth and timely transitions from admission to discharge.
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Readmissions are a big factor in Medicare spending per beneficiary since an additional hospital stay adds significantly to the total cost of care, points out Susan Wallace, MEd, RHIA, CCS, CDIP, CCDS, director of inpatient compliance for Administrative Consultant Services, a Shawnee, OK-based healthcare consulting firm.
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The Centers for Medicare & Medicaid Services (CMS) is adding new metrics to its Value-based Purchasing Program each year, and case managers should look ahead to ensure that their hospital performs well on the measures.
