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A new regulation from the Centers for Medicare & Medicaid Services (CMS) will have a far-reaching impact on Medicare patients and their providers, including hospital-based case managers, says Jackie Birmingham, RN, BSN, MS, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group.
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Faced with an influx of patients following Hurricane Katrina, North Oaks Health System in Hammond, LA, placed case managers in the emergency department, an initiative that ultimately led to 24-7 coverage by emergency department case managers.
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Since case management's entry into the acute care setting in the mid-1980s, most of the significant changes in health care delivery have been associated with changes in health care's reimbursement structure.
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As part of its transition to becoming an accountable care organization, Cheyenne (WY) Regional Medical Center has redesigned its case management model and implemented a transfer center, a single point of entry for all patients whether they are transfers from smaller hospitals, direct admits from provider offices, or patients admitted by emergency department physicians.
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How's this for a turnaround? A few years ago, patient satisfaction levels in the three EDs of the Cambridge (MA) Health Alliance were in the lowest decile in Massachusetts, and now they are consistently in the top quartile.
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The dramatic improvements achieved in patient flow at Cambridge (MA) Health Alliance could not have been possible without culture change, says Assad Sayah, MD, FACEP, chief of emergency medicine for the system.
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It's hard to imagine a tougher point-of-service collection challenge than collecting from emergency department patients. Patients may expect to pay a small copay, and when they change to inpatient status, may suddenly owe thousands of dollars toward their deductible.
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Every patient access department has registrars who can be counted on to rise to every occasion, but better pay may lure these valuable employees to other hospital departments or industries. Instead, why not give these employees "an offer they can't refuse" that is, a clear path to career advancement.
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Patient estimation software implemented in late 2009 at Tallahassee (FL) Memorial Hospital has "helped tremendously" with collections, says Joan S. Braveman, director of patient access and financial services. "In this past fiscal year, we increased our front-end cash collection by 40%," she says.
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Data breaches cost health care organizations more than $6 billion annually, and 71% of the respondents to a study released by the Ponemon Institute say they do not have enough resources to prevent or to quickly detect a loss of patient data.
