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With healthcare reform efforts encouraging hospitals to align with physicians more closely, questions are arising about how to do that without running afoul of rules prohibiting kickbacks and collusion.
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In the recent Office of Inspector General (OIG) opinion regarding co-management, the OIG noted that the arrangement was not protected by any Anti-Kickback Statute safe harbor because the aggregate payment to the group was not set in advance, explains Janice Anderson, JD, shareholder with the law firm of Polsinelli Shughar in Chicago.
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Theres no one size fits all for case management training, which means that hospitals need to create their own training and orientation process based on the specific responsibilities of the department, says Beverly Cunningham, RN, MS, vice president of resource management at Medical City Dallas Hospital. What is covered will vary from hospital to hospital, depending on the role of case management, she adds.
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At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.
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Faced with high readmission rates and patients who made multiple visits to the emergency department and were hospitalized frequently, a multidisciplinary team at Lehigh Valley Health Network began analyzing the cases of frequent utilizers one at a time, getting to the root cause of the readmissions, and developing a plan to keep them out of the hospital and emergency department.
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The Centers for Medicare & Medicaid Services (CMS) proposed rule for the 2014 Inpatient Prospective Payment System (IPPS) is subject to change, but hospital case managers still should familiarize themselves with the rule and determine the impact, says Ralph Wuebker, MD, MBA, chief medical officer for Executive Health Resources, a Newton Square, PA, physician advisor company.
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At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.
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The continuing shift toward basing hospital reimbursement on quality emphasized by the Centers for Medicare & Medicaid Services in the Inpatient Prospective Payment System (IPPS) proposed rule for 2014 raises the stakes for hospitals, especially those that treat a lot of Medicare patients.
