-
Insurers and CMS have encouraged providers and health systems to adopt value-based care to lower healthcare costs and increase competitive positioning. Investing in value-based care means a greater emphasis on the primary care physician and preventing hospital admissions and readmissions.
-
The Biden administration is promising an effort to improve safety and quality of care in the nation’s nursing homes. The fact sheet foreshadows substantially stiffer oversight and harsher enforcement.
-
The effects of COVID-19 have brought behavioral health issues to light — and, in some cases, the handling of the pandemic has even caused behavioral health problems. With more patients presenting with mental and behavioral health issues, it is more important than ever to consider a collaborative model of care.
-
Ideally, the case manager’s utilization management role integrates discharge planning, care coordination, and resource management. It takes place on the unit where the case manager can interact directly with the care delivery team. It also is important for departments and hospitals to develop policies for utilization management procedures at the outset.
-
In this Q&A, Hospital Case Management asked Vera Usinowicz, APN-C, supervisor of The Center for Comprehensive Heart Failure Care at The Valley Hospital in Ridgewood, NJ, to discuss how her transitional care unit kept heart failure patients out of the emergency department and hospital during the COVID-19 pandemic.
-
More than one-third of Medicare beneficiaries said they were more socially disconnected, and nearly one in four reported they were lonelier during the COVID-19 pandemic, according to the results of a recent survey.
-
As the United States becomes more diverse, healthcare facilities treat more patients with limited English proficiency. This highlights the need for more effective interpreter services, especially at discharge. Care coordination and transitions could improve if health systems provide more consistent and adequate interpretation help to patients with limited English proficiency, research shows.
-
A government billing records audit will make most hospital leaders nervous because of the potential financial — and even criminal — consequences, but understanding the process and best practices can alleviate the stress.
-
As U.S. healthcare providers shift to value-based care, they need to keep up with various governmental funding plans that could increase options for patients. For example, some states create opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans and Medicaid plans operated by the same insurer. Researchers suggest these plans can decrease inpatient admissions and nursing home admissions.
-
The case management team should be trained thoroughly on utilization review and medical necessity to avoid payer denials. The goal is to ensure patients receive medically necessary, high-quality care.