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Health systems that employ care coordination/case management teams in the ED can save hundreds of thousands of dollars, and improve the health of some of their most vulnerable patients. The results of a recent study showed that frequent ED users experience higher death rates and greater health-related social needs. One solution is care coordination and communication.
ED navigation teams can connect patients to primary care providers, psychosocial programs, and community-based organizations to help keep people out of hospital beds and the ED.
If a patient fears he or she will get robbed leaving the pharmacy, he or she is less likely to buy the medication. The patient may be homeless, or simply cannot afford the medication. He or she may struggle with literacy and reading the prescription information. The patient may be depressed, or may not believe the medication will help. These all are realities for patients, especially those living in inner cities. The result is medication nonadherence, which can pose serious consequences for a patient’s health — and lead to billions of dollars in excess healthcare costs in the U.S. annually.
As health systems update and revamp their electronic health records, they might want to consider adding a case management module. An electronic health record that includes an acute case management module with robotic process automation can create seamless efficiency.
Legislation and regulatory changes do not always seem in patients’ best interests. Insurance coverage issues have made news headlines. In skilled nursing facilities, physical therapy time has been limited by CMS, which has also triggered concerns. What can a case manager do? How can one influence state legislators/regulators, and public policy? Advocacy for patients is integral to the case manager’s role.
Patients with serious and life-threatening illnesses are faced with choices on the treatments they receive or elect not to receive. The treatment for a patient with advanced cancer is different than the treatment for a patient with advanced heart failure or chronic obstructive lung disease. However, the essence of a serious illness conversation is the same: What are the patient’s goals, values, and preferences? How do those inform their plan of care?
In 2015, CMS introduced proposed rules for discharge planning. These proposed rules were to be used to update the current rules under the Conditions of Participation for Discharge Planning. In 2019, CMS provided the elements of the proposed rules that would be adopted in November 2019. This month, we will discuss the current rules, the proposed rules, and the final rules published in 2019.
Financial Disclosure: Author Melinda Young, Author Jeanie Davis, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, and Nurse Planner Toni Cesta, PhD, RN, FAAN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.
