Hospital Case Management – April 1, 2013
April 1, 2013
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Readmission reduction has begun and the penalties will escalate
Beginning Oct. 1, 2012, more than 2,000 hospitals serving Medicare patients began losing reimbursement under the Centers for Medicare & Medicaid Services (CMS) readmission reduction program, which penalizes hospitals experiencing excess 30-day readmissions for heart failure, acute myocardial infarction, and pneumonia. The average penalty is about $125,000. -
Don’t just get them out — Make sure they stay out
In the past, case managers and discharge planners have concentrated on how to get patients out of the hospital, but now they also need to focus on how to keep them from coming back, says Deborah Hale, CCS, CCDS, president and chief executive officer of Administrative Consultant Service, a healthcare consulting firm based in Shawnee, OK. -
Initiative leads to 11% drop in HF readmissions
After the University of California San Francisco Medical Center began a heart failure readmission reduction program at its 559-bed main hospital, 30-day readmission rates for heart failure patients dropped 46%, from 24% in 2009 to 13% in 2011 and 11% in 2012. -
Hospital team reaches out to post-acute providers
Recognizing that the inpatient staff can do only so much during a three-to-five-day hospital stay, the heart failure readmission reduction team at the University of California San Francisco Medical Center collaborates with post-acute providers and outpatient treatment centers to develop ways to improve transitions between levels of care and ensure that patients receive the same education on managing their conditions regardless of where they are receiving care. -
Team helps hospital avoid readmission penalties
Bassett Medical Centers readmission reduction project has resulted in a reduction of up to 70% among highest-risk patients. -
SNF visits help hospital reduce LOS, readmissions
A program at the University of Michigan Health System in which physicians and nurse practitioners visit patients after their transfer to a skilled nursing facility has smoothed transitions and reduced the average length of stay of older patients from 10.6 days to eight days. -
ED redesign improves patient flow, satisfaction
Just eight months after Sycamore Medical Center emergency department in Miamisburg, OH, launched a Lean project to improve patient flow in the emergency department, the percentage of patients who left without being seen dropped dramatically and the departments patient satisfaction scores rose to the 90th percentile. -
Department redesign frees up CMs to coordinate care
A redesign of the care coordination department at Riverside Medical Center in Kankakee, IL, assigns utilization review tasks to dedicated nurses, freeing up case managers to spend more time with patients and develop a close working relationship with physicians to facilitate smooth and timely progression of care.