Hospital Case Management – April 1, 2015
April 1, 2015
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The RACs are back: Auditors to start performing complex reviews
After almost a year’s reprieve, hospitals can expect to begin getting records requests from Recovery Auditors as the program goes into full swing again.
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AHA seeks delay of two-midnight rule
The American Hospital Association (AHA) has asked the Centers for Medicare & Medicaid Services (CMS) to delay enforcement of its controversial two-midnight policy until Oct. 1, 2015, or until the agency develops and implements a short-stay payment policy, whichever comes later.
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Changes in RA program are intended to reduce burden on providers
The Centers for Medicare & Medicaid Services (CMS) has announced a number of changes to the Recovery Audit program that will become effective when each new contract is issued. The process to rebid the contracts has been halted because of a lawsuit by a contractor, according to Elizabeth Lamkin, MHA, chief executive officer and partner in PACE Healthcare Consulting, LLC, based in Beaufort County, SC.
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Game changer: HHS sets goals for basing payments on quality
The U.S. Department of Health and Human Services’ (HHS) announcement of goals to tie Medicare fee-for-service payments to quality or value is a game-changer that will impact every case manager across the nation and make the case management role critically important throughout the continuum of care, according to Andy Ziskind, MD, managing director at Huron Consulting, a Chicago-based healthcare consulting firm.
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Tools improve communication with SNFs, reduce readmissions
By developing a tool that can be used to identify high-risk patients and a checklist to use when patients transition, UPMC Presbyterian Shadyside Hospital in Pittsburgh has improved communication between the hospital and skilled nursing facilities and reduced readmissions.
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Hospital cuts length of stay for babies in the NICU by four days
The average length of stay for premature infants in Cedars-Sinai Medical Center’s 45-bed Neonatal Intensive Care Unit (NICU) has dropped from 21 days in 2011 to 17 days, following a series of initiatives to improve care coordination and throughput, along with changes in treatment protocols. The unit is part of the Maxine Dunitz Children’s Health Center.
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Health system, churches work together to support patients after discharge
A partnership between Methodist LeBonheur Healthcare and 512 Memphis, TN, churches, supports enrolled church members as they transition from the hospital to the community and has resulted in less utilization, lower healthcare costs, lower mortality, and fewer readmissions for participants in the program compared to a similar group.