Centers for Medicare and Medicaid Services (CMS)
RSSArticles
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Case Management Challenges in the Emergency Department
Hospital case management already is unique. But carrying out this role in the ED brings even more challenge and intensity to bear. It also affects operations and well-being in the rest of the hospital.
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For Clinicians, Discharge Safety Is a Growing Ethical Concern
More often, clinicians are asking ethicists questions such as, “Is this discharge plan ethical?” It seems clinicians are distressed over what they consider to be unsafe decisions. Clinicians create a treatment plan based on what they believe is in the patient’s best interest. For various reasons, sometimes the plan is just not feasible.
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Case Managers Could Use Z Codes More for Patient Care and QI
Case managers, providers, and health systems underuse ICD-10 Z codes eight years after they were introduced. These codes could provide a wealth of data to researchers and case management quality improvement projects. They still hold promise to be a way for providers to collect reimbursement for their work to help patients with their social determinants of health.
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Screening and Documenting Cases of Human Trafficking Are Important, But Carry Risks
Human trafficking is a critical issue from a public health perspective. It has lasting psychological and physical effects on victims. There is too little information about how prevalent human trafficking is in the United States and how often the victims are seen in healthcare settings. Case managers, hospitals, and ambulatory providers could improve the data by documenting suspected or confirmed human trafficking cases via Z codes.
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How Case Managers Can Help Victims of Trafficking
Case managers can learn skills and tactics for helping patients who have been trafficked. For example, investigators used an online training module to educate ED staff about human trafficking. Participants reported more confidence in identifying a possible human trafficking victim, noting they were more likely to screen patients for human trafficking.
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Stroke Patient Navigator Prevents 30-Day Readmissions
A stroke nurse navigator team can prevent 30-day readmissions in stroke patients treated with thrombolysis, investigators found. A health system’s 30-day readmission rate was 13.6% before it began to use a stroke nurse navigator. The rate declined to 6.9%. Patients with the stroke nurse implementation were 67.6% less likely to be readmitted within 30 days compared to patients without the navigator.
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Nurse Care Coordinators Are Valuable in Federally Qualified Health Centers
A Federally Qualified Health Center that invested in a registered nurse care coordination program in a primary care setting found the position provided a valuable service and was cost-effective.
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How to Fight Denials
Case managers do not have to settle for denials. In fact, they can use their skills to overturn denials. There are certain tactics that can help in this process, and some case management professionals even specialize in this.
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Hispanic Patients with Diabetes Need Better Care Transition Models
About one in 10 Americans are diagnosed with diabetes, and the Hispanic/Latino population is disproportionately affected. Their risk is higher — and their outcomes are worse — than the white, non-Hispanic population. Researchers designed a transition of care model and pilot to see if they could improve outcomes.
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Care Transitions Through ACHIEVE Study Score Points with Patients
Care transitions across organizations and the community require better collaboration and communication among providers and social service organizations, according to recent research. Patients benefited from improved collaboration. They reported feeling better supported and cared for by providers involved in a care transition project.