Centers for Medicare and Medicaid Services (CMS)
RSSArticles
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Care Coordination, Value-Based Care, and Reducing Medicare Spend
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. -
EMTALA Misconceptions for ED Patients in Observation Status
Once an ED patient is in observation status, providers might assume their EMTALA obligations are over. This is not the case. Observation is an outpatient status, even if exactly the same care is provided as inpatient status. As such, observation is merely an extension of ED care.
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CDC and CMS Report Alarming Decline in Patient Safety During Pandemic
An analysis by the CDC and CMS indicates important metrics in patient safety reversed during the COVID-19 pandemic. -
Biden Administration Cracking Down on Nursing Home Safety
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. -
Integrating Behavioral Health and Medical Case Management
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. -
Discharge Waiting Room Gives Patients a Comfortable Place Between Bed and Home
A health system’s nurse case manager oversees a discharge waiting lobby that has helped shorten the time to discharge patients and frees beds for patients waiting in the ED. The discharge waiting lobby helps ease transitions during a difficult time for hospitals.
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More Patients Are Refusing Discharge
The COVID-19 pandemic caused unprecedented bottlenecks in moving patients through the care continuum. But more patients are simply refusing to be discharged from hospital beds. -
Recommendations Target Making Improvements in U.S. Organ Transplant System
The authors aimed for equity, transparency, and efficiency.
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Best Practices in Utilization Management
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. -
Updates to Hospital Value-Based Purchasing
The Centers for Medicare & Medicaid Services (CMS) released updates and changes to its Hospital Value-Based Purchasing Program. In response to the public health emergency, CMS is suppressing certain measures for 2022.