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From the Centers for Medicare & Medicaid Services' (CMS) perspective, the saying "ignorance is bliss" does not apply when it comes to a patient's status.
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A new rule from the Centers for Medicare & Medicaid Services (CMS) makes it imperative that case managers and/or discharge planners be familiar with new coverage requirements for inpatient rehabilitation facilities and that they begin discharge planning earlier with inpatient stay, says Jackie Birmingham, RN, MSN, MS, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group.
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Elderly heart failure patients who are at risk for rehospitalization are getting help following their treatment plan after discharge through a collaborative effort of The Methodist Hospital in Houston and Care for Elders, a community coalition of 80 private and public agencies that develops and tests pilot projects serving older adults.
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In the first year of Stony Brook University (NY)Medical Center care management department's interdisciplinary project to reduce the length of stay for long-stay patients, aggregate patients days dropped from 4,400 to just more than 3,000 in a year, resulting in a revenue opportunity of approximately $4 million.
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Case managers typically have concentrated on what has to happen before the patient can be discharged from the hospital, but now, to reduce readmissions, hospitals also have to take into consideration what happens to patients after they leave the acute care setting, says Beverly Cunningham, RN, MS, vice president, clinical performance improvement, Medical City Dallas Hospital, and health care consultant and partner in Case Management Concepts LLC.
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Case managers are a hospital's first line of defense when it comes to smoothing transitions of care and preventing readmissions.
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In an effort to ensure that the patients most vulnerable for readmission stay safe at home after discharge, Lutheran Medical Center is developing a pilot program with a local home care agency to provide at least one home care visit for the majority of congestive heart failure patients going home with no services.
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If you haven't started analyzing your hospital's readmission rates and the role case managers can play in reducing readmissions, it's time to start so your hospital can avoid penalties from the Centers for Medicare & Medicaid Services (CMS).
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In preparation for the Recovery Audit Contractors (RACs) and to improve patient flow, Durham Regional Hospital redesigned its case management department and moved to a triad model of patient care.
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By redesigning its case management program and beefing up technology, Saint Thomas Health Services reduced the average length of stay systemwide by 0.20 days and saved more than $6 million in just two years.
