Hospital case management : the monthly update on hospital-based care planning and critical paths
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The Centers for Medicare & Medicaid Services' (CMS') mandatory bundled payment pilot project makes clear that the agency intends to reform Medicare reimbursement. Hospitals in 75 geographic areas are required to participate in a five-year pilot project that puts them at risk for the cost of hip and knee replacements from the time of surgery until 90 days after discharge. ⋯ Even if they won't be part of a bundled payments arrangement, case managers need to shift their thinking to prepare for the future of reimbursement by developing close working relationships with post-acute providers, knowing the services and quality delivered by post-acute providers, and being aware of the costs for the entire episode of care. Case managers will not be able to handle all the responsibilities necessary in a bundled payment arrangement if they have large caseloads.