Hospital case management : the monthly update on hospital-based care planning and critical paths
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More hospitals than ever before are being penalized by the Centers for Medicare & Medicaid Services for excess readmissions and insurers are starting to develop their own readmission reduction programs. According to experts: Case managers and hospitals have to look beyond the hospital walls and determine what happens to patients throughout the continuum. Improving communication with post-acute providers is a critical part of reducing readmissions. Recognize that family members or other caregivers are an important factor in a patient's success after discharge and involve them in creating the discharge plan.
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The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services' move toward basing reimbursement on quality of care, not quantity. The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients. CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly. The agency proposes to add two safety measures to value-based purchasing in the future.
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Hospital efficiency of care, a new domain in the Centers for Medicare & Medicaid Services Value-based Purchasing Program, bases hospital scores on spending three days before admission through 30 days after discharge. Case managers need to take the time to develop a discharge plan that works and look at cost-effectiveness as well as appropriateness of the level of care, experts say. Because the data used for this measure is risk-adjusted, it's crucial for the documentation in the medical record to clearly and accurately reflect the patient's severity of illness. Become familiar with all the potential discharge destinations and spend time with each provider, experts recommend.
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The Centers for Medicare & Medicaid Services (CMS) is adding new metrics to its Value-based Purchasing Program each year, and case managers should look ahead to ensure that their hospital performs well on the measures. CMS automatically withholds a percentage of the Medicare base operating payment each year (1.5% in fiscal 2015), and hospitals can earn back what was deducted or more by performing well. Value-based purchasing for 2015 includes four domains: clinical processes of care, outcomes, Hospital Consumer Assessment of Healthcare Programs and Systems (HCAHPS), and hospital efficiency of care. Any measure that is in the Inpatient Quality Reporting Program is considered to be on deck for value-based purchasing.
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Hand-off communication provides an important link for patients and care providers as patients transition across the continuum of care. make it part of your everyday practice!