Hospital case management : the monthly update on hospital-based care planning and critical paths
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Two-thirds of hospitals in the United States are losing reimbursement on each Medicare discharge as a result of their performance on the Centers for Medicare & Medicaid readmission reduction program--and the penalties and diagnoses included will only escalate. Hospitals and case managers have to make a paradigm change and focus not only on moving patients through the continuum but keeping them from returning to the hospital, some experts say. Reach out to post-acute providers and make sure that they have the information they need to care for patients at the next level of care and that patients aren't receiving follow-up calls from multiple sources. Analyze all readmissions to determine why patients came back and take steps to improve your processes.
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When patients stay in the emergency department waiting for an inpatient bed, it creates patient safety issues and increases the risk of mortality. Analyze what happens during the entire hospital stay to find out where there are roadblocks to timely patient throughput. Come up with ways to ensure that patients are moved to the next level of care as soon as it is appropriate. Begin discharge planning on day 1 and engage the patient and family early on, informing them of the anticipated discharge date.
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This month we have discussed the fundamentals of patient flow and its related theories. We reviewed the concepts of demand and capacity management as they apply to the hospital setting. Patient flow requires daily diligence and attention. ⋯ Patient flow needs to be addressed at the patient, departmental, and hospital level. In next month's issue we will continue our discussion on patient flow with a detailed review of specific examples that any case management department can use. We will also review all the departments and disciplines that contribute to patient flow and their role in it.
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When Hurricane Sandy devastated parts of Manhattan, Lutheran Medical Center in Brooklyn prepared in advance to handle an influx of patients evacuated from nursing homes and hospitals. Case management staff worked overtime in advance to discharge appropriate patients and free up beds. When evacuated patients came into the emergency department, the staff transferred stable patients to the hospital's own nursing homes and others with available beds, and admitted patients who met inpatient criteria. After the storm passed, case managers worked to discharge more patients to free up beds for injured patients and find placement for patients who presented to the emergency department but didn't meet admission criteria.
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The Centers for Medicare & Medicaid Services' (CMS) Inpatient Prospective Payment System final rule for 2013 makes it clear that in the future, hospital reimbursement is going to hinge even more on the quality of care patients receive. CMS announced its intentions to add more risk-adjusted measures to the reimbursement reduction and value-based purchasing initiatives in future years, penalizing hospitals that do not do as well as their peers on these measures. Case managers must make sure that patients are in the appropriate level of care and that documentation clearly reflects how sick patients are and the care they receive. Even though some measures won't be added to value-based purchasing until fiscal 2015, the performance period starts as early as Oct. 1, 2012, making it imperative for hospitals to make improvements now.