Hospital case management : the monthly update on hospital-based care planning and critical paths
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The Centers for Medicare and Medicaid Services (CMS) made significant changes in the final rule for creating accountable care organizations (ACOs) to coordinate care across healthcare settings. CMS made changes in how ACOs will share savings based on input from the industry. ACOs are one way the healthcare field is recognizing the value of care coordination. The number of quality measures on which ACOs report has been reduced from 65 to 33.
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Hospitals will suffer when the Medicaid Recovery Audit Contractor (RAC) starts on Jan. 1, 2012, if case managers aren't scrutinizing those patients as closely as those who are covered by Medicare. Make sure your documentation is complete to avoid denials and prepare for appeals. ⋯ Learn the rules for all states in which your patients reside. Be aware that the Medicaid RACs are charged with taking a proactive approach to identify potential fraud.
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The Centers for Medicare and Medicaid Services (CMS) emphasizes improving quality and efficiencies across settings in the Inpatient Prospective Payment System (IPPS) final rule for 2012. Hospitals will receive a 1% market basket increase in reimbursement. CMS announced a Medicare spending-per-beneficiary measures that will be used in the Value-Based Purchasing program and the Hospital Inpatient Quality Reporting program. CMS is adding new quality measures involving infection control in 2014 and 2015.
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With patient satisfaction in the single digits and door-to-doc times unacceptably high, the ED at Sumner Regional Medical Center in Gallatin, TN, initiated a staff-driven improvement effort aimed at weeding out inefficiencies. By putting the triage process under close scrutiny, staff members were able to eliminate dozens of tasks from the triage process, thereby slashing wait times. ⋯ A 44-step triage process has been streamlined into four steps, and average door-to-doc times have decreased from 67 minutes to 18 minutes. Further improvements are anticipated when ED administrators put staff scheduling under the same scrutiny.