One of the more talked-about initiatives in the Patient Protection and Affordable Care Act is the creation of accountable care organizations (ACO) and the global payment pilot projects.
Care providers accept the general principle that patients have the right to direct their own care, but what if the patient refuses every discharge option you provide and wants to stay in inpatient care indefinitely?
The rules for making proper level-of-care decisions are lengthy and confusing, which makes the role of the physician advisor within the utilization review (UR) committee extremely critical.
Condition code 44 has been problematic for hospitals since its inception in 2004 due to CMS’ unclear language, multiple changes to the observation billing rules, and inconsistent guidance.
CMM asked hospital case management professionals what tasks their facilities expect them to perform and how those responsibilities affect their productivity in the CMM Job Responsibilities Survey. Nearly 500 case managers, discharge planners, social workers, clinical documentation improvement (CDI) specialists, and appeals specialists responded to the survey. Responses broke down as follows:
CMS has seen an increase in the number of extended observation stays and wants to know why. That was the reason it gave for holding an August 24 listening session regarding the matter. The reason providers misuse observation services may not have been as interesting as the solution proposed by some callers—namely, that CMS should abolish observation services.
Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is gaining popularity among providers nationwide as a method to reduce preventable hospital readmissions. Since the program began in September 2008, more than 1,400 facilities have downloaded the free toolkit from the Society of Hospital Medicine’s (SHM) website, and 65 sites have enrolled in the mentorship program. (See the “All about BOOST” sidebar below for more information on Project BOOST.)
As the case manager’s role has matured, specific best practices have proven to be a valuable conduit to the provision of care coordination, outcome achievement, and quality of care.
