The 2018 OPPS final rule, published in the Federal Register on November 13, has two changes that could affect case managers—the removal of the total knee replacement from the inpatient-only list and cuts to payments for drugs purchased through the 340B drug discount program.
CMS announced November 30 through a final rule and interim final rule that it plans to cancel the Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model, as well as make changes to the Comprehensive Care for Joint Replacement Model.
Mary, an experienced nurse case manager, has worked on her medical unit for five years. She likes her assignment because it is never boring; she services a wide variety of patients with complex medical problems, and she feels satisfyingly challenged by the intricacies of each case. This is why, when the unit’s nurse manager approaches Mary about transferring a patient to another acute care setting with only a few hours’ leeway, Mary believes she can make it happen.
This April, CMS made a switch, changing the volume of charts allowed for Quality Improvement Organization (QIO) short-stay audits. Prior to this change, the number of charts selected for audit ranged from 10 charts for small hospitals to 25 charts for larger hospitals. Now, the 175 hospitals with the highest volume of short stays will have 25 charts audited, while hospitals with a “Major Concern” rating on a previous audit will receive a request for 10 charts.
Participation in the Supplemental Nutrition Assistance Program can lead to decreased healthcare claims and out-of-pocket costs for low-income adults, according to a JAMA Internal Medicine study.
Catastrophic hurricanes, mass shootings, and devastating wildfires—this autumn brought disasters that affected many regions of the country, which should have prompted organizations to consider how well equipped they are to handle such events.
