Making sure patients are prepared for discharge can be a tricky process. When certain laws are considered, getting patients to their next destination becomes even more complex.
Case managers have already become familiar with the Medicare Recovery Audit Program. In January, however, government Recovery Auditors began focusing on new territory: Medicaid claims.
One of the riskiest times for patients comes when they are leaving the hospital and heading home or to aftercare. This is the time when medications are mixed up, follow-up doctors' appointments are missed, or discharge instructions get lost in the fax machine. Poor handoffs with poor communication can lead to unnecessary readmissions.
When case managers are looking at patients who are frequently readmitted to their facility within 30 days of their last discharge, chances are they'll find a lot of chronic heart failure (CHF) patients among them. That's because CHF patients typically have a higher readmission rate than any other disease, says Jan Lear, RN, CMC, director of case management at MedStar Franklin Square Medical Center (MFSMC) in Baltimore.
It's no longer a mere possibility; the Department of Health and Human Services HHS has confirmed its intent to delay the ICD-10 compliance deadline, according to its latest press release.
Utilization review (UR) and case management are as traditional a team as peanut butter and jelly. But some facilities are asking whether this longtime duo is really the best combination.
In December 2011, Detroit Medical Center (DMC) got word that it had been selected as one of only 32 medical organizations in the country to participate in Medicare's new Pioneer Accountable Care Organization (ACO).
So you've looked at your readmission data, and you've found a problem. One nursing home or SNF is sending back a large number of patients for readmission within 30 days.
New nurses just out of school often find themselves at work alongside veterans who have little patience for those who don't perform at par. It's no different for nurse case managers.
