Hospital Case Management – January 1, 2007

January 1, 2007

• ED case managers can improve throughput, reduce denials

  If your hospital doesn't have case managers who are dedicated to the emergency department (ED) and who work during peak hours, you're missing an opportunity to improve patient throughput, reduce denials, and cut down on patients who return to the ED over and over.

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• Identify areas where a CM can have an impact

  It's not necessary to have a case manager in the emergency department 24 hours a day, seven days a week, and case managers don't necessarily have to screen every patient who comes into the ED, says Toni Cesta, RN, FAAN, vice president, patient flow optimization for the North Shore-Long Island Jewish Health System.

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• Value-based purchasing gives CMs chance to shine

  The Centers for Medicare & Medicaid Services (CMS) took additional steps toward value-based purchasing and transparency in health care in the final rule for Medicare payment for outpatient services issued Nov. 1.

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• Initiative helps to improve patient throughput

  An initiative that includes capacity alerts, "hall beds" used when the hospital is approaching capacity, and having one person responsible for coordinating bed placement has helped Spartanburg (SC) Regional Medical Center improve patient throughput and avoid being on emergency department diversion for more than a year.

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• Critical Path Network: CMs partner with coders for appropriate documentation

  A documentation enhancement project that pairs case managers and coders increased the Medicare case-mix index at North Mississippi Medical Center from 1.48 to 1.92 in six years for the Tupelo, MS, hospital.

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• Critical Path Network: ED CMs improve throughput as patient advocates

  When Cooley Dickinson Hospital (CDH) in Northampton, MA, put the first case manager in its emergency department, some of the staff were skeptical about how well the initiative would work, recalls R.F. Conway, MD, medical director of emergency services and chief of emergency medicine.

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• Discharge Planning Advisor: Sutter DM, CM programs strike balance for best patient outcomes

  The successful integration of case management and disease management is the latest step in the ongoing evolution of the Sutter Health Sacramento Sierra Region Care Management Programs, says Jan Van der Mei, RN, the region's continuum case management director.

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• Discharge Planning Advisor: 'Ideal Patient Day' gives heads-up on care

  When Elmhurst Memorial Healthcare looked at improving patient throughput, one of the issues that surfaced had to do with housekeeping, which historically had deployed its work force in a way that did not serve the facility, says Matthew J. Lambert III, MD, MBA, FACS, FACHE, senior vice president, clinical operations.

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• Patient Safety Alert supplement

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