Hospital case management : the monthly update on hospital-based care planning and critical paths最新文献

Emergency department case managers are essential to prevent payer denials by ensuring that patient status and level of care is correct; prevent admissions and readmissions by linking patients to community services; improve patient throughput by ensuring that tests are procedures are conducted in a timely manner; and to facilitate hospice and palliative care referrals. Case managers should cover the ED seven days a week during the hours when the volume is highest. Hospitals with a lot of payers that require preauthorization, or a large volume of complex patients, or those with behavioral disorders may need 24-hour coverage. EDs also need social workers on hand to coordinate community services, facilitate mental health referrals, and handle issues such as abuse, neglect, domestic violence, and chemical dependence. The best candidates for ED case management positions are experienced case managers with a high level of clinical knowledge, good organizational skills, and the ability to work quickly.

By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures.

As the pressure increases for case managers to help ensure that hospitals comply with payer requirements and get paid appropriately, physician advisors can be a valuable ally. Physician advisors have clinical expertise as well as credibility with the physician staff, which gives them an advantage when it comes to educating physicians about patient status, documentation needs, patient throughput, and transitions in care. Case managers and their physician advisors should work together to ensure that everything in the patient record is correct up front so the hospital will avoid costly appeals when the claim is denied. Good physician advisors have the kind of personality that enables them to have difficult conversations as well as being well-respected by their colleagues, knowledgeable about admission criteria and reimbursement, accessible, approachable, articulate, and collaborative.

Case managers are in a good position to recognize patients who have serious medical problems that are causing them and their family members stress, and refer them for a palliative care consultation, experts say. The palliative care team coordinates with the team providing medical care and helps control pain and other physical symptoms, relieves depression and anxiety, and provides support and spiritual help for the patient and family. The core palliative care team typically includes a medical specialist, a nurse who also acts as a case manager, a social worker, and a spiritual counselor. Palliative care improves outcomes and patient satisfaction when patients have a consultation early in the stay or even in the emergency department.

While the Two-Midnight Rule can be confusing to staff and patients alike, if you implement and hardwire your processes you will be more likely to maintain compliance going forward.

DCH Health System's seven part-time physician advisors perform a variety of tasks to help ensure that the hospitals are appropriately reimbursed and that patients move smoothly through the continuum of care. They work with care managers on patient status and also assist with documentation, writing medical necessity appeals, resource utilization, and patient throughput. They attend daily transition rounds with the nurses, care managers, and social workers, and participate in weekly long-stay rounds and capacity rounds in the ICU and acute cardiac care. The health system brought in experts to educate the physician advisors, sent them to educational symposia, and pays for membership in professional organizations.