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

An $800,000 investment in a respite program that provides a place for homeless patients to recuperate after discharge has saved participating hospitals in Santa Rosa, CA, $17 million in the first three years.Qualified patients get a bed in a ward in a federally qualified health center and three meals a day. The health center provides medical care and case managers who connect patients to community resources.Hospital case managers identify patients who no longer meet inpatient criteria but are too sick to be released to the street, and contact the program's intake coordinator to visit patients and enroll them in the program.Representatives from the three hospitals and Catholic Charities, which administers the program, meet quarterly to discuss ways to work together.

Recognizing that bundled payments were likely to be one way healthcare is reimbursed in the future, Sentara Healthcare in Norfolk, VA, began numerous bundled payment arrangements under the Bundled Payments for Care Improvement initiative so they could gain experience for the future. An executive-level steering committee looked for opportunities for improvement and determined that the biggest gaps occur when patients transition from acute to post-acute care.The health system contracted with an outside firm to manage its bundled payment program and to provide telephonic follow-up and case-management during the post-acute period, and developed a systemwide steering committee to make sure the programs are in alignment with work flows, compliant with regulatory requirements, and to provide feedback on what is working and what isn't.Sentara started building relationships with post-acute providers four years ago by organizing the Sentra Hampton Roads Long-Term Council, which includes representatives from the hospital's integrated care management department and post-acute providers in the Hampton Roads area, including those not affiliated with Sentara.

Vanderbilt University Medical Center's first bundled payment program for cardiac valve replacement and valve repair surgery patients was so successful that the medical center added total joint replacement and stroke to its bundles.A multidisciplinary team, led by nursing, physician, and business leadership, looked for areas of opportunity and set up work groups for each component of the program.The team designed a care coordination program and the hospital hired two care coordinators who follow the patients from the pre-surgical educational session through post-acute care.To meet the goal of reducing overutilization of post-acute facilities, the team created "prehab," a pre-surgical physical therapy program for patients who need it, and everyone who comes in contact with the patients educates them to expect a discharge to home.

The fact that the CMS is extending its three-year voluntary Bundled Payments for Care Improving pilot and has launched the mandatory bundled payment project, Comprehensive Care for Joint Replacement in 7 markets leads experts to conclude that bundled payments are here to stay and will be expanded. Bundled payments mean case managers need to manage the length of stay and choice of post-acute options more closely than ever before and make sure that patients receive the most cost-effective and efficient care to meet their individual needs.Even if their hospital isn't part of a bundled payment program, case managers should prepare for the future by cementing relationships with post-acute providers and analyzing the variability in cost of care and patient outcomes and identifying opportunities for improvement.Relationships with post-acute providers are critical and should go beyond getting to know the staff, and include sharing patient data.