Sneak Peek: Case study: Preparing for an ACO
Case Management Weekly, March 21, 2012
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).
That's when the work began for Joan Valentine, RN, BSN, MSA, administrative director for transitions care at DMC's Sinai-Grace Hospital in Detroit.
Becoming part of an ACO means big changes for any case management department, Valentine says.
One of the biggest shifts for case managers under the ACO model? The hospital is now responsible for patients well past discharge, she says.
"The hospital's responsibility no longer ends when the patient goes home," says Valentine. "Planning for continuing care in a postacute setting needs to be built into every patient's discharge plan."
Case managers also need to identify barriers that may interfere with the patient's ability to be successful at home and help them access available community services. "The focus needs to shift from insurance issues to truly understanding the patient's needs in the home," Valentine says.
This item is adapted from an article which originally appeared in the March, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.
- Study: Almost half of nurses are thinking about leaving the profession
- Fracture coding in ICD-10-CM requires greater specificity
- Differentiate between types of wound debridement
- What does case-mix index mean to you?
- Complications from immobility by body system
- OB services: Coding inside and outside of the package
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- What is the difference between an IPA and a medical group?
- Bill and charge for supplies correctly to reduce risk and minimize lost revenue
- Seven tips for slashing ED wait times with limited resources
- Increase patient satisfaction by improving your discharge process
- Homecare Direction
- QA:Coding multiple initial infusions
- Q&A: Coding for transplant complications
- Peeling away the confusion: Split billing guidance
- OIG focuses on documentation, frequency, and duration for outpatient PT services
- Note from the Instructor: Review of hospital inpatient mental health services payable under the inpatient psychiatric facility prospective payment system (IPF PPS)
- HIPAA Q&A: Maintenance of medical records after physician death