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Case Management Weekly

Case Management Weekly is a free e-mail newsletter that offers news, resources, and Q&As to help case managers from all settings find ways to enhance quality and reduce legal and compliance risks.

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Case Management Weekly

Issue 57, December 30, 2004

• CMS proposes coverage for smoking cessation counseling

  The Centers for Medicare & Medicaid (CMS) recently announced that it intends to cover counseling...

• Government touts success of Nursing Home Quality Initiative

  CMS announced the results of the Nursing Home Quality Initiative in which nursing homes were...

• Improve your working relationship with your physician advisor

  A physician advisor on your case management team is an invaluable tool for reducing LOS and...

Issue 55, December 15, 2004

• CMS announces results of expanded analysis of payment errors

  The Centers for Medicare & Medicaid recently announced results from its new error measurement...

• One Medicare advisory board may suggest changing DRG system

  The Medicare Payment Advisory Commission may propose to Congress an overhaul of the DRG system...

• Holiday decorating mishaps result in increased ED visits, hospitalizations

  ED staff better brace themselves-according to a new study EDs treated two to three people an hour...

Issue 54, December 9, 2004 - VIEW THE FULL ISSUE

• More than 40% of US residents taking prescription drugs

  More than 40% of US residents take at least one prescription drug, and 17% take at least three.

• Rate of uninsured FL residents on the rise

  The rate of Floridians without health insurance rose from 17% to 20% over the past five years...

Issue 53, December 1, 2004

• Obesity death rate not as high as previously reported

  A study conducted by the Centers for Disease Control (CDC) created some buzz last spring when it...

• Lack of health insurance limits access, affects health

  People without health insurance for more than a year are three times more likely to lack a regular...

• Number of obese seniors doubled in last two decades

  The percentage of senior citizens who are obese has doubled from 18% in 1980 to 36% in 2002...

Issue 51, November 22, 2004

• Healthcare consumers open to limits of managed care

  Many healthcare consumers are open to cost control practices imposed by managed care companies...

• Tennessee may cut state health program that aids poor, uninsured

  Due to financial difficulties, Tennessee Gov. Phil Bredesen says he may have to dissolve TennCare...

Issue 50, November 16, 2004

• More research needed before CMS covers obesity surgery, says panel

  A Centers for Medicare & Medicaid (CMS) advisory panel recommends more research before the agency...

• Reduced dose of flu vaccine just as effective as full dose

  It may be possible to stretch flu vaccine supplies by providing a reduced dose to healthy, younger...

• Hospice consultation coverage included in final physician payment rule

  The Centers for Medicare & Medicaid (CMS) announced its final physician payment rule.

Issue 49, November 8, 2004

• Cardiovascular discharge checklist reduces LOS and morbidity

  A discharge checklist reduced readmission and morbidity rates of heart failure patients, according...

• Annual flu revaccination reduces mortality risk in elderly

  Elderly people who receive a flu vaccine each year reduce their risk of death by up to 31...

Issue 46, October 14, 2004

• High cost and intensity of care doesn't lead to better health outcomes

  Just because a patient's medical care is costly does not necessarily mean that patient will have...

• HHS awards grants to provide substance abuse and mental health services to homel

  The Department of Health & Human Services recently awarded 34 grants totaling $67.6 million to...

• Robot making doctors' rounds reduces LOS at VA hospital

  At Sentara Norfolk General Hospital in Norfolk, VA some patients are visited by a robot helping...

Issue 42, September 15, 2004

• Number of flu hospitalizations increases among elderly

  On the cusp of the flu season a new study in the Journal of the American Medical Association says...

• Patients not telling physicians they underuse meds because of cost

  More than one-third of chronically ill patients who underuse medications because of high costs do...

• CMS announces inpatient hospital deductible

  The Centers for Medicare & Medicaid (CMS) recently announced the inpatient hospital deductible and...

Issue 40, September 1, 2004

• Patients admitted to the hospital on the weekend have higher mortality rates

  When patients are admitted to the hospital on a weekend, the patients' mortality rates rise 3...

• The JCAHO to study smoking cessation programs in hospitals

  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently announced a new...

• Hospitals to get new drug payments quicker

  The proposed 2005 Outpatient Prospective Payment System (OPPS) will speed access to new treatments...

Issue 38, August 18, 2004

• Hospitalists decrease LOS and costs, says study

  Patients cared for by hospitalists stayed, on average, one day less in the hospital than those who...

• ED visits due to anti-anxiety drug abuse sharply escalate

  The number of antianxiety drug abuse-related ED visits increased by more than 40% since 1995.

• Virginia increases Medicaid payments for obstetrics

  Virginia Governor Mark Warner issued an emergency regulation that will boost Medicaid payments for...

Issue 37, August 16, 2004

• CMS to cover brain cancer treatment

  The Centers for Medicare & Medicaid (CMS) recently announced it will cover Gliadel Wafer therapy, a...

• FY 2005 inpatient prospective payment system rule announced

  CMS recently issued the fiscal year 2005 hospital inpatient prospective payment system (PPS...

• Study: Many Medicare-eligible women in Virginia don’t receive annual mammograms

  Thousands of Medicare-eligible Virginia women do not receive annual mammograms, according to a new...

Issue 36, August 10, 2004

• CMS proposes coverage for preventative services

  Next year all newly enrolled Medicare beneficiaries will have their initial physician examination...

• Substance abuse and anxiety most common psychiatric disorders in US

  Substance abuse and mood and anxiety disorders are the most prevalent psychiatric disorders in the...

• CMS to give hospitals $1 billion for uninsured patient care

  CMS plans to distribute $1 billion to U.S. hospitals to pay for emergency care for uninsured...

Issue 35, August 2, 2004

• Physicians often disregard patient directives when making end-of-life decisions

  When presented with hypothetical patient cases, physicians commonly made end-of-life treatment...

• New osteoporosis drugs increase frequency of patient visits

  Patient visits for osteoporosis increased four times between 1994 and 2003, according to a study...

• The JCAHO approves 2005 National Patient Safety Goals

  The Joint Commission on Accreditation of Healthcare Organization (JCAHO) has approved new National...

Issue 33, July 15, 2004

• Uninsured adults have a higher mortality rate than those with private insurance

  Uninsured adults between the ages of 55 and 64 have a higher mortality rate than adults with...

• Pfizer outlines plan to offer discounted drugs to uninsured

  Pfizer recently announced plans to offer discounts of up to 37% on prescription drugs to 43 million...

• African Americans in nursing homes more likely to lose vision due to cataract

  Fifty-four percent of African American nursing home residents had low vision because of cataract...

Issue 31, July 1, 2004

• Medicare to provide discounts on drugs for those with serious illnesses

  Medicare recently announced a demonstration program that will provide discounts on prescription...

• Pediatric patients acquiring infections cause a 30-day increase in average LOS

  Pediatric patients often experience medically adverse events during their hospital stay-greatly...

• Almost one-third of people under 65 are uninsured

  Nearly 82 million people-one third of the U.S. population younger than 65-lacked health insurance...

Issue 30, June 23, 2004

• Medicare announces proposed coverage for Alzheimer's brain scan

  The Centers for Medicare & Medicaid Services (CMS) plans to expand Medicare coverage for brain...

• Hysterectomy patients undergoing unnecessary cervical cancer screens

  Physicians are providing unnecessary Pap smears to women who have had hysterectomies, despite the...

• Only one in 20 women receiving annual mammograms

  Only one in 20 women received annual mammograms-drastically reducing the potential for preventing...

Issue 28, June 10, 2004

• Visualization helps elderly remember to take medications

  When seniors visualized themselves testing their blood sugar and following medical advice, they...

• Medicare aims to lessen restrictions on homebound individuals

  Medicare recently launched a demonstration project aiming to lessen restrictions on homebound...

• Pfizer may provide services to uninsured Michigan residents

  Pfizer and the state of Michigan are in talks about a deal that would provide the drug company's...

Issue 27, June 4, 2004

• More than one-third of US adults use alternative medicine

  Thirty-six percent of adults in the United States use some type of complementary and alternative...

• Medicare drug card takes effect this week

  The Medicare drug card takes effect this week, allowing seniors and people with disabilities to...

• Almost half of all ED visits by the uninsured treatable outside the ED

  In a recent study that analyzed the safety net for the uninsured in ten U.S. cities, researchers...

Issue 26, May 26, 2004

• Hospitals with more RNs have shorter lengths of stay

  A compilation of nurse staff analyses showed that hospitals with less RNs have longer lengths of...

• Medicare drug card to offer savings of up to 92 percent

  Medicare beneficiaries can start using their new drug discount card on June 1, and the Centers for...

• Elderly black male cancer patients are hospitalized longer than white patients

  A recent study of cancer patients by three otolaryngology surgeons found that elderly black male...

• Tip of the week: Effective group decision making

  Decision making within a team can be challenging, especially when the different clinical...

Issue 25, May 19, 2004

• Heart failure patients who see specialized nurses less likely to be readmitted

  When elderly heart failure patients receive specialized nursing care in the hospital and at home...

• Patients less likely to take meds when co-payments increase

  When health plans raise beneficiary co-payments for prescription medication, people are less likely...

• CMS issues final proposed rule for 2005 inpatient payment increases

  Acute-care hospitals, specifically rural facilities, are the target of CMS’ latest...

Issue 24, May 12, 2004

• Steps to ensure that your patients and their families are prepared for discharge

  When it comes to discharge planning there are some critical steps you must take to ensure that the...

• Include respiratory therapists in discharge planning when appropriate

  Donna Tearl, CRT, patient/family educator for respiratory care at the Alfred I. DuPont Hospital for...

• Nursing homes caring for patients with AIDS receive payment increase

  The Centers for Medicare & Medicaid Services (CMS) recently announced that nursing homes treating...

• Tip of the week: Avoid denied claims for ED diagnostic testing

  Medical necessity determinations in the ED can be a controversial subject.

Issue 23, May 5, 2004

• Centers for Medicare & Medicaid Services (CMS) revise rule for inpatient rehab

  CMS announced the new criteria for reimbursement for inpatient rehabilitation facilities.

• New Web site compares drug prices for Medicare beneficiaries

  As people begin to enroll in the new drug discount card program this week, they can compare prices...

• Long-term care hospitals to receive 3.1 percent hike in payment

  CMS recently increased Medicare payment rates for long term care hospitals (LTCH) by 3.1 percent.

• Tip of the week: How to use email more effectively

  There's always a ton of information to share with fellow staff and so little time to do it. Do the...

Issue 22, April 28, 2004

• One in five type II diabetes patients not taking medication

  Almost one out of every five diabetics is not taking anti-diabetes medication or insulin-leading to...

• Critical access hospitals can soon open inpatient psychiatric and rehab units

  Medicare recently informed rural critical access hospitals (CAHs) that beginning October 1, they...

• Funds distributed for Aging and Disability Resource Centers

  Health and Human Services (HHS) announced funding to 10 states for additional Aging and Disability...

• Ten chronic care programs to launch by year's end

  Medicare plans to launch 10 chronic care programs throughout the country by year's end.

• Tip of the week

  Access Community Health in Chicago equipped its case managers with wireless Tablet PCs that allow...

Issue 21, April 21, 2004

• Higher Medicare spending doesn't result in higher quality care

  States with a higher level of Medicare spending provide a lower quality of care, says a recent...

• 90 million Americans have low health literacy

  Almost half of all American adults have difficulty understanding and using health information...

• Readers respond to last week's metastatic lung cancer case

  Several readers responded to last week's case in which a physician refused to consider hospice...

• Medicare simplifies drug discount program enrollment

  Starting in May, some state pharmacy assistance programs can automatically enroll low-income...

• Tip of the week: How to resolve conflicts within a care giving team

  Bringing together people of different education, training, values, and beliefs is likely to result...

Issue 20, April 14, 2004

• Intensive procedures for inpatient Medicare patients jump

  Inpatient treatment intensity for all Medicare fee-for-service beneficiaries increased between 1985...

• Typical length of stay for a broken hip

  Medicare diagnosis related group: 6 days. This is the usual course for a patient with insurance.

• Dorsal column stimulator for back surgery

  A 45-year-old patient has had two back surgeries. A pain management specialist recommends a dorsal...

• Case: Metastatic lung cancer

  A physician refuses to consider hospice care for a dying 66-year-old woman with metastatic lung...

• Tips for frantic case management directors

  From Peter Moran, RN, CCM, case management director of Mass General's emergency department.

Issue 19, April 7, 2004

• Nurses being called to testify in more cases

  Hospitals are eliminating their "education director" functions at an increasing rate, forcing...

• Data shows poor use of anti-psychotic medication

  About 60% of schizophrenics don't take anti-psychotic medications as prescribed by their doctors...

• Home health insurer owes gov't for billing gaffe

  Home healthcare providers often receive reimbursement at unnecessarily high service levels...

• Resources

  Lunchtime and evening support groups, plus a daytime group for Spanish speakers.

• Tip of the week

  Patient education is an important factor in the care and maintenance of Peripherally Inserted...

Issue 18, March 30, 2004

• Benchmarking study reveals best practices

  Top-performing hospitals have solid preregistration programs in place, according Zimmerman...

• Increase your reimbursement

  Financial losses are just one aspect of medical necessity denials for inpatient claims.

• Charting errors to avoid

  Incomplete documentation in patient clinical records can cause your organization legal and...

• MA hospitals introduce smart cards

  By giving all patients a card to put in their wallets, two Northeast Health System (NHS) facilities...

• Tip of the week

  Pressure ulcers have rapidly become the number one legal issue for hospitals.

Issue 17, March 24, 2004

• ED and patient flow connection?

  When you have flow problems in any part of the hospital, they will always be reflected in the ED.

• Difficult patients Q&A

  What signs and symptoms should you look for in a patient who presents in the ED complaining of pain...

• Burn center hit with largest EMTALA fine

  In February, Jackson Memorial Hospital paid the largest fine to date for violating the...

• Tip of the week

  Identify patient access trouble spots to decrease denials

Issue 16, March 17, 2004

• CMS offers HIPAA guidance

  Five brief instructional texts published in February by the Centers for Medicare and Medicaid...

• Claim rejection

  A new Medicare program transmittal contains more reasons why claims processors might send your...

• Complex case

  A 64-year old female presented to the ED on a Sunday evening with med-sternal chest pain radiating...

• Free Web tools

  Are you looking for innovative ways to enhance the training options available at your facility?

• Tip of the week

  Continued monitoring your high-risk coding and billing departments will be more effective if

Issue 15, March 9, 2004

• Claims issues holding up payments

  Iowa hospitals last month cited missing claims and information disappearing from claims as two...

• CMS will match states’ costs

  The Centers for Medicare and Medicaid Services (CMS) urged states to adopt programs to help those...

• Savings accounts may increase debt

  Hospital officials are bracing for more bad debt if health savings accounts from the Medicare...

• Tip of the week

  Keep the all-stars on your staff.

Issue 14, March 3, 2004

• Hospitals reduce lengths of stay

  New Jersey hospitals constantly struggle with length of stay. Hospitals today are admitting sicker...

• Gov't to investigate LTACHs

  The following are the top four priorities this year for the House of Representatives Ways and Means...

• FDA approves cancer drug

  The Food and Drug Administration approved Avastin (bevacizumab) on February 26, 2004 as a...

• Tip of the week

  For patients who are offered a choice of home health agencies, give them and their families a list...

Issue 13, February 26, 2004

• Canadian ED see drop in wait times with new technology

  Emergency department (ED) wait times at Calgary hospitals in Canada are expected to decline because...

• Iowa healthcare workers struggle with unused drug laws

  The law that bans the "recycling" of unused drugs, no matter the intention is frustrating many...

• EMTALA enforcement: What you need to know

  Off-campus, provider-based hospital departments are not obligated to meet the final regulations...

• Length of Stay Tip of the Month

  Here's how to structure extended stay meetings

Issue 12, February 17, 2004

• LCF urges CMS to cover cancer drugs

  Several interest groups want the Centers for Medicare and Medicaid Services (CMS) to reimburse...

• Poor discharge planning

  Months after it paid a large settlement to a patient, a hospital in Oklahoma is now holding monthly...

• Case managers key to diabetes education

  The Navy Hospital in Pensacola, FL, has started a diabetes education program, called...

• Jump start your compliance program

  From compliance-related documents to hotlines to proper medical records maintenance, this timely...

• Tip of the week: patient teaching

  If patient teaching is needed for a patient going home from the ED, then remember you can get an...

Issue 11, February 11, 2004

• Norwalk Hospital offers overcrowding solutions

  Norwalk Hospital offers overcrowding solutions Although there are currently no permanent solutions...

• 2004's top compliance focus areas

  As you prioritize your compliance plan for 2004, consider where other professionals will devote...

• Mutual aid agreements improve patient transfers

  Create a predetermined mutual aid agreement with facilities to which you may have to transfer...

• Communication Is Important

  Communication among physicians, nurses, and allied health professionals is generally best handled...

Issue 10, February 4, 2004

• VOPA files suit for patient names

  Last week, the Virginia Office for Protection and Advocacy (VOPA) filed a lawsuit against the...

• Technology can help you get your job done

  In many facilities, staff are using e-mail to...

• Caring for patients

  If you ever feel you need to do more for a patient, but have been told not to because he or she is...

Issue 9, January 28, 2004

• Medicare reform may force more outpatients into hospitals

  According to the Georgia Hospital Association, hospitals are facing an increasing number of...

Issue 8, January 21, 2004

• Pennsylvania hospital's express care system aims to treat all patients

  Under a new program at Mercy Hospital in Wilkes-Barre, PA, called "express care," a nurse...

• Flu helps U.S. hospitals hone SARS disaster plans

  When a glut of flu patients swamped medical workers in Nashville, TN, last month, Vanderbilt...

Issue 7, January 14, 2004

• Medicare ED bills show worrisome variations in hospital coding

  More than a year after implementation of the Medicare outpatient prospective payment system (PPS...

• Free-standing ERs to bring medicine to rural areas

  Under political pressure to bring public medicine to its western suburbs, the North Broward...

Issue 6, January 7, 2004

• New Medicare Bill Increases Reimbursement for SIR-Spheres(R) Therapy

  Hospitals will now be able to recover the full cost of treatment when they use SIR-Spheres(R), a...

• Flu Outbreak Causing HIPAA Concerns

  The flu outbreak is causing problems for Arkansas health officials, who are limiting what they will...

• ER phone now answered by automated attendant

  That automated voice everyone loves to hate is now in use at the emergency department (ED) at...

Issue 2, November 22, 2004

• Report predicts deep Medicare cuts for hospitals

  Aging baby boomers, a growing federal deficit, and increased healthcare spending could spell deep...

Issue 49, November 8, 2004

• CMS launches project to improve cancer care

  The Centers for Medicare & Medicaid (CMS) announced it is launching a one-year demonstration...