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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 46, December 18, 2007

• Cost of uncompensated care continues to rise

  Healthcare facilities are paying for a record amount of uncompensated care, according to an annual...

• Hospitals cut costs by reducing readmissions

  According to The Wall Street Journal, hospitals are looking to reduce costs by cutting down on the...

• States' take on nonbilling practices for medical errors

  A report by Modern Healthcare suggests many state hospital associations are considering a formal...

• Five tips for cutting stress for the New Year

  Case management is a stressful profession, and many case managers feel so pressured that they are...

Issue 45, December 11, 2007

• States' economic pressures intensified by Medicaid

  A new report released by the National Governors Association and the National Association of State...

• CDC reports one out of five Americans lack adequate healthcare

  "Health, United States, 2007," the Centers for Disease Control and Prevention (CDC)'s annual report...

• Real-life solutions: 'Important Message'

  Since CMS introduced the "Important Message from Medicare" (IM) in July, Monique Bessent Smith...

• Determine realistic patient throughput solutions

  Poor patient throughput is common in hospitals nationwide. Emergency departments are overcrowded...

Issue 44, December 4, 2007

• AHA announces concerns with Medicare hospital payment change proposal

  Last week the American Hospital Association (AHA) responded to CMS' proposed changes in the...

• Foley's top 10 compliance risks for hospitals

  The Health Care Industry Team of national law firm, Foley & Lardner LLP, announced its "Top 10...

• Quality care lacking for U.S. children

  According to The New England Journal of Medicine, insured children in the U.S only receive...

• Answering your questions about case management models

  The Center for Case Management's Karen Zander, RN, MS, CMAC, FAAN, and Shawna Kates LSW, MSW, MBA...

Issue 43, November 27, 2007

• Hospitals struggle for emergency on-call coverage

  According to a study by nonpartisan policy research organization, the Center for Studying Health...

• Hospitals struggle for emergency on-call coverage

  According to a study by nonpartisan policy research organization, the Center for Studying Health...

• Optimize your discharge planning process

  The first step toward optimizing your discharge planning process is to understand what it looks...

• Hospital healthcare improvements

  Last week, The Joint Commission released its second annual report on healthcare quality and patient...

• Resolving disputes with physicians

  When it comes to conflict between case managers and physicians, much depends on whether there is a...

Issue 42, November 20, 2007

• Baby boomers mistaken on care

  One in four baby boomers mistakenly believe they have long-term care coverage. According to a...

• Scheme cuts ED visits by half

  A health literacy program claims to have cut ED visits by 58%. The study, conducted by the...

• CMS corrects inpatient rules

  CMS has published corrections to the Inpatient Prospective Payment System, reports Hugh Aaron's...

• Expert tips: physician advisors

  In the December issue of Case Management Monthly, Karen Zander, RN, MS, CMAC, FAAN, gives a...

Issue 41, November 13, 2007

• CMS adds to hospital-acquired conditions information

  CMS has released new details on reporting and coding hospital-acquired conditions.

• Nursing home hospitalizations avoidable

  Nearly one-third of nursing home hospitalizations for common outpatient conditions are avoidable...

• Hand-held device to support chronic condition care

  Canadian researchers are studying whether hand-held Blackberry devices can help nurses monitor the...

• Your questions: expert answers

  In this issue of Case Management Weekly, we're offering you a quick insight from Karen Zander, RN...

Issue 40, November 6, 2007

• Uncompensated care costs top $30 billion

  Hospitals provided $31.2 billion in uncompensated care in 2006, according to new figures from the...

• CMS revises IPPS numbers

  CMS has revised some of the key numbers used in calculating payments under the inpatient...

• Every patient deserves palliative care screening

  Every patient should be screened for palliative care needs, says Yvonne D’Arcy, MS, CRNP...

• Ergonomics 'not influential' in staff turnover

  A survey of nursing professionals has found that most do not believe ergonomics and staff turnover...

Issue 39, October 30, 2007

• Comments invited on industry standards

  The Case Management Society of America (CMSA) has called for public comments as it revises its...

• Senate backs telehealth funding increase

  The Senate has voted to increase funding for the Office for the Advancement of Telehealth by $6.8...

• Rising costs stopping physician visits

  Rising out-of-pocket healthcare costs are forcing Americans to delay doctor visits, with many...

• Your questions: expert answers

  In this issue of Case Management Weekly, we're offering you a quick insight from Deborah K. Hale...

Issue 38, October 23, 2007

• Health advocates to fight patients' cause

  A New York insurance plan claims to be the first to offer patients a personal 'health advocate' as...

• Heart rehab underused

  Medicare patients are failing to take advantage of rehab therapy after a heart attack or bypass...

• Use of restraints should be documented

  Recording every use of restraints on patients could help case managers and nurses prevent possible...

• Bills aim to stop hospice cuts

  The trade body for home and hospice care providers has urged legislators to back federal bills that...

Issue 37, October 16, 2007

• New tools to support care transition

  The National Transitions of Care Coalition (NTOCC) is to pilot a set of tools, including...

• Call for ED patient charter

  An emergency physicians group is attempting to build support for a charter of patient rights...

• New approach to denials

  A hospital in West Virginia claims a new approach to appeals has improved its denial reversal rate...

• Florida targets LOS cut for immigrants

  Lawmakers in Florida have passed a budget that will cut hospital payments for legal aliens.

Issue 36, October 9, 2007

• Discharge planning under fire

  Critics of post-discharge planning have taken the stand in front of a California legislative panel...

• New approach aims to improve hospice take-up

  Hospice programs and insurers are changing their approach to encourage more patients to take up...

• Hospital guarantees ED wait times with free gift

  Medical centers in Kansas City, MO, are backing their guarantee of shorter ED wait times with free...

• Community hospitals back telemedicine

  Community hospitals may be bucking a national trend to embrace telemedicine for critical care...

Issue 35, October 2, 2007

• Hospitalist use reduces length of stay

  Employing hospital-based physicians to care for patients with complex clinical or discharge needs...

• Federal ruling changes immigrant reimbursement

  The federal government has told New York state officials that emergency chemotherapy for illegal...

• Inpatient infections costs hospitals $14.5 billion

  A common inpatient infection could be costing hospitals $14.5 billion every year. In a six-year...

• How to: Build a back-up team

  Building a by-the-day team of case managers to call on when absence or leave threaten to bite into...

Issue 34, September 25, 2007

• Let the celebration begin: National Case Management Weeks

  National Case Management Week, as celebrated by the American Case Management Association (ACMA...

• Cutting coverage for experimental drugs

  According to The Wall Street Journal, health insurers are limiting coverage of high cost specialty...

• Getting creative with competency training

  Although most department directors measure and evaluate their case managers solely through a...

• For cancer patients, benefit caps can mean big bills

  Employers and health plans are putting increased caps on the maximum benefits they will pay for...

Issue 33, September 18, 2007

• Remote ICU centers: Redefining the face of healthcare

  According to Newsweek, the latest trend for overburdened healthcare facilities is to outsource the...

• Pressure ulcer survey could save hospitals millions

  Hill-Rom, Hillenbrand Industries' healthcare unit, recently released the results of its 10th Annual...

• Performance indicators of poor patient throughput

  Poor patient throughput is common in hospitals throughout the country. Large and small, rural and...

• System changes to improve patient flow

  In addition to the larger system changes implemented at Lehigh Valley Hospital in Allentown, PA, to...

Issue 32, September 11, 2007

• Technology automates patient flow

  As part of an initiative to accommodate expected patient increases due to the closure of...

• CMS finalizes Medicare reimbursement rates for home health agencies

  As of August 22, 2007, CMS finalized revisions of the Home Health Prospective Payment System, which...

• BlueCross implements new care management technology

  By the end of this year, BlueCross BlueShield of South Carolina intends to execute a new care...

• Improve communication, end verbal abuse

  Whether it's between physicians and nurses, nurses and nurses, or nurses and patients, verbal abuse...

Issue 31, September 4, 2007

• New disease management program significantly lowers hospital costs

  According to the American Journal of Critical Care, an experimental disease management program...

• Record highs: Americans without health insurance

  The U.S. Census Bureau revealed alarming statistics last week involving the record number of...

• LOS reports measure financial success

  Case management departments that can accurately report their financial and quality gains have...

• Bottleneck breakdown: Resolve your discharge process first

  People often point to long wait times in the ED as the source of bottlenecks in the patient access...

Issue 30, August 29, 2007

• Now showing: Covering the Uninsured, starring the AMA

  In an effort to raise awareness regarding the number of uninsured people in the U.S., the American...

• New resource provides free palliative care help

  A free educational DVD on caring for end-of-life cancer patients is now available through the...

• New resource provides free palliative care help

  A free educational DVD on caring for end-of-life cancer patients is now available through the...

• California center, university partner to bring back former nurses

  Tri-City Medical Center, based in Oceanside, CA, wants to lure former nurses back to the field by...

• Build a per diem case management staff to protect your department

  Unexpected absences, long-term medical leaves, and vacancies all create staffing problems for case...

Issue 29, July 25, 2007

• House to Medicare: No cuts in hospital payments

  The House of Representatives approved an amendment last week that would prohibit Medicare from...

• Part D prices to drop in 2008

  The average premium paid by beneficiaries for standard Part D coverage in 2008 will be roughly $25...

• CMS to hospitals: We will no longer pay for mistakes and errors

  Beginning in 2008, the next time a patient contracts a hospital-acquired disease or experiences a...

• Recruiting and communicating across generations

  "The times they are a-changin'," sang Bob Dylan in 1964. For the case management workforce, the...

• New quality improvement award announced

  The Society of Hospital Medicine (SHM) announced that, beginning in 2008, it will present the Team...

Issue 28, July 18, 2007

• Top of their game: Best U.S. hospitals announced

  U.S. News & World Report last week announced publication of the 2007 edition of America’s...

• Hospital groups angry with CMS' IPPS ruling

  CMS is facing heavy criticism from hospital groups after issuing its final inpatient prospective...

• Uninsured Americans raise Medicare costs

  A recent study revealed that Medicare recipients who were uninsured before qualifying for Medicare...

• IBM's "ePedigree" system to combat drug counterfeiting

  To help pharmaceutical companies combat drug counterfeiting, IBM is launching an electronic...

• Study: Preventable deaths linked to quality initiatives

  Approximately 2,200 hospital deaths would be avoided each year if the lowest-performing hospitals...

• Study: Preventable deaths linked to quality initiatives

  Approximately 2,200 hospital deaths would be avoided each year if the lowest-performing hospitals...

• In-store clinics rankle some physicians

  In-store clinics that provide rudimentary healthcare services are spreading in stores such as...

• Self worth: LOS reports help measure a department's success

  Financial reports are the bread and butter of a case management department. Unlike other nursing...

• No surprises: Strategies for staying on the cutting edge

  One of the biggest challenges for directors of case management is to stay aware and informed of new...

Issue 27, July 11, 2007

• State of nursing shortage in critical care

  Experts say the serious shortage of nurses is one of the biggest threats to the U.S. healthcare...

• CMS announces new payment reforms

  CMS' last week issued the final rule that takes significant steps to improve the accuracy of...

• Discharge appeal rights: Are your systems in place?

  CMS' "Important Message from Medicare and Notification of Hospital Discharge Appeal Rights" went...

• Technology helps San Antonio hospitals reduce IV medication errors

  Nurses and medical staff at Christus Santa Rosa Hospital in San Antonio, TX, are using computerized...

• Report: Number of uninsured U.S. adults rises again in 2006

  The number of adults without health insurance jumped by two million from 2005 to 2006, according to...

• Report: Number of uninsured U.S. adults rises again in 2006

  The number of adults without health insurance jumped by two million from 2005 to 2006, according to...

• Part D patients often denied drugs for "off-label" uses

  Part D beneficiaries often cannot obtain drugs prescribed for "off-label" uses such as the...

• Unloading delays cause availability problems

  The time it takes for emergency personnel to unload a patient at a hospital’s emergency...

• "Joint School" prepares patients for home, reduces LOS

  Davis Memorial Hospital (DMH) is a 99-bed facility located in Elkins, WV, and has a busy operating...

Issue 26, June 27, 2007

• Wide variances in Part D drug coverage

  Fewer than half of prescription drugs are widely covered by the 72 different variations of Medicare...

• Report: U.S. children's health a mixed bag

  National trends in child well-being have improved slightly since 2000, according to the KIDS COUNT...

• Joint Commission Resources looks for test hospitals for new study

  Joint Commission Resources (JCR), the education and consulting arm of The Joint Commission, is soon...

• Lack of foreign doctors contributing to physician shortage

  A nationwide physician shortage affecting rural and inner-city residents the most is being...

• New program focuses on electronic medical records for Medicare participants

  CMS announced a pilot effort last week to give beneficiaries improved access to Internet-based...

• Feds investigate LA hospital

  CMS investigators are examining Los Angeles' Martin Luther King Jr.-Harbor Hospital after a series...

• Universal discharge time takes serious planning

  At many hospitals across the country, the discharge process is quickly becoming one of the make or...

• Save time, lives with a transfer-of-care checklist

  It takes just one slip-up or distraction to put a patient at risk during a transfer. For this...

Issue 25, June 20, 2007

• Survey says: Wisconsin best state in the country for healthcare

  The Agency for Healthcare Research and Quality (AHRQ), the research and quality assurance arm of...

• State of U.S. healthcare: You don't get what you pay for

  Americans have the most expensive healthcare system in the world, yet rank below other healthcare...

• Peaks and valleys: Number of licensed nurses rises and falls

  The number of RNs has increased by 75% since 1980, but will begin to decline in 2010, the first...

• Medicare to halt payment for six hospital-acquired conditions

  CMS recently announced that Medicare will stop paying for six hospital-acquired conditions in 2008...

• Palliative care programs help patients, lower costs

  Palliative care programs, which incorporate some aspects of the hospice philosophy while continuing...

• Managing alcohol withdrawal patients

  A few years ago, Saint Joseph Mercy Hospital (SJMH), a 529-bed community-based teaching hospital in...

• The role of ED case management in quality improvement

  An ED case manager is uniquely positioned to provide quality oversight of patient care and...

Issue 24, June 13, 2007

• Mediocre performance from pay-for-performance initiative

  According to a recent study, the pay-for-performance (P4P) program has not significantly improved...

• Florida Hospital guarantees 60-minute or less ED wait times

  Florida Hospital is promising its ED patients they will have less than an hour wait to see a...

• Documentation in an era of intense oversight

  Documentation is the cornerstone of a case management department's practice and is becoming even...

• Survey: Physicians will decrease Medicare services if reimbursement is cut

  Physicians would make substantial reductions in the care of Medicare beneficiaries, and in other...

Issue 23, June 6, 2007

• CMS clarifies transfer component of new discharge rule

  Under Medicare's new discharge notification rule, hospitals need not provide a follow-up notice if...

• AHA launches patient flow products

  AHA Solutions, a subsidiary of the American Hospital Association (AHA), last month launched a...

• New Web site offers quality report cards

  A new internet-based tool demonstrating different approaches for health quality report cards was...

• Franklin Award winner announced

  The Joint Commission and the American Case Management Association (ACMA) named Morton Plant Mease...

Issue 22, May 30, 2007

• CMS clarifies POA implementation schedule

  Last week, CMS issued a new transmittal relating to the requirement that hospitals begin reporting...

• Consider these methods to improve patient flow

  A recent survey conducted by the American College of Emergency Physicians (ACEP) and...

• Open house: An inside look at a DRG case management model

  Examining whether a case management model is current and best meeting the needs of a hospital and...

• Survey: Patients in favor of electronic health records

  Forty-seven percent of respondents to Kaiser Permanente's recent telephone survey of 1,000...

Issue 21, May 23, 2007

• PA hospital group offers patients 90-day guarantee

  The Geisinger Health System, a hospital group in central Pennsylvania, is attempting to change...

• Articles examine medication reconciliation, patient handoffs

  Separate articles in the May issue of Academic Emergency Medicine examine medication reconciliation...

• Report: State of U.S. emergency care troubling

  In a three-part series last week, Newsweek examined how there is no silver bullet solution to the...

• Maximizing reimbursement through concurrent coding

  Maximizing reimbursement is one of the most important responsibilities in a case manager's job...

Issue 20, May 16, 2007

• Palliative care programs on the rise

  As the U.S. population ages and develops more illnesses, the need for palliative care programs will...

• San Francisco mayor focuses on alcoholic patients to reduce ED costs

  In an effort to reduce ED costs, San Francisco mayor Gavin Newsom plans to call for new services...

• Survey: Docs say patient flow affects quality of care

  A recent survey of physician leaders found that one of the most pervasive problems affecting...

• Recruitment secrets: Hiring for attitude, training for skill

  What do Southwest Airlines, UPS, and Thomas Hospital in Fairhope, AL, all have in common? They all...

Issue 19, May 9, 2007

• Poll: Most Americans favor extensive employer health insurance

  More than three-fourths of Americans support proposals to expand health insurance coverage, such as...

• Hospitals improve care in 2006, but patient complaints persist

  Patient satisfaction with hospitals nationwide increased in 2006, according to a survey released...

• Hospitals use coordinators, bed meetings to improve patient flow

  Hospitals are using a number of methods to improve patient flow, including flow coordinators and...

• Save time, lives with a transfer-of-care checklist

  It takes just one slip-up or distraction to put a patient at risk during a transfer. For this...

Issue 18, May 2, 2007

• CMS clarifies Emergency Services Conditions of Participation

  Most Medicare-participating hospitals are required to be able to evaluate and provide initial...

• Avoiding avoidable days and bed crunches: A Bismarck hospital slices wait times

  One of Detroit's largest health systems-Beaumont Hospital in Royal Oaks, MI-recently shaved ED wait...

• Electronic systems improve discharge times

  Electronic discharge systems can help improve the discharge process by quickly giving referred...

• Director tips: Strategies for managing a diverse department

  Directors of case management may be registered nurses, social workers, or business professionals...

Issue 17, April 25, 2007

• CMS releases proposed 2008 hospital inpatient rule

  CMS last week released a proposed rule intended to continue the transition to a more accurate...

• Study: Health benefits more important than salary for most workers

  A majority of U.S. workers employed at large businesses consider health coverage to be the most...

• Book explores deaths related to ED diversions

  A new book on the U.S. healthcare system explores the circumstances surrounding several deaths...

• Found in translation: Maximizing the use of your interpreters

  You may not be taking full advantage of a valuable resource in your hospital: Interpreters are...

Issue 16, April 18, 2007

• States more aggressive with pay-for-performance programs

  The number of Medicaid pay-for-performance programs has dramatically increased, according to a...

• Electronic systems improve discharge times

  Electronic discharge systems can help improve the discharge process by quickly giving referred...

• Avoiding case management/social work turf battles

  Despite the good intentions, talent, and passion of case mangers and social workers, turf battles...

• Study: Many California EDs dangerously crowded

  California EDs were closed to ambulances 10% of the time during 2005, according to a new report...

Issue 15, April 11, 2007

• Just saying no: Studies show thousands of patients forgo their medications

  Only about 50% of chronically ill patients in the U.S. and other industrialized nations take their...

• CMS plans hospital quality improvement program

  CMS will launch a dry run in December 2007 for a hospital quality program by publishing details...

• A ticket to ride: Experimental white boards prepare patients for discharge

  In an effort to expedite the discharge process, the staff on the acute care of the elderly (ACE...

• Australian hospital’s emergency medical unit improves patient flow

  Townsville Hospital, located in Townsville, Australia, has created a new emergency medical unit to...

Issue 14, April 4, 2007

• Pay attention to Present on Admission (POA)

  If you're not already aware of the Present on Admission (POA) indicator-a critical data element...

• Generics doughnuts only: Lack of brand-name drug options for Part D beneficiarie

  More prescription drug plans will offer some kind of doughnut hole or gap coverage in 2007 than in...

• IL hospital improves flow, saves money

  Beaumont Hospital in Royal Oak, IL, has over 1,000 licensed beds and typically runs close to...

• "Ask DR. WIKI" Web site receives praise, criticism

  Several Cleveland Clinic physicians have recently launched a Web site called Ask Dr. Wiki-a medical...

Issue 13, March 28, 2007

• How covered are you? Study finds the insured facing mounting medical debt

  An increasing number of individuals are incurring medical debts, despite having health insurance...

• Massachusetts ED wait times vary drastically depending on setting

  Patients treated in Boston's EDs at teaching hospitals or hospitals that treat large numbers of...

• The Joint Commission: Quality of care improved for three conditions

  A new report by The Joint Commission has found that hospitals across the United States have...

• Save time, lives with a transfer-of-care checklist

  It takes just one slip-up or distraction to put a patient at risk during a transfer. For this...

Issue 12, March 21, 2007

• New CMS final notification rule requires case management organization

  The most recent Medicare item to affect case managers is the "Notification of Hospital Discharge...

• Study: Financial barriers cause patients to skip follow-up care, require repeat

  Many patients do not receive the necessary follow-up care they need, regardless of whether they...

• Study: Financial barriers cause patients to skip follow-up care, require repeat

  Many patients do not receive the necessary follow-up care they need, regardless of whether they...

• Study: Financial barriers cause patients to skip follow-up care, require repeat

  Many patients do not receive the necessary follow-up care they need, regardless of whether they...

• Study: Financial barriers cause patients to skip follow-up care, require repeat

  Many patients do not receive the necessary follow-up care they need, regardless of whether they...

• Study: Financial barriers cause patients to skip follow-up care, require repeat

  Many patients do not receive the necessary follow-up care they need, regardless of whether they...

• Canadian hospital institutes new information systems to aid patient flow

  Information kiosks are to be located in emergency department waiting areas at both campuses of The...

• Minorities less likely to use hospice care, study says

  Far fewer minorities use hospice care for terminal illness compared with whites, according to a...

Issue 11, March 14, 2007

• Pass the test: Strategies for improving discharge times

  While many patient flow issues contribute to delayed patient stays and late hospital discharges...

• MedPAC examines ways to cut readmissions in hospitals

  The Medicare Payment Advisory Commission (MedPAC), the independent federal body that advises...

• New Web site allows patients to shop for their care

  A new Web site launched last week allows California residents to compare more than 200 hospitals on...

• Patients, staff, equipment tracked with radio chips

  Providence Medical Center in Waco, TX, has started a new program that uses radio frequency...

Issue 10, March 7, 2007

• Best practice strategies for reducing LOS

  Case managers are increasingly involved in initiatives such as core measures and clinical...

• Hospital trustees turn their attention to patient safety

  While most hospital trustee seats have long been associated with raising money and networking, many...

• Hospitals move boarded ED patients to units

  Hospitals in Edmonton, Canada, are to follow the example of a Vancouver-area hospital and move...

• Uninsured kids receive worse care, quicker discharges, study finds

  Hospitalized children who lack health insurance are twice as likely to die from their injuries as...

Issue 3, January 17, 2007

• Millions of U.S. residents lack assess to preventive care

  While the overall quality of the U.S. healthcare system continues to improve, millions of U.S...

• Long waits, tests slow cancer patient flow

  A new study offers some insight into the amount of time cancer treatment patients lose to...

• End of late fees: CMS waives Part D penalty

  CMS has extended the Part D special enrollment period for low income beneficiaries through 2007 by...

• Checklist focuses on discharge of elderly

  An article in the November/December 2006 issue of The Journal of Hospital Medicine outlines a...

Issue 1, January 3, 2007 - VIEW THE FULL ISSUE - VIEW THE FULL ISSUE - VIEW THE FULL ISSUE

• CMS to send out second Medicare Provider Satisfaction Survey

  CMS recently announced it will conduct its second annual provider satisfaction survey of Medicare...

Issue 8, February 21, 2007

• Healthcare spending to double by 2016

  By 2016, U.S. healthcare spending will nearly double to $4.1 trillion and account for one-fifth of...