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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 52, December 31, 2008

• CMW News: Gaps in Medicaid coverage may cause increased hospitalizations

  A five-year retrospective study published recently in the Annals of Internal Medicine proposes that...

• CMW News: CMS surveys healthcare providers about MACs

  This month, CMS will be sending the fourth annual Medicare Contractor Provider Satisfaction Survey...

• CMW Tip of the Week: Communication is key with physician advisors

  This week’s tip comes from Sharon Mass, PhD, ACM, and Donna Ukanowicz, MS, RN, ACM.

• CMW Sneak Peek: Collaboration for improved documentation and communication

  In this month’s edition of our bimonthly “Building better relationships” series...

Issue 51, December 24, 2008

• CMW News: Study shows drug companies report biased test results

  A study done by the University of California in San Francisco (UCSF) says physicians may not be...

• CMW News: Insurance companies hope to have presence at neighborhood discussions

  President-elect Barack Obama supporters will be gathering in homes across America to discuss...

• CMW Tip of the Week: Case managers and core measures

  This week’s tip, an “Ask the Expert” is provided by June Stark, RN, BSN, MEd.

• CMW Sneak Peek: Maximize your PA program

  If you are not taking advantage of the expertise your physician advisor (PA) can offer to your case...

Issue 50, December 17, 2008

• CMW News: Hospitals around the nation look to cure ED overcrowding

  Too many patients and not enough capacity in the emergency department has been a longstanding...

• CMW News: Almost half of all Americans use complementary and alternative medicine

  A steady number of Americans—38% of adults and 12% of children—rely on some form of...

• CMW Tip of the Week: Data collection dos and don'ts

  This week’s tip, an “Ask the Expert,” comes from Karen Zander, RN, MS, CMAC, FAAN.

• CMW Sneak Peek: Taking an interdisciplinary approach to attacking avoidable days

  As facilitators and coordinators of patient care services, case managers are in the best position...

Issue 49, December 10, 2008

• CMW Tip of the Week: Hospitalists reduce length of stay

  Hospitalists create a win-win situation for themselves and the hospitals they work in, says Toni...

• CMW News: The Joint Commission, CMS not enough to keep hospitals safe

  The United States has difficulty penalizing or closing unsafe hospitals because it lacks a single...

• CMW News: Medicare introduces electronic enrollment system

  CMS now offers an electronic Medicare enrollment system known as Internet-based Provider...

• CMW Sneak Peek: Data collection, analysis lead to positive outcomes

  Recovery audit contractors (RAC), present on admission, and January’s loss of the Program to...

Issue 48, December 3, 2008

• CMW News: Wristband colors standardized in New Hampshire

  Using color-coded patient wristbands can quickly communicate information about patients to hospital...

• CMW News: Web site helps seniors choose Medicare Part D plan

  Now seniors and caregivers can find the most suitable and cost effective Medicare Part D plan by...

• CMW Tip of the Week: Clarifying delivery of the IM

  Last week’s tip on delivering the Important Message (IM) from Medicare prompted some...

• CMW Sneak Peek: Preadmission interventions can help improve LOS

  Case management department employees will hear the familiar phrase “We need to decrease...

Issue 47, November 26, 2008

• CMW News: Hospitals receive different reimbursements for identical procedures

  Some Massachusetts hospitals earn much higher rates than other hospitals in the state for...

• CMW News: Pilot study provides lessons learned for cardiac care

  Ten hospitals increased the number of patients receiving all recommended care for heart failure by...

• CMW Tip of the Week: Know when to deliver the Important Message from Medicare

  This week’s tip, an “Ask the Expert” was submitted by Kimberly D. Mallory, MSN...

• CMW Sneak Peek: Transforming the elective precertification process

  The corporate care management staff at the University of Pittsburgh Medical Center (UPMC) knew its...

Issue 46, November 12, 2008

• CMW News: Survey reports physician concerns regarding never events

  On October 1, CMS began withholding additional payments to hospitals for certain identified serious...

• CMW News: AMA investigates repatriation of hospital patients

  The American Medical Association’s House of Delegates has voted to investigate the issue of...

• CMW News: Hospitals see decline in paying patients, rise in non-paying

  As emergency departments are filled to capacity with patients who have no insurance or can’t...

• CMW News: CMS prepares to launch electronic record pilot program

  In an effort to decrease paperwork and give patients more control over their health records, CMS is...

• CMW Tip of the Week: Properly document discharge plans

  This week’s tip, an “Ask the Expert,” was provided by Karla Mariska, RN, a...

• CMW Tip of the week: Understand the difference between a Medicare appeal and a Medicare reopening

  This week’s tip is provided by Deborah K. Hale, CCS.

• CMW Sneak Peek: Manage your fear of the RAC

  CMS’ Recovery Audit Contractor (RAC) program elicits feelings of fear, but Brenda Keeling...

• CMW Sneak Peek: Focus on advocacy and quality

  If your case management program is like most, it focuses mainly on utilization review and discharge...

Issue 45, November 5, 2008

• CMW News: Palliative care programs save hospitals money

  While palliative care is a relatively new specialty, a recent study provides more evidence of its...

• CMW News: Health insurance companies urge physicians to prescribe generic drugs

  In the past, drug companies have been criticized for encouraging physicians to prescribe their...

• CMW Tip of the Week: Hospitalists complement case management objectives

  This week’s “Ask the Expert” is provided by June Stark, RN, BSN, MEd.

• CMW Sneak Peek: Are case managers real nurses?

  For almost as long as hospital case managers have existed, the question of whether they can still...

Issue 44, January 29, 2008

• California panel ends Gov. Schwarzenegger’s health plan

  The Californian Senate has rejected Gov. Arnold Schwarzenegger’s proposal to provide almost...

• CMW Sneak Peek: Improving nurse and case manager relations

  As a case manager, your job inevitably involves working with a variety of people each day to...

• CMW News: Moving patients to hallway beds safer than ED boarding

  Hospitals have long-faced the troublesome problem of too many patients and not enough beds. Most...

• Medical schools preparing for aging Baby Boomers

  Many medical schools are rushing to include geriatric education in their curriculum and add...

• CMW News: Free data available for healthcare use

  The recently released Healthcare Cost and Utilization Project (HCUP) report, sponsored by the...

• Growing number of people reaching insurance coverage limits

  The Washington Post recently highlighted the "small but growing" issue of people with chronic...

• CMW Tip of the Week: HIM can help you de-code data

  This week’s tip comes from Harriet Kinney, RHIT, CHC, organizational integrity manager for...

• Leveraging the role of the physician advisor

  Physician advisors (PA) play a critical role in enhancing the clinical credibility of case...

Issue 43, October 22, 2008

• CMW News: Stewardship programs help prevent hospital-acquired infections

  October 1, 2008 brought an end to CMS’ reimbursement to hospitals for patients who acquire...

• CMW News: Hawaii terminates universal healthcare for children

  After only seven months, state government officials announced Hawaii will stop giving universal...

• CMW Tip of the Week: Talk with patients to determine outcome goals

  This week’s tip, an “Ask the Expert,” comes from Karen Zander, RN, MS, CMAC, FAAN.

• CMW Sneak Peek: Collaboration accelerates discharge planning process

  St. Luke’s Episcopal Hospital in Houston had several problems in its ICU: LOS rates had...

Issue 42, October 15, 2008

• CMW News: Hospitals absorb costs of treating uninsured immigrants

  Hospitals in New York, Connecticut, and New Jersey are increasingly finding themselves providing...

• CMW News: Medicare launches Web site for 2009 prescription drug and health plans

  Medicare beneficiaries can now compare 2009 Medicare drug plans, hospitals, and health plans on the...

• CMW Tip of the Week: Evaluate patients' continuity-of-care needs

  This week’s Tip of the Week comes from Jackie Birmingham, RN, BSN, MS, CMAC.

• CMW Sneak Peek: Say yes to best practices in denial prevention

  Today, hospitals are facing many challenges: Shrinking payer sources, increasing charity care...

Issue 41, October 8, 2008

• CMW News: Telehealth program cares for elderly patients

  Overcrowded emergency rooms, an increasing elderly population, and a decreasing number of...

• CMW News: Report shows variances in access to palliative care

  In the United States today, about 90 million people are living with serious, life threatening...

• CMW Tip of the Week: Educate physicians on POA reporting

  Last week’s tip on the timeline for querying physicians for POA reporting prompted several...

• CMW Sneak Peek: LOS initiative saves one facility more than $1 million

  When New Hanover Regional Medical Center (NHRMC) in Wilmington, NC, wanted to decrease LOS...

Issue 40, October 1, 2008

• CMW News: California passes law to prevent hospital-acquired infections

  The Centers for Disease Control and Prevention estimates that every year, two million patients...

• CMW News: DNV becomes newest approved hospital accreditation program

  Det Norske Veritas Healthcare, Inc. (DNV) last week joined the ranks of the Joint Commission and...

• CMW Tip of the Week: Understand POA query timeline

  This week’s tip, an ask the expert, is provided by Deborah Hale, CCS, author of Observation...

• CMW Sneak Peek: Present on admission: Distinguishing an opportunity for case managers

  Throughout the United States, hospitals are trying to keep pace with new regulations, requirements...

Issue 39, September 24, 2008

• CMW News: Medicare announces 2009 deductibles, premiums

  CMS announced last week that the 2009 monthly premium for Medicare Part B will stay at $96.40, the...

• CMW News: Google, Microsoft compute benefits of taking on healthcare

  In an effort to shift power to consumers in healthcare, both Google and Microsoft are seeking ways...

• CMW Tip of the Week: Improve POA documentation

  This week's tip, an ask the expert, is provided by June Stark, RN, BSN, MEd.

• CMW Sneak Peek: Hospital case managers should take on fall prevention strategies

  As healthcare organizations look to October 1 as the day they will no longer be reimbursed by...

Issue 38, September 17, 2008

• CMW News: Some hospitals, payers favor a return to managed care

  While hospitals, healthcare professionals, and politicians are all desperately looking forward for...

• CMW News: Open door policy: MA hospitals can no longer turn ambulances away

  When a hospital’s emergency department is overflowing and ambulances just keep coming, it has...

• CMW Tip of the Week: Readers write in about the effects of attitude

  Last week’s tip brought in some extra feedback from our readers who wanted to share ways they...

• CMW Sneak Peek: Prepare for POA

  $23,772: That’s the projected average annual loss per hospital starting October 1, when...

Issue 37, September 10, 2008

• CMW News: Hospitals wage war on 'superbugs'

  Each year, 90,000 patients die from infections they acquire in hospitals, according to The Wall...

• CMW News: Case managers assist disaster victims

  Victims affected by Hurricane Gustav will turn to case managers to help them recover from the...

• CMW Tip of the Week: Encourage problem-solving with telephone etiquette

  This week’s tip comes from Sandra Ibach, RN, MS, CCM, a community-based case manager at...

• CMW Sneak Peek: Reaching out to the disadvantaged obstetrics population

  The nurses in the Maternity Care Coordinator Program office in the birthing center at Prince...

Issue 36, September 3, 2008

• CMW News: Glitch in system causes Medicare to overpay

  Medicare would have saved $6.5 million in March if it had a system that could more easily react to...

• CMW News: Oahu medical center files for bankruptcy

  Hawaii Medical Center, LLC (HMC) had been working hard to increase its number of patients and to...

• CMW Tip of the Week: Take steps to change case management culture

  This week’s tip, an “Ask the Expert,” is provided by Karen Zander, RN, MS, CMAC...

• CMW Sneak Peek: Rewiring the discharge planning process

  Sutter Health Sacramento Sierra Region in California recognized there was room for improvement in...

Issue 35, August 27, 2008

• CMW News: Caring for uninsured costs U.S. $56 billion, study finds

  Uninsured Americans will leave an unpaid tab of $56 billion for healthcare this year, according to...

• CMW News: Some patients stop taking medications due to drug coverage gap

  Elderly patients with chronic conditions face a tough choice after their total Medicare drug...

• CMW Tip of the Week: Learn to save time by delegating tasks

  Many of us struggle with the demands on our time, particularly when we feel like a great deal of...

• CMW Sneak Peek: Recruiting and retaining quality case managers

  If there are two things top corporations understand and execute better than anyone, it is the...

Issue 34, August 20, 2008

• CMW News: Thomson Reuters names 100 most improved hospitals

  One hundred hospitals around the nation are celebrating their ability to improve patient care and...

• CMW News: Drug therapy can be as effective as angioplasty, study finds

  About one million angioplasty surgeries are done in the United States every year, each with a price...

• CMW Tip of the Week: Screen patients to establish potential discharge planning hold-ups

  This week’s tip comes from Jackie Birmingham, RN, BSN, MS, CMAC. Although all patients...

• CMW Sneak Peek: Create a collaborative case management program

  Spectrum Health in Grand Rapids, MI, has an award-winning care management program, which combines...

Issue 33, August 13, 2008

• CMW News: Drug companies dramatically raise prescription drug prices

  Imagine your baby needs medication to control a condition that causes spasms. Now imagine that the...

• CMW News: Uninsured immigrant population multiplies

  The uninsured population in the United States increased every year between 1994 and 2006 due to a...

• CMW Tip of the Week: Shift your focus away from LOS

  Concentrating on LOS as the main indicator of a hospital’s quality of patient care and...

• CMW Sneak peek: Improving access to care for the self-pay population

  Across our nation, many face the challenge of finding, keeping, and affording medical insurance.

Issue 32, August 6, 2008

• CMW News: CMS adds two new conditions to do-not-pay list

  Only two conditions, instead of the originally proposed nine, will be added to the list of...

• CMW News: Study finds huge increase in heart failure hospitalizations

  The rate of heart-failure (HF) related hospitalizations tripled in the U.S. between 1979 and 2004...

• CMW Tip of the Week: Perfect your practical interview process

  This week’s tip is an “Ask the Expert” with a question provided by a disease...

• CMW Sneak Peek: Technician role adds much needed support to CM team

  One of the most useful positions to emerge in recent years to support and enhance the role of the...

Issue 31, July 30, 2008

• CMW News: CMS allocates $49 million to high-risk insurance pool

  CMS is splitting a $49 million grant between high-risk Health Insurance Pools (HIPs) in 31 states...

• CMW News: Physicians use creative scheduling to cope with outdated system

  If you’re a Medicare patient, your doctor may not be willing to take a quick look at your...

• CMW Tip of the Week: Learn to enhance relationships with nursing staff

  This week’s tip comes from Linda O’Neil, RN, BSN, CCM, director of care management at...

• CMW Sneak Peek: Bridge the gap between RNs and social workers to create a cohesive case management program

  For patients to receive the right care and to deal with the effect that an injury or health problem...

Issue 30, July 23, 2008

• CMW News: U.S. leads world in healthcare spending

  A report slated for release on Thursday claims the U.S. has the most expensive healthcare system in...

• CMW News: Technology adds to growing healthcare costs

  Increased technology in most industries often leads to better, more cost-efficient results. But...

• CMW Tip of the Week: Use these strategies for medical staff education

  This week’s tip comes from Deborah K. Hale, CCS, author of HCPro’s Observation Status...

• CMW Sneak Peak: A brief assessment tool can improve productivity and patient care

  Until January 2007, the University of North Carolina (UNC) Health Care System in Chapel Hill was...

Issue 29, July 16, 2008

• CMW News: CMS develops program to prevent Medicare fraud

  After findings suggested that CMS has paid more than $92 million to fraudulent Medicare claims for...

• CMW News: RAC program has saved CMS almost $700 million, report says

  Since its implementation in 2005, CMS’s recovery audit contractor program (RAC) has returned...

• CMW Tip of the Week: Clearing up concurrent coding

  This week’s tip is an ask the expert with a question provided by Case Management Weekly...

• CMW Sneak Peek: Increase your facility's access to healthcare while improving the bottom line

  When Joel F. Karman, MSW, LSW, MPH, senior director of social services and guest relations at the...

Issue 28, July 9, 2008

• CMW News: New online tool set to help uninsured locate care

  The Health Resources and Services Administration (HRSA) recently developed an online tool to help...

• CMW News: The Joint Commission places 2009 standards online

  The Joint Commission recently revised its standards and made them available online.

• CMW Tip of the Week: Nailing down a case manager's job responsibilities

  This week’s tip is an ask the expert with a question provided by Case Management Weekly...

• CMW Sneak Peek: Complex Case: Two strategies for dealing with the uninsured

  One of the advantages of having an ED case management program is having a case manager available...

Issue 27, July 2, 2008

• CMW News: CDC reports on numbers of uninsured

  The Centers for Disease Control and Prevention (CDC) released the findings of its latest National...

• CMW News: The American Hospital Association launches updated RAC Web site

  On June 27, the American Hospital Association (AHA) launched a Web site with information about the...

• CMW Tip of the Week: Let's dig deeper into case management ratios

  Last week’s ask the expert gave us an insightful look at case management ratios and drew a...

• CMW Sneak Peek: Directing a system offers different challenges, benefits

  When Mary E. Whitehead, BSN, MA, began developing the case management program for the Scripps...

Issue 26, June 25, 2008

• CMW News: CMS declares pay-for-performance pilot a success

  CMS announced last Tuesday that the hospitals participating in its Value-Based Purchasing (VBP...

• CMW News: Psychiatric patients contribute to ED overcrowding

  In a survey recently conducted by the American College of Emergency Physicians, nearly 80% of...

• CMW Tip of the week: Case manager to patient ratio

  This week’s tip is an ask the expert contributed by Case Management Weekly reader Angela...

• CMW Sneak Peek: Case managers can make a difference in improved coding

  Although many think a case manager’s job includes utilization, resource management, and...

Issue 25, June 18, 2008

• CMW News: Toolkit released to help hospitals improve quality of care

  The Robert Wood Johnson Foundation, along with the Institute for Healthcare Improvement, recently...

• CMW News: Top 26 hospitals receive award from Premiere healthcare alliance

  Twenty-six hospitals—out of 3,800 nationwide—recently earned the 2008 Premiere Award...

• CMW Tip of the week: The role of the physician advisor

  This week’s tip, an ask the expert, is provided by Karen Zander, RN, MS, CMAC, FAAN and...

• CMW Sneak Peek: Technology helps case managers avoid burnout

  With so many case management departments understaffed and underfunded, several case managers around...

Issue 24, June 11, 2008

• CMW News: New regulations give hospice patients more choices

  New CMS regulations published June 5, 2008, in the Federal Register detail the first major changes...

• CMW News: Hospitals auctioning off debt

  In an effort to collect unpaid medical bills, some hospitals are auctioning off their...

• CMW Tip of the Week: Case load confusion

  This week’s tip, an ask the expert, is provided by June Stark, RN, BSN, MEd

• CMW Sneak Peek: Steps for starting an ED case management program

  Having a case management program in the ED can help alleviate capacity issues, ensure CMS...

Issue 23, June 4, 2008

• Atlanta launches TAP-IN program to care for uninsured

  In order to meet the rising demand for free clinics in Atlanta, the city has launched a program...

• Study rates efficiency of health insurance companies

  Athenahealth, Inc., a provider of Internet-based business services to physicians, recently released...

• Tip: Narrow the focus of your physician education

  When determining where to focus your physician education efforts, ask the following questions:

• What does RAC mean to case managers?

  The Recovery Audit Contractor (RAC) program, an initiative identified by the Tax Relief and Health...

Issue 22, May 28, 2008

• Medicare to bundle hospital, physician payments

  CMS will launch a three-year pilot program beginning January 1, 2009, that will bundle Medicare...

• New Web site allows patients to compare hospitals

  The Nebraska Hospital Association has launched a new Web site called “Care Compare&rdquo...

• Florida governor signs a bill to allow low-cost health policies

  Many states are trying to cover more uninsured residents while dealing with smaller budgets...

• Setting up a charity care team can save your hospital money in the long run

  There’s no getting around the fact that the number of uninsured and underinsured patients...

Issue 21, May 21, 2008

• Report offers solutions to decrease ED overcrowding

  A task force from the American College of Emergency Physicians, a specialty medical organization...

• Americans taking more prescription drugs

  A new study shows that, for the first time, more than half of all insured Americans are taking...

• High drug prices cause some patients to turn to the Internet

  A growing option for some Americans who can’t afford their high-priced prescription drugs is...

• Revised ABN should cause less confusion for patients

  On March 3, CMS released the new ABN. This form, also known as the ABN-R-131, will be used for all...

Issue 20, May 14, 2008

• Wal-Mart, Target to offer $10 prescription drug programs

  Last week, Wal-Mart announced the third phase of its low-cost prescription drug program saying that...

• Safety-net hospitals seek ED alternatives for non-urgent patients

  The Center for Studying Health System Change,  a non-partisan policy research organization...

• Insured population struggles with healthcare costs

  The economic slowdown is not only affecting healthcare costs for the uninsured. Many insured...

• Massachusetts hospital finding way to help repeat substance abusers in the ED

  Substance abuse is a chronic illness just like congestive heart failure or diabetes, but it...

Issue 19, May 7, 2008

• Using silver-lined catheters could reduce urinary tract infections, study finds

  A study authored by two nurses from St. Vincent’s Rehabilitation Hospital in Sherwood, AK...

• Rise in uninsured could strain public resources

  At present, 47 million people, or 16% of the population, are uninsured. This number is projected to...

• Health insurance premiums rise 10 times faster than incomes

  The results of a study by researchers at the State Health Access Data Assistance Center at the...

• Complex case: Finding recovery for a rehab patient and his wife

  In this month’s complex case, we look at a 70-year-old male patient who presented with wound...

Issue 18, April 30, 2008

• Language help in NY hospitals has room for improvement

  A report released last week by The New York Immigration Coalition says that language assistance in...

• U.S. needs to prepare for aging population, report says

  The healthcare community needs to start making preparations for the aging baby boomers, says a...

• Hospitals face insolvency from troubled economy

  A global professional services firm that recently analyzed more than 4,500 U.S. hospitals found...

• Become a successful case management director

  One of the most difficult challenges a case management director faces is trying to keep staff...

Issue 17, April 23, 2008

• Hospital program brings lawyers to low-income patients

  More than 80 hospitals across the country have begun working with lawyers to help low-income...

• Tier 4 drugs make prescription prices soar

  In an effort to lower premiums, many insurance companies are adopting a new prescription pricing...

• Medicaid announces grants of $50 million to reduce ED visits

  CMS will give 20 states total grants of $50 million over four years in an effort to improve access...

• Save money and time by developing a collaborative case management program

  In the January Director’s Desk feature of Case Management Monthly, Sharon Mass, PhD, ACM, a...

Issue 16, April 16, 2008

• Reimbursement halted for 11 errors

  Following Medicare’s lead, and possibly setting the stage for other insurance companies to do...

• Economic effect of hospitals measured

  A report released April 7 by the American Hospital Association found that the effect that hospitals...

• Efficiency vs. quality of care

  The 2008 edition of The Dartmouth Atlas of Health Care shows great disparities among hospitals...

• LTACHs can help control patients’ LOS

  Case managers with patients facing an LOS that is longer than expected or above the DRG geometric...

Issue 15, April 9, 2008

• Many patients dissatisfied with hospital care, survey finds

  According to an article in The New York Times, the first uniform government survey given nationwide...

• Majority of physicians in favor of universal healthcare

  The results of a recent survey published in the Annals of Internal Medicine found that most...

• California to ban "balance billing"

  New legislation was drafted in California by the Department of Managed Health Care to stop...

• Communication: A main factor in reducing readmissions

  In most cases, a hospital’s goal is to improve a patient’s health and eventually...

Issue 14, April 2, 2008

• Medicare to become insolvent by 2019

  According to an article in The New York Times, a new report prepared by government actuaries and...

• Medicare changes affect oxygen suppliers, patients

  Beginning July 1, only some suppliers of oxygen will continue to be contracted by Medicare as the...

• Uninsured patients causing U.S. healthcare costs to rise

  A report issued by the New America Foundation estimates the cost to the U.S. economy for caring for...

• Complex case: How do we educate patients and families about hospice programs?

  Case managers in inpatient hospital settings that also include inpatient hospice programs have to...

• Contest! Enter to win $100 for taking our ED and clinic revenue cycle survey

  We’re researching how to meet your needs for managing the ED and clinic revenue cycle, and we...

Issue 13, March 25, 2008

• Gap in life expectancy widens

  New government research shows a widening gap between socio-economic classes for life expectancy...

• Study concludes that hospitalists reduce length of patient stays

  A recent study published by The New England Journal of Medicine reports that, on average...

• The journey toward case manager certification

  Three years ago, I supported my RN and social worker case manager staff as they went through the...

Issue 12, March 18, 2008

• HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative

  HCPro, Inc. is launching a new corporate branding campaign designed to reflect the company’s...

• CMS releases changes to ABN

  In a much anticipated move, CMS released the new Advance Beneficiary Notice of Noncoverage (ABN...

• NIH to study healthcare disparities

  The National Institutes for Health (NIH) has launched a new center that will investigate social...

• Physician querying is a must for accurate charting

  The best way for your hospital’s documentation to be accurate is for physicians to take their...

Issue 11, March 11, 2008

• Medicare proposed rule draws criticism

  CMS’ approach to prevent certain Medicare beneficiaries from having to change their Medicare...

• Feeling lucky? Oregon offers health insurance lottery

  Winning the lottery usually entails riches beyond one’s wildest dreams, but a new lottery in...

• Hispanics most worried about insurance coverage, study finds

  A quarter of Hispanics surveyed last year by the Rockefeller Foundation reported they were worried...

• MS-DRG system makes complete documentation essential for maximum reimbursement and minimum denials

  The idea behind CMS' Medicare Severity DRG (MS-DRG) system was to financially reward hospitals that...

Issue 10, March 4, 2008

• California hospitals must report drug-resistant infections

  California hospitals must now report cases of community-acquired staph infections resulting in...

• New study finds cardiac arrest cases deadlier at night

  A study in The Journal of the American Medical Association (JAMA) says patients who experience...

• Substance abuse: Survey results illustrate demand for more resources, funding, and better follow up

  In hopes of gathering feedback from you on how your peers at other hospitals manage substance abuse...

• Pilot study shows benefits of case management intervention for patients in physician practices

  The theory was that an efficient nurse case manager and an invested primary care physician (PCP...

Issue 9, February 26, 2008

• Managing substance abuse: From the ED to follow-up care post discharge

  Managing patients with substance abuse who come to your hospital’s ED is a national problem...

• Researchers find limited cancer care for nursing home residents on Medicare

  A new study in Michigan has raised alarming questions about cancer care of patients in long-term...

• Proposed Bush budget cuts would hit hospitals hard, administrators say

  The federal government is proposing cuts to the Medicare and Medicaid programs and now hospital...

• Retaining case managers starts with the interview process

  With so many hospitals running understaffed on a nearly constant basis, case managers are always in...

Issue 8, February 19, 2008

• Mental health law extension approved by House

  The U.S. House of Representatives recently approved legislation to extend a mental health law that...

• U.S. has fewer primary care physicians

  The number of American medical students interested in primary care is declining. The current number...

• Flu cases could multiply as current vaccine lacks two key strains

  The Centers for Disease Control and Prevention (CDC) has announced that the current flu vaccine...

• Case managers play a critical role in clinical documentation improvement in light of new MS-DRGs

  In October 2007, CMS implemented the most dramatic restructuring of the DRG system since its...

Issue 7, February 12, 2008

• Physicians say EDs are not the safety net they promise to be

  One in five emergency department physicians know of a case where a patient has died due to having...

• California experimenting with telemedicine to lower cost of chronic diseases

  Treating chronic disease consumes the majority of healthcare expenditures in the U.S., and diabetes...

• New Medicare trend using more resources than ever

  A new trend is placing the Medicare trust fund in danger of evaporating faster than previously...

• Disease management program cuts readmission days

  An advanced practice nursing program with a disease management component has been shown to reduce...

Issue 6, February 5, 2008

• U.S. flu pandemic plans inadequate, say public health experts

  The threat of a global flu pandemic and the potential strain placed on the country's healthcare...

• Voters believe next president will have huge influence on healthcare

  As Americans went to the polls this week for Super Tuesday-24 states held primaries or caucuses...

• Top-rated hospitals have 27% reduced mortality

  Patients at the nation's top-rated hospitals, as designated by the annual HealthGrades Hospital...

• Complex case: Advance directives and the Surrogate Health Care Act

  As case managers, we are often faced with medically complex patient admissions, especially those...

Issue 4, January 23, 2008

• Federal law hinders states coverage of uninsured

  According to USA Today, states are restricted by federal law from implementing healthcare programs...

• Negative results left unpublished

  A study published in The New England Journal of Medicine reveals that pharmaceutical companies...

• Private insurers will no longer pay for hospital-related medical errors

  The Wall Street Journal reports several private health insurers, including Aetna and WellPoint...

• Big initiatives for case managers

  The current president of the Case Management Society of America (CMSA), Peter Moran, RN, C, BSN...

Issue 3, March 25, 2008

• Planning for ventilator use in an epidemic

  A report by New York state health officials says that physicians, healthcare workers, and the...

Issue 49, January 15, 2008

• U.S. falls behind nations in preventable deaths

  According to a new study in the January/February issue of Health Affairs, authors Ellen Nolte and...

• Medicare spending on the rise

  The Centers for Medicare and Medicaid Services (CMS) released a new report detailing an 18.7...

• The complexities of case management

  Case managers must advocate for the most optimal course of care for patients across the healthcare...

• Survey shows consumers care about pricing data

  Consumers care about healthcare prices and quality, and will shop around if they are provided with...

Issue 48, January 8, 2008

• Uninsured cancer patients suffer the costs of healthcare

  A study performed by the American Cancer Society revealed cancer patients who have no health...

• A different kind of insurance policy for the uninsured

  In an attempt to help people obtain health insurance, America's Health Insurance Plans (AHIP), a...

• What’s actually keeping hospitals from early discharges?

  According to Bud Pate, REHS, practice director for The Greeley Company, a division of HCPro, Inc...

• Finding the appropriate level of care for extended LOS patients

  Case managers have to continually learn, maintain, and update a large body of knowledge and skill...

Issue 47, January 2, 2008

• Medicare spending predicted to skyrocket beyond budget

  The U.S. Treasury Department and the Office of Management and Budget report funding for Medicare...

• Healthcare costs threaten economy

  According to the Congressional Budget Office (CBO), the predicted increase in healthcare costs...

• UnitedHealth billing flaws persisted as company grew

  UnitedHealth, which provides 90 million Americans with health insurance, has been sanctioned in...

• Collaborative practice is the future of case management

  A founding member of the American Case Management Association (ACMA) and still on its board of...