HCPro.com - Case Management Weekly

Audio conference: Readmission Reduction Program

Wed, 08 Feb 2012 15:35:00 GMT

Effective October 1, hospitals with high readmission rates may face a 1%, across-the-board cut in Medicare inpatient reimbursements under CMS’ 2012 Inpatient Prospective Payment System final rule. Learn how your organization can meet the new requirements and avoid a potential big-dollar loss in Medicare payments during a February 28 HCPro audio conference “Readmission Reduction Program: Avoid Medicare Reimbursement Cuts with Improved Coordination of Care.”

During this 90-minute live audio conference, our speakers, Ralph Wuebker, MD, and Barbara Ozmar, will give you strategies to reduce your readmissions rate; CMS has targeted acute myocardial infarction, heart failure, and pneumonia. You will also hear from a case management director who will discuss her organization’s successful approach to avoid readmissions. Objectives covered in the audio include:

Describe the impact of the Readmission Reduction Program
Reduce readmission rates in acute myocardial infarction, heart failure, pneumonia
Achieve buy-in from outside organizations that affect your readmissions rates
Conduct an internal audit to uncover root causes of readmissions

Information about this audio conference is available at www.hcmarketplace.com.

News: Hospital to use RNs only in acute-care inpatient setting

Wed, 08 Feb 2012 15:31:00 GMT

Rochester General Health System will be replacing licensed practical nurses currently working acute-care inpatient hospital settings with registered nurses, according to a February 1 Democrat and Chronicle article. Approximately 45 LPNs will be affected by the change; however no layoffs are in effect. Those LPNs working toward becoming a RN may continue in their acute-care setting positions so long as they complete their degree by the end of 2014.

The move coincides with a national trend toward staffing certain hospital departments with RNs to reflect the higher level of education needed to treat the more complex cases generally seen in these areas, according to hospital officials cited in the article.

Read more on the Democrat and Chronicle website.

Mentor Moment: Blanketed approach to seeking continued care for our patients

Wed, 08 Feb 2012 15:25:00 GMT

As case managers, you may often work directly with leaders of other departments. Check out this post on HCPro’s Case Management Mentor blog where a Health Information Management director queries the privacy and legal implications of adapting a blanket policy for finding adequate SNF facilities for patients ready for discharge.

Our case manager (UR) wants to send out a copy of the patient’s medical record to 10 or 20 SNF’s within a 100- to 200-mile range our facility to see if they are willing to accept a patient. These are inpatients, hard to place and we are in an extremely rural area with only a few SNF’s within driving distance for families in this area.

What kind of consent form would be needed to cover this blanketed approach to seeking continued care for our patients? Would this even be legal? Do any of you have such practices within your systems and if so, would you be willing to share your consent forms? Need some help please as I’ve never heard of such a proposition.

Have you encountered a similar problem at your facility? Do you have any advice for this HIM director or a fellow case manager who may be trying to enact an unconventional policy? Please leave your comments below the post!

Sneak Peek: Effort underway to establish caseload benchmarks

Wed, 08 Feb 2012 15:21:00 GMT

Many case managers today feel like they're overburdened, but it may not be clear whether they're actually shouldering too much work. This is because the industry doesn't really have any validated figures indicating what the typical caseload is-or should be, says Pat Stricker, MEd, RN, senior consultant at CMI in Little Rock, AR.

But that's changing.

The Case Management Society of America (CMSA) is busy collecting data using its caseload calculator, available on its website.

The calculator uses self-reported data from case managers to calculate caseload capacity. Its creators want to give case managers a better idea of how their caseload compares to that of other case managers. They also hope to eventually allow experts to better develop guidelines about what an average caseload should look like.

Editor's note: This item is adapted from an article which originally appeared in the February, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.

Tip: Consider HHA or post-acute level transfers

Wed, 01 Feb 2012 16:34:00 GMT

Discharge planners have the difficult task of being the messenger with respect to continued stay. They require the support of administration in working through the process with physicians and other caregivers in compliance with applicable laws.

Patient or family inconvenience can be a significant factor with respect to length of stay, especially when the discharge plan requires education or coordination of multiple services. Without valid medical conditions, however, factors that may cause the patient or family inconvenience don’t justify a continued hospital stay. Factors can include time and money necessary to care for the patient at home, concern about traveling to a physician’s office, or matters that cause the patient to worry.

For example, if a patient is medically no longer in need of hospital care but the primary caregiver isn’t comfortable handling that role, the discharge plan may require modification. If a patient is being discharged to home without services, referral to an HHA or transfer to a post-acute level of care may be necessary while the patient’s family learns to administer care.

This week’s tip is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.

News: Hospital takes on septicemia, saves 36 lives

Wed, 01 Feb 2012 16:30:00 GMT

Around Opelika, AL, a city of about 26,000 and an hour's drive from Montgomery, 36 people are alive today who otherwise would have died after receiving suboptimal care at East Alabama Medical Center.

That's a harsh admission. But executives with the 314-bed hospital say they know this is true because three years ago, they joined a project with 156 other health systems to share quality data for comparison. The data revealed that patient mortality rates at EAMC were higher than expected, acknowledges hospital CEO Terry Andrus.

"That was obviously something we did not want on our marquee," he said in a January 25 HealthLeaders Media article. "But working with other hospitals, we found that care of septicemia was the thing we needed to work on."

EAMC discovered what some other hospitals in the Premier Quest collaborative already knew: It needed to have the emergency department team be much more attentive to a combination of symptoms: high fever, high heart rate, mental status changes, and high blood pressure.

By the third year of the program in 2010, Andrus says, the hospital identified "36 lives [that] were saved because we took this sepsis initiative and put in this bundle. That is, 36 people that probably would otherwise have died did not die."

Read more on the HealthLeaders Media website.

Mentor Moment: Overweight physicians display bias in obesity care

Wed, 01 Feb 2012 16:25:00 GMT

Doctors who are overweight or obese are less likely than physicians of normal weight to diagnose weight problems with their heavy patients or to launch discussions with them about their need to slim down, says a Johns Hopkins report authors say is the first of its kind.

The report “indicates that if you’re a heavier physician you are biased when it comes to providing obesity care and that may be something physicians do not realize they’re doing,” lead author Sara Bleich, assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health, explains in an interview with HealthLeaders Media.

“When they see patients who look like themselves—in that overweight or obese category—they think, ‘This person looks like me and I feel healthy, therefore let me focus on the more extreme’” complaints or issues they may have, such as diabetes and hypertension, rather than the underlying excess weight which may exacerbate their health problems.

Check out the rest of post and more on the Case Management Mentor blog.

Sneak Peek: Planning for homecare can reduce avoidable readmissions

Wed, 01 Feb 2012 16:16:00 GMT

Case managers want their patients to leave the hospital with a successful transition to home or aftercare and not have to return to the hospital unnecessarily.

But the reality is that many patients are coming back too soon.

Nearly 20% of Medicare patients boomerang back to the hospital within 30 days of being discharged, according to Deborah Perian, RN, MHA, who works in the visit clinical leadership office, a support office for the skilled visit service offices, at Bayada Nurses, a home health agency in Moorestown, NJ. As many as three-quarters of those return visits may be preventable, Perian says.

A substantial number of rehospitalizations occur when patients are discharged home without aftercare, she says. Targeting the main causes of readmissions and forming strong partnerships with homecare agencies can help reduce readmissions substantially, says Perian.

This item is adapted from an article which originally appeared in the February, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.

Audio conference: Observation services: A guide to compliant level of care determinations

Wed, 25 Jan 2012 18:57:00 GMT

Understanding proper protocol for observation services creates confusion for many case managers, especially when trying to determine appropriate billing practices. “Observation services: A guide to compliant level of care determination,” a March 6 HCPro audio conference, will offer commentary from our expert speaker, Deborah K. Hale, CCS, CCDS, and will review observation case studies to determine proper billing protocol. Scenarios will include Condition Code 44, observation prior to inpatient admission, observation following outpatient surgery, and accounting for active monitoring. You'll walk away with proven strategies for billing observation services appropriately and preventing denials.

This is an intermediate level program and designed for participants with a basic understanding of observation services and Condition Code 44.
The program can help case managers do the following:

Describe billable opportunities for observation services
Calculate billable observation hours
Define complication of a procedure
Explain proper use of Condition Code 44

Information about this audio conference is available at www.hcmarketplace.com.

News: Spectrum Health targets ED frequent fliers for primary care

Wed, 25 Jan 2012 18:53:00 GMT

A new program at Spectrum Health in Grand Rapids, MI is identifying "frequent fliers" at the system's emergency departments and placing those patients with a multi-specialist intervention team, according to a January 18 HealthLeaders Media article.

The program, while only six weeks old, has steered more than 140 patients to the less-expensive coordinated care program and has saved the health system a net total of about $300,000.

"It's going really well—better than we had hoped," R. Corey Waller, MD, a specialist in addiction and emergency medicine, and director of the Spectrum Health Medical Group Center for Integrative Medicine, told HealthLeaders Media.

"We are focusing on getting the patients better and not decreasing ED visits, because if you do the one the other will follow," he says.

The program was launched in early December and identified about 950 patients who'd used the emergency rooms at Spectrum's Butterworth and Blodgett hospitals more than 10 times in a year. Those patients accounted for more than 20,000 total visits and up to $50 million in costs annually.

Read more on the HealthLeaders Media website.

Mentor Moment: Giving every patient the Beyonc� experience

Wed, 25 Jan 2012 18:47:00 GMT

The gossip mills have gone into overdrive since celebrity power couple Beyoncé and Jay-Z welcomed their daughter Blue Ivy into the world this month at Lenox Hill Hospital in Manhattan.

Much of the hype is standard fare among celebrity births—discussing the child’s unique name, guessing when photos will be released, and debating which weight-loss company the mother will sign with to lose the extra pregnancy pounds. But in Blue Ivy’s case, the media is also focusing on the allegedly lavish hospital suite in which she was born.

Of course, the media has also been reporting on the tight security measures that may have been enacted in the Lenox Hill maternity ward while Beyoncé was there. There were rumors that other parents weren’t allowed to see their babies and that the musicians’ personal security guards patrolled the halls, but so far New York state health officials have dismissed the two complaints that were filed, according to the Wall Street Journal.

Check out the rest of post and more on the Case Management Mentor blog.

Sneak Peek: Ring in the new year with quality resolutions

Wed, 25 Jan 2012 18:39:00 GMT

It's January. Time to ring in the new year and make some resolutions for 2012.

Case managers have a busy year ahead. They'll be dealing with everything from their typical day-to-day business to regulatory changes that could have a broader impact on their jobs.

We asked some case management experts to come up with a to-do list for case managers this year. Below are some resolutions to help you start 2012 on the right foot:

Toot your own horn. You know that you're making a difference at your organization. Do others? The start of the new year marks a good time to demonstrate your productivity, says Stefani Daniels, RN, MSNA, CMAC, ACM, managing partner at Phoenix Medical Management, Inc., in Pompano Beach, FL. Draft an outcome report card for the case management program. This report card should display your achievements with an eye toward proving return on investment to your higher-ups.
Be certain to choose measurable outcomes. "You're not looking for indicators that count widgets," says Daniels. "This is not about how many patients you saw or how many referrals you made to a rehabilitation center." It's about what the case management program accomplished in terms of patient care.

This item is adapted from an article which originally appeared in the January, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.

Audio conference: Observation services: A guide to compliant level of care determinations

Wed, 18 Jan 2012 15:19:00 GMT

This is an intermediate level program and designed for participants with a basic understanding of observation services and Condition Code 44.

The program can help case managers do the following:

Describe billable opportunities for observation services
Calculate billable observation hours
Define complication of a procedure
Explain proper use of Condition Code 44

Information about this audio conference is available at www.hcmarketplace.com.

News: Steward Health vs. nurse union fight an ugly harbinger

Wed, 18 Jan 2012 15:13:00 GMT

The union-management animosity at Holy Family Hospital in Methuen, MA, did not end with last July's vote by nurses to join the Massachusetts Nurses Association/National Nurses United.

The National Labor Relations Board has taken up a complaint that a veteran nurse at the hospital was fired last year by Holy Family's parent Steward Health Care Systems, allegedly for her role in the organizing effort. An administrative judge will hear the complaint on Feb. 14.

Steward Health Care Systems denies the allegation and has issued a statement saying that "participation in union organizing activities played no role in the decision" to fire nurse Mary Ramirez, 61, who'd been at the Holy Family for 18 years.

Read more on the HealthLeaders Media website.

Mentor Moment: Top 12 healthcare quality concerns in 2012

Wed, 18 Jan 2012 15:08:00 GMT

Which quality issues will provoke the most influential changes in healthcare in 2012? Or, which ones will most rapidly accelerate the graying of chief quality officers’ hair? There are so many, it’s hard to pick the most significant. HealthLeaders Media interviewed quality experts around the country to glean the most influential and then picked a dozen.

Here’s the list:

1. Patient experience scores hinge on “always” responses

The value-based purchasing sweepstakes have begun, with the first performance period for clinical process of care and HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) questions scheduled to end March 31. Payment adjustments will begin for patients discharged as of Oct. 1, and the winners and losers will then be revealed.

What makes many hospitals and clinical nurse managers most nervous, however, is that the patients responding to these surveys must reply “Always,” in order for the hospital to get credit for high quality patient experiences. Responses “Sometimes,” or “Usually” aren’t going to cut the mustard.

“How often did nurses listen carefully to you?” “How often did doctors treat you with courtesy and respect?” “How often was your pain well controlled?”

“Always.”

And by the way, Jan. 4, 2012 was the data submission deadline for patients discharged in July, August and September, 2011.

Check out the rest of post and more on the Case Management Mentor blog.

Sneak Peek: Four areas that break down physician relationships

Wed, 18 Jan 2012 15:03:00 GMT

Most case managers have had a spat with a physician at one time or another.

Maybe a physician discharged a patient who may not have been clinically ready for discharge, or perhaps a physician disagreed with a case manager about the proper level of care for a particular patient.

According to Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of The Center for Case Management, Inc., in Wellesley, MA, when conflicts arise, they're generally related to one of four hot-button issues:

Level of care determinations
Readiness for discharge
Disagreements related to patient/family circumstances
Issues related to physician coverage and consistency

But other times it's a larger organizational issue at work. "Some hospitals are still using case management to work around physicians instead of physicians really governing themselves, and a lot of problems come up because of that," says Zander.

Whatever the source of the problem, help smooth over prickly issues with physicians by making sure the physicians have adequate resources to help resolve conflicts. Case managers should also establish positive relationships with physicians from the outset.

This article is adapted from an article which originally appeared in the January, 2012 issue of eight-page, HCPro, Inc. newsletter, Case Management Monthly.

Tip: Understand Medicare options for late-day discharges

Wed, 11 Jan 2012 19:40:00 GMT

Discharge planners must consider late-day discharges. Many hospitals target a specific discharge time, such as 11 a.m. This target is possible if the patient is medically ready for discharge, has a plan in place, and has undergone the required steps such as patient education and delivery of the Important Message from Medicare.

Chapter 3 of the Medicare Benefit Policy Manual addresses late discharges as follows:

When a patient chooses to continue to occupy hospital or SNF accommodations beyond the checkout time for personal reasons, the hospital or SNF may charge the beneficiary for the continued stay. Such a stay beyond the checkout time, for the comfort or convenience of the patient, is not covered under the program, and the hospital’s or SNF’s agreement to participate in the program does not preclude charging the patient. However, the hospital must provide the beneficiary with an Advanced Beneficiary Notice (ABN) before the noncovered services are provided.

This means there is an option for late discharges, which should be used to ensure that efforts to manage patient flow, affected by a patient who doesn’t leave, are discussed with that patient.

This was adapted from Discharge Planning Guide: Tools for Compliance, Third Edition, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.

News: OIG to CMS, AHRQ: Help hospitals determine incident reports

Wed, 11 Jan 2012 19:37:00 GMT

The OIG found that hospital incident reporting systems only capture an estimated 14% of adverse events involving Medicare beneficiaries, according to a report released by the OIG on January 6.

Of the remaining 86%, hospital staffs believed the events either did not qualify as reportable or thought another staff member had reported the incident. Furthermore, few hospitals made policy or practice changes upon investigating the reported events.

The OIG recommended that CMS and the Agency for Healthcare Research and Quality (AHRQ) develop a list of potentially reportable events for hospitals to use as a guide for determining reportable events, according to the report. CMS should also analyze survey standards for assessing hospital compliance with requirements for tracking adverse events. Both CMS and AHRQ concurred with the finding of the OIG and will work jointly to strengthen reporting practices in the future.

Read the complete report on the OIG website.

Mentor Moment: CMS innovation advisors aim to improve quality of care

Wed, 11 Jan 2012 19:33:00 GMT

CMS has tapped 73 healthcare professionals for its innovation advisors program. Funded with $6 million from the healthcare reform act, the program is designed to help drive improvements to patient care and help reduce healthcare costs. A second group of 120 advisors will be selected in June.

The program, which is managed by the CMS Innovation Center, includes six months of orientation as well as in-person national and regional meetings, virtual training sessions, and seminars and presentations by healthcare experts. Each advisor will receive a stipend of about $20,000 to help cover the cost of transportation, lodging, and other expenses.

This first group of advisors includes clinicians, allied health professionals, health administrators, physicians and nurses from 27 states. Each one is required to develop a systems improvement project that will be scalable to other areas.

Check out this post and more on the Case Management Mentor blog.

Sneak Peek: How a patient tracking system is improving case management

Wed, 11 Jan 2012 19:29:00 GMT

Earlier last decade, when patients came into the ED at Christiana Care Health System in Newark, DE, they were difficult to track.

In 2004, Christiana served about 90,000 patients per year. It was a busy place. Patients were bustled from their rooms to testing locations and back again.

Finding where a patient was at any given time presented quite a challenge, says Linda Laskowski Jones, RN, MS, ACNS-BC, CEN, FAWM, vice president of emergency and trauma services for Christiana Care. Sometimes family members would come in looking for a patient and the staff would actually need to hunt the patient down.

A new, real-time patient tracking system, installed in both the Christiana and Wilmington Hospital EDs (they each are part of Christiana Care Health System), eliminated those concerns. Patients who come to the facility now wear clip-on badges, tracked by sensors positioned around the building, that relay information back to hospital staff.

This article is adapted from an article which originally appeared in the January, 2012 issue of eight-page, HCPro, Inc. newsletter, Case Management Monthly.