HCPro.com - Case Management - DO NOT USE Top Stories

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!

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.

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.

News: Hospital develops program to combat nurse compassion fatigue

Wed, 04 Jan 2012 18:55:00 GMT

Barnes-Jewish Hospital in St. Louis has launched a successful program aimed at reducing nurse burnout due to compassion fatigue, The Wall Street Journal recently reported.

Compassion fatigue, a combination of secondary traumatic stress from witnessing the suffering of others and burnout, can affect a nurse’s ability to manage the emotional and physical stress of caring for acutely ill patients. As a result, some nurses avoid caring for these patients, leading to substandard care.

Hospital administrators at Barnes-Jewish Hospital found that compassion fatigue contributed to higher turnover rates in their oncology unit, according to the article. They agreed to fund the program to provide assistance and educate nurses about the dangers of compassion fatigue. The program offers a range of support, including a checklist of symptoms and physical, stress-relieving exercises designed to release tension.

Read more on The Wall Street Journal website.

Tip: Assess executive function prior to discharge

Wed, 28 Dec 2011 16:46:00 GMT

Evaluating executive function, which relates directly to a patient’s decision-making capacity, is becoming increasingly important. Executive function refers to a patient’s physical abilities and mental capacities. During impaired executive function, instrumental activities of daily life (IADL) such as handling money, shopping, and medication management may exceed an individual’s capacity, even if memory impairment is mild. The capacity to exercise command and self-control, and to direct others to provide care, diminishes. For these reasons, patients’ executive function greatly affects their ability to follow a discharge plan.

Assess the patient’s perception of discharge options and whether the patient’s advance directives will affect the plan of care. Speaking with patients apart from their families may be necessary to ascertain their desires. Families sometimes make assumptions about patient preferences. Patients have the right to decide unless they are incapable of doing so. Activating an advanced directive or delegating healthcare decision-making authority to someone else is a significant event.

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: Readmission penalties likely to impact hospitals serving low income patient population

Wed, 28 Dec 2011 16:43:00 GMT

A Kaiser Health News analysis of CMS data found that hospitals were three times more likely to have higher readmission rates for heart failure if the majority of their patient population came from low-income backgrounds. The data show heart failure accounts for the greatest number of Medicare readmissions and, according to a Washington Post article published on December 19, hospitals that predominantly treat the Medicare population may face disproportionately reduced reimbursement beginning in October 2012.

Physicians indicate that a variety of issues contribute to these higher readmission rates, including a lack of access to healthful food and affordable medication. Additionally, these patients tend to have difficulty understanding the complex discharge plans necessary to avoid readmission, according to the article.

Read more on the Washington Post and Kaiser Health News websites.

News: Nursing strikes loom on both coasts

Wed, 21 Dec 2011 16:58:00 GMT

Twenty-three thousand nurses in California and 6,000 nurses in New York plan to strike by the end of the year over disputes with hospital executives, according to a December 15 New York Times article. While there is no firm date for the strike in New York, nurses in nine San Francisco and Long Beach hospitals plan for a 24-hour walkout on December 22.

Nurses associations in both California and New York told the New York Times that they oppose increases in their health benefit premiums as well as increased strains on staffing. Additionally, they state that nurses feel disrespected by the corporate hospital culture that pays millions of dollars to executives while those who provide care to the patients must make sacrifices. Hospital officials responded in the New York Times article by defending the executive pay structure as the price of attracting top leadership.

Read more on the New York Times website.

OIG Work Plan targets inpatient, outpatient mix for 2012

Fri, 14 Oct 2011 20:45:00 GMT

The auditing arm of the Department of Health and Human Services (HHS) plans to crack down on hospital performance in the areas of reporting of adverse events and quality measure data, present on admission coding, inpatient outlier payments, and same-day readmissions.

Those are some of the highlights of the Office of Inspector General’s (OIG) Fiscal Year 2012 Work Plan, the latest yearly report that outlines the OIG’s review targets with respect to HHS programs and operations. It was released October 5.

The Recovery Audit Contractors (RAC) program remains on the OIG’s list. It plans to monitor how well RACs identify and recoup improper payments. RACs conduct postpayment reviews to identify overpayments and underpayments and attempt to recoup any overpayments they identify.

Further, OIG plans to focus on HIPAA compliance reviews of security controls in Medicaid programs and federal oversight of two key HIPAA regulations.

The OIG cited four HIPAA target areas it will review in the next 12 months:

States’ data security requirements under business associate agreements
Medicaid security controls over state web-based applications
OCR oversight of the HIPAA Privacy Rule
OCR oversight of the HITECH breach notification rule

CMS releases final rule on Medicaid RACs

Wed, 14 Sep 2011 18:04:00 GMT

by James Carroll

In February, the Centers for Medicare and Medicaid Services (CMS) delayed its expected April 1 implementation of the Medicaid recovery audit contractors (RACs) final rule until an unspecified time later this year.

That unspecified date became today: CMS released its Medicaid RACs final rule.

The new initiative, modeled after the Medicare RAC program, aims to fight waste and fraud in Medicaid and will save taxpayers an estimated $2.1 billion over the next five years, according to a press release from the Department of Health and Human Services (HHS). About $900 million will be returned to states.

“Today we are building on an already successful program that targets improper payments in our healthcare programs and recovers those dollars, making Medicare and Medicaid more reliable and responsible,” HHS Secretary Kathleen Sebelius said today's press release. “We simply can't afford to see even one penny of our healthcare dollars wasted and expanding this program will help us reach that goal."

The rule itself implements section 6411 of the Affordable Care Act and provides guidance to individual states related to federal/state funding of state start-up, operation, and maintenance costs of Medicaid RACs, and the payment methodology for state payments to Medicaid RACs, according to the rule.

Editor's note: Click here to access the Medicaid RACs final rule.

CMS releases revised ABN, mandatory as of November 1

Tue, 30 Aug 2011 05:00:00 GMT

by Judith Kares, JD, regulatory specialist for HCPro, Inc.

During the July 13 Hospital Open Door Forum call, CMS announced the release of a revised ABN form (CMS-R-131) with the release date of March 20, 2011, printed in the lower left-hand corner. The new ABN form is available for immediate use. CMS only changed the format, not the substance, of the form.

The purpose of an ABN is to provide prior notice to a beneficiary (or his or her representative, in the event that the beneficiary is not competent) when the provider believes that Medicare will not pay for certain Part B outpatient services because limitation on liability applies. Limitation on liability applies when Part B outpatient services fall into one of three categories:

The services do not meet Medicare’s medical necessity guidelines for that patient’s condition
The services are screening services that are being provided more frequently than Medicare provides a benefit for
The services are custodial

Once the beneficiary knows that Medicare is not expected to pay for these services, he or she (or his or her representative) can decide whether to have these services performed, even though he or she is likely to end up paying for them. The ABN is designed to assist in that decision-making process by providing all the information necessary to make an informed decision.

Although the new ABN form is currently available, its use is not mandatory until November 1, 2011. This transition period permits hospitals, and other providers and suppliers required to notify beneficiaries using the ABN form, to use up any stockpiles of the old forms. All ABNs with the release date of March 2008 that are issued on or after November 1, 2011, however, will be considered invalid. Hospitals need to ensure that they utilize the new form for all ABNs issued on and after that date.

Editor’s note: Click here to read the article on the MedicareMentor blog.

OCR audit questions with Susan McAndrew

Mon, 29 Aug 2011 19:45:00 GMT

Below is the first in a series of questions answered by Susan McAndrew, deputy director of health information privacy for the Office for Civil Rights (OCR). The questions are from the upcoming September edition of the 12-page HCPro, Inc. newsletter, Briefings on HIPAA (BOH).

How will the OCR HITECH-required audit program begin?

The audit program will occur in three steps, McAndrew says. After working with audit contractor KPMG to develop audit protocols, an initial round of audits to field-test the program will occur, she says.

If these test audits return positive results, OCR will launch a full range of on-site audits and an evaluation process, she says. McAndrew anticipates that the audit program will begin in the fall.

News: Up to $500 million in funds available to help reduce HACs and readmissions

Wed, 06 Jul 2011 05:00:00 GMT

On a recent trip to Capitol Hill, ACMA members urged legislators to revise the reporting requirements for the face-to-face encounter rule.

ACMA members told lawmakers that the requirements add to the discharge process, and have resulted in delayed discharges to home health, which cause significant risk for patients. ACMA members request that CMS revise the reporting requirements through the following actions:

Add a line to form 485, the “Physician Certification and Plan of Treatment,” that certifies the face-to-face encounter.
Allow documentation of the face-to-face encounter by non-physician providers so long as the physician certifies the clinical findings and the patient’s need for home health care services.

Nearly 60 Senators have weighed in on the issue – either through a joint letter or one of their own, and 105 Representatives signed the House letter.

Source: ACMA

News: Up to $500 million available to help reduce HACs and readmissions

Wed, 29 Jun 2011 05:00:00 GMT

HHS will make up to $500 million in Partnership for Patients funding available to help hospitals, healthcare provider organizations, and others improve care and prevent healthcare acquired conditions (HAC) and unnecessary readmissions.

The Partnership for Patients is a public-private partnership that aims to reduce harm in hospital settings by 40% and reduce hospital readmissions by 20% over a three-year period. It seeks to achieve these goals by contracting with large healthcare systems, associations, state organizations, and other interested parties to support hospitals in redesigning care processes. Their tasks will include:

Designing intensive programs to teach and support hospitals how to make care safer
Providing training for hospitals and care providers
Providing technical assistance for hospitals and care providers
Establishing and implementing a system to track and monitor hospital progress with respect to meeting quality improvement goals.

Obtain additional information by visiting the Federal Business Opportunities website at: www.fbo.gov.

Source: CMS

News: CMS seeks comments on vascular readmissions measure

Wed, 15 Jun 2011 05:00:00 GMT

CMS requests public comment on a measure currently in development, “Hospital-Level 30-Day All-Cause Risk-Standardized Readmission Rate following Vascular Procedures.”

All comments are welcome, but CMS is particularly interested in feedback that addresses the following areas:

Definition of the cohort
Definition of the outcome
Risk adjustment
Technical Expert Panel comments

CMS will accept comments until Thursday, June 30, 11:59 pm EDT. Submit comments and review the measure specifications at www.CMS.gov/MMS/17_CallforPublicComment.asp.

Source: CMS

AL woman arrested for stealing patient records

Wed, 15 Jun 2011 05:00:00 GMT

U.S. Postal Inspectors arrested an Alabaster, AL woman on charges that she stole identifying information on about 4,500 patients from a Birmingham hospital, according to a Department of Justice (DOJ) press release.

Chelsea Catherine Stewart, 26, allegedly stole the patient information from Trinity Medical Center between March 22 and April 8, while an associate of hers was a patient at the hospital. Stewart allegedly violated the HIPAA Privacy and Security Act by wrongfully obtaining individually identifiable health information.

According to the DOJ, the stolen records spanned several years and include patient names, dates of birth and Social Security numbers. Alabaster police executed a search warrant at the residence in which Stewart was staying and recovered hundreds of pages containing the patient information.

A preliminary hearing for the case is scheduled for June 10.

Note: Medicaid payments and provider-preventable conditions

Tue, 14 Jun 2011 05:00:00 GMT

Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

Last February, I wrote about the proposed rule for Medicaid health care-acquired conditions (HCACs) and some of the similarities between HCACs and Medicare’s hospital-acquired conditions (HACs). Last week, CMS published the final rule in the Federal Register with few changes to the proposed rule, despite many comments by providers about the inconsistencies between programs and the ability to expand payment reductions into new frontiers.

Continue reading Debbie's note on the MedicareMentor Blog.