Case Management

CMW mentor moment: Promoting efficient use of resources and appropriate hospitalization length of stay to physicians, a different approach

Case Management Weekly, November 18, 2009

The following article is an excerpt from HCPro’s—a free blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.
Physicians sometimes acquiesce to family wishes and desires and admit a patient for social reasons. Conversely, physicians sometimes keep patients in the hospital an extra day because they express a desire to stay “just one more day.” These unnecessary, avoidable hospital affect potential revenue loss for hospitals when third-party payers deny days or deny hospital stays.
A major challenge in motivating physicians to move the patient along the continuum is the disconnect between the necessity for prudent hospital fiscal management and the practice patterns of physicians. The physician generally receives payment for his evaluation and management services regardless of whether the hospital is paid or denied for the patient care.
Change is on the horizon, however. CMS currently is considering provisions that will promote the efficient practice of medicine. Medicare and other third-party payers also are committed to transitioning from physician payment based strictly on volume to payment based on the relationship of quality, costs, and outcome. The efficiency and effectiveness physicians’ practice of medicine will determine their individual financial welfare and business success. 

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