Case Management

Mentor moment: Address fragmented care to prevent readmission denials

Case Management Weekly, August 18, 2010

Hospitals that admit patients for services that should have been provided during an earlier admission can expect denials from their quality improvement organizations (QIO), according to Jackie Birmingham, RN, BSN, MS. Birmingham is vice president of regulatory monitoring and clinical leadership at Curaspan Health Group in Newton, MA.

The OIG recently has been monitoring consecutive-stay sequences, such as when a patient moves from inpatient care to a SNF and then back to an inpatient stay, writes Jackie Birmingham in “Myth Busting: The Truth About Medically Necessary Readmissions” published in Curaspan Connections. Because each admission triggers payment for an entire episode of care, providers may appear to be circumventing the prospective payment system.

Hospitals must address fragmented care when developing strategies for preventing inappropriate or avoidable readmissions. Birmingham suggests working closely with hospitalists, specialists, and community-based primary care physicians to ensure all necessary care for an episode of care is complete before discharge.

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