Archive for January, 2009
Survey shows more Americans unable to afford prescriptions in 2007
In a recent issue of Case Management Weekly we reported that the Center for Studying Health System Change, a nonpartisan policy research organization, found that one in seven Americans under age 65 went without a prescription drug in 2007 because they could not afford it. The study found this problem has been mounting; in 2003 only one in 10 Americans said they couldn’t afford their prescriptions.
Not surprising, people who were most likely to be unable to afford their prescriptions were uninsured and suffering from a chronic condition. Without their medications, their conditions were likely to worsen, causing them to seek expensive medical treatment. The study also found, however, that insured Americans were not immune to prescription pricing troubles. One in 10 Americans insured by their employer reported going without a prescription because of cost, also up from the last study in 2003.
This is an issue we will probe deeper in the April issue of Case Management Monthly. Until then, what are you seeing at your facilities? Do you see an increasing number of the uninsured, or underinsured, forgoing their prescriptions as a way to save money? What is this doing to your readmission rates?
Source: The New York Times
CMW News: Hospitals facing extreme funding problems
Nine out of 10 hospitals reported that borrowing money has become harder due to the economic recession, and the same number report that obtaining charitable funds has also become more difficult, according to the American Hospital Association (AHA).
A recent survey of 639 hospital CEOs showed that because of the lack of access to capital, hospitals have had to put projects on hold:
- 82% have put facility projects on hold
- 65% have put clinical technology projects on hold
- 62% have put information technology projects on hold
Putting projects on hold hinders hospitals’ ability to continually increase quality and efficient care, and to respond to community needs.
CMW Tip of the Week: How to handle Advance Beneficiary Notices of Noncoverage
This week’s tip comes from Jackie Birmingham, RN, BSN, MS, CMAC.
A Medicare beneficiary (or authorized representative) who has been given an Advance Beneficiary Notice of Noncoverage (ABN) may elect to receive the item or service anyway. In this case, the beneficiary should indicate that he or she is willing to be personally and fully responsible for payment by marking options 1 or 2 in box G on the ABN form. This new version of the ABN is used before services are rendered (as the name implies) and it may be given by outpatient department staff.
Here are some more tips regarding filling out the ABN:
- Option 1 indicates the beneficiary or representative will pay for the service out of pocket, but the hospital will also bill Medicare to see whether Medicare will pay for the item or service. If Medicare does not pay, the patient has the opportunity to appeal, but there is no guarantee Medicare will pay for the item or service.
- Option 2 indicates the individual accepts full financial responsibility for the item or service. Medicare will not be billed, and the beneficiary cannot appeal. This option requires that the patient be informed of the cost of the service prior to receiving the service.
- When a beneficiary decides to decline an item or service, he or she should indicate this by marking option 3 in box G on the ABN form. Counseling the patient on this decision and documenting the discussion is important. The service has been ordered based on the patient’s physician’s advice, and if the patient declines the item or service, it is important to be sure that he or she is fully informed of the consequences of the decision.
- The beneficiary cannot refuse to sign the ABN and still demand the item or service.
- If a beneficiary refuses to sign a properly executed ABN, the notifier should consider not furnishing the item or service, unless the consequences (health and safety of the patient, or civil liability in case of harm) are such that this is not an option.
- Additionally, the notifier may annotate the ABN, and have the annotation witnessed, indicating the circumstances and persons involved.
CMW News: Surgical checklist increases patient safety
A new study concludes that a 19-item surgical safety checklist decreased post-surgical complications, deaths, and surgical site infections for non-cardiac patients aged 16 and older in eight hospitals in eight countries.
The checklist was based on safety standards developed by the World Health Organization, which also funded the study.
The institutions that participated in the study were selected based on the goal of representing a diverse set of socioeconomic environments in which surgery is performed. The results of the study suggest that a significant amount of surgery complications and deaths could be reduced if similar checklists were implemented globally.
The checklist, which includes verifying patient identity, surgery site, and procedure, may also help providers avoid certain CMS “never events” for which it does not reimburse hospitals. To view a sample of the checklist, click here.
Sources: HealthLeaders Media, The New England Journal of Medicine
CMW Tip of the Week: Investigate transportation options for patients from the ED
This week’s tip comes from Kathleen Walsh, RN, MS.
Many patients are brought to the ED by ambulance or dropped off by a friend or family member and do not have transportation home once medically cleared. For these patients, the case manager could try, with the patient’s help, to call family, friends, or neighbors for assistance. Some EDs offer bus or subway tokens, or prearranged taxicab company vouchers. For others, developing contracts with local ambulance companies for chair-van services at a reduced rate is helpful.
Investigate whether a hospital ATM machine could be used by the patient to secure cash for a cab or whether the patient/family will be able to pay a cab with cash at home.
Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!
Training and retaining case managers
Despite the effect the economic downturn is having on the national job market, hospitals still face a daunting challenge in retaining quality case managers.
We spoke with training expert Beverly Cunningham, MS, RN, vice president of clinical performance improvement at Medical City Dallas Hospital in Dallas about ways to improve training and retention techniques in both our recent audio conference Designing Case Management Orientation: Simple Solutions to Educate Staff and Reduce Turnover and in the January issue of Case Management Monthly
Cunningham says that some of the reasons for case manager turnover are the high stress of the profession, long hours, and the difficulty of transitioning from nursing or social work into case management. But many of these issues can be resolved with a strong preceptor program.
”When new case managers merely shadow senior case managers, senior staff members usually pay more attention to the job at hand than to their trainees’ individual learning styles,” Cunningham says.
Cunningham says that effective preceptorships must be planned, organized, defined, and tailored to the individuals. Successful preceptor programs:
- Assign a designated person to manage precepting of new employees, and this person must be educated about the training process.
- Create specific goals based on individuals’ strengths, weaknesses, and planned career paths.
- Have employees meet with a selection of senior case managers, so they can view varied skills and approaches.
- Request reviews of trainees’ skills from their preceptors.
- Have regular meetings with new employees throughout the first year of employment, which identifies areas where trainees need further support.
What are you doing at your facility to improve staff retention and training?
CMW News: CMS announces demonstration sites for bundled fee-for-service payments
In an effort to better align the incentives for both hospitals and physicians, CMS has established a three-year demonstration called the Acute Care Episode (ACE). The ACE will test the use of combined payments for both hospital and physician services for acute care episodes within Medicare fee-for-service.
Under the current process, Medicare pays a hospital a single amount determined under the Inpatient Prospective Payment System for all the services it furnishes to the patient during an inpatient stay, and physicians are paid separately for the services they have provided to the patient while in the hospital. The demonstration, scheduled to begin early this year, will bundle both payments into one.
The sites chosen for the demonstration are:
- Oklahoma Heart Hospital in Oklahoma City
- Exempla Saint Joseph Hospital in Denver
- Hillcrest Medical Center in Tulsa, OK
- Lovelace Health System in Albuquerque, NM
The goals of ACE are to:
- Improve quality for fee-for-service Medicare beneficiaries
- Produce savings for providers, beneficiaries, and Medicare using market-based mechanisms
- Improve price and quality transparency for improved decision making
- Increase collaboration among providers
CMW News: California bans “balance billing”
The California Supreme Court recently ruled that physicians can no longer bill patients for emergency room treatments that physicians feel HMOs do not adequately pay.
HMOs and patient advocates celebrate the decision as a way to stop physicians and hospitals from overcharging for emergency services. Physicians say the court has taken away their only leverage against HMOs to receive fair payments, and this ruling may put emergency departments in economic jeopardy.
Regulations require HMOs to pay physicians and hospitals reasonable amounts, but do not specify what constitutes reasonable.
Sources: HealthLeaders Media, Los Angeles Times
CMW Tip of the Week: A second look at observation orders
Last week’s tip on standardizing physician level of care orders inspired some readers to write in about what works for their facilities.
Joby Kolson, DO, the medical director of quality and care management for AtlantiCare Regional Medical Center in Atlantic City, NJ, says:
What we have found works best for us is to make observation orders very specific. We use orders like:
“Place in observation status on
____med/surg
___telemetry”
In this case, the option for floor designation would be checked or circled. This eliminates the confusion around admission and observation since there is no mention of admission, and also specifies in which location in the hospital the patient should be placed.
Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!
CMW Sneak Peek: Eliminate ED Overcrowding
ED overcrowding is a problem almost every hospital faces. Many patients inappropriately come to the ED for nonurgent issues, but, by law, the ED is required to treat everyone. This puts hospitals in the difficult situation of having to care for all patients safely and efficiently.
Peter Moran, RN, C, BSN, MS, CCM, case manager at Massachusetts General Hospital in Boston, says his ED has been working diligently on resolving overcrowding issues during the past two years. “We’re running into systems issues and operational issues, and we’re trying to pinpoint where the problems are,” Moran says.
Moran’s facility has implemented the following strategies:
- Have a physician present during triage. “Patients used to come in, they’d register, they’d be seen at triage, and then they’d wait to be seen by a physician,” Moran says. “Now, when patients register at triage, they’re seen and examined by a physician who then does a preliminary exam and orders initial testing.” When patients enter the waiting room, some workup has already been done, which gives patients a head start with their care.
- Train case managers to recognize patients requiring other levels of care. “We try to have expedited referrals for patients that can be diverted to other levels of care,” Moran says. The case managers will call screeners from other facilities, such as long-term acute care hospitals (LTACH), to move patients out of the ED, when appropriate.
Check out the January 2008 issue of Case Management Monthly to get the full story, and discover all the benefits of being a Case Management Monthly subscriber!
