Archive for February, 2009
CMS rules on counting observation hours: Is your hospital compliant?
According to Transmittal 1445 (Change Request 5946), “Observation services should not be billed concurrently with diagnostic or therapeutic services for which active monitoring is a part of the procedure (e.g., colonoscopy, chemotherapy).
In situations where such a procedure interrupts observation services, hospitals would record for each period of observation services the beginning and ending time during the hospital outpatient encounter and add the length of time for the periods of observation services together to reach the total number of units reported on the claim for the hourly observation services HCPCS code G0378 (Hospital observation service, per hour).” [more]
Has human communication been forgotten in the hospital?
As a hospital-based case manager, have you ever wondered if the right hand knows what the left hand is doing?
Every healthcare provider touts they are doing what is right for the patient, providing what the patient needs, with the goal being that of getting the patient ready for discharge. In reality, everyone is working independently of each other and in some instances you may find there is one interdisciplinary group working against another. As the director of case management, knowing the case management role is to provide collaborative care to patients in a timely and cost effective manner, I also know that it is essential for the entire healthcare team, including the patient, to have a common goal. It is also important to discuss the goal and the steps necessary to achieve the goal. One thing I have found is, no matter how big or small a hospital is, communication among interdisciplinary groups is almost non-existent; I think our great advancements of computer charting has made human communication unnecessary. [more]
Coordinating and negotiating – with the patient, the family, and the system
The following is a complex case that challenged the case managers’ and care team’s abilities to get a patient discharged safely. While reading the case, think about what you would have done in this situation, and leave any suggestions or comments you may have at the end of the post.
The case of Mr. F called upon and challenged all aspects of our case management skills. His medical needs were complex, his social and family issues were both multifaceted and frustrating, and the system issues that stalled his discharge exasperating. Only after an extensive amount of coordinating and negotiating by the case management team was he successfully discharged.
Mr. F, a 77 year old man, arrived in our emergency department on October 30, 2007 with complaints of weakness, lethargy, and weight loss. He was quite ill with acute renal failure, severe anemia, atrial fibrillation, peripheral vascular disease, and a recent sixty pound weight loss. Both legs had 3+ pitting edema. [more]
Do you use case management protocol?
Every facility, it seems, struggles to ensure patients are being assigned and treated at the correct level of care designation. An even bigger struggle is making sure physicians are educated to choose the appropriate level of care, write an order, and document it at the time of admission.
Inpatient orders cannot be changed or written retrospectively by the physician. When physicians don’t document correctly, it impacts the facility and the patient in many negative ways. [more]
Solutions in the ED: Add-on or value-added?
A few weeks ago, a hospital system that is experienced in failed attempts at reducing non-emergent emergency room visits asked me why people keep coming back to the emergency department (ED). I reflected back on observations over the past eight years and came up with this response: People keep coming back to the ED because patients tend to be viewed most often in terms of “symptoms and acuity.” [more]
Dealing with Medicare and commercial observation cases
As we see more and more uninsured and underinsured patients entering the ED, we’re seeing more and more patients languishing in Observation Status. What are your challenges with Observation Cases? At Scottsdale Healthcare System, we have both Medicare and commercial observation cases; both have their own sets of challenges. [more]
Clinical Social Worker (CSW) or Registered Nurse (RN)?
Effective working relationships between nurses and social workers are the foundation of effective patient care management. Both disciplines bring value and there own unique perspective to the patient/family situation. But philosophical differences, and unclear role delineations can sometimes disrupt collaboration among the two.
HCPro has offered two audio conferences devoted to this subject. Where do you sit on the case management spectrum? Are you an RN or a LCSW?
