Archive for July, 2011

Hospitals must begin using revised ABN form November 1

CMS has released a new advance beneficiary notice (ABN) form that hospitals must use beginning in November. The form is currently available for immediate use.

The changes affect the ABN form’s format, but not its substance, Judith Kares, JD, wrote in a blog post for Medicare Mentor. Kares, an expert in Medicare rules and regulations, is an HCPro Medicare Boot Camp-Hospital Version^® instructor.

“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,” Kares said in an earlier post. Limitation on liability applies when Part B outpatient services fall within one of three categories:

• The services do not meet Medicare’s medical necessity guidelines for a patient’s condition;
• The frequency of  a screening service exceeds Medicare coverage for that benefit; or
• The services are custodial.

The intent of the ABN form is to explain to patients that a provider anticipates Medicare will not pay for certain services. Patients will be responsible for payment to providers when they (or their representatives) opt to receive these services.

Use of the ABN form is more common in outpatient settings, but case managers may issue it to observation patients. For example, an observation patient who refuses to leave the hospital may receive an ABN form that explains Medicare will not pay for custodial care.

CMS will allow providers that have supplies of the current form may continue using it until November.  However, ABN forms with a March 2008 release date issued on or after November 1, 2011 will be invalid.

Learn more about ABN and other patient notification forms during HCPro’s August 9 audio conference, “Delivering Inpatient Notifications: Manage The Important Message from Medicare and HINNs”. For more information, visit www.hcmarketplace.com/prod-9598/Delivering-Inpatient-Notifications.html.

Keep case management on your patients’ radar

Are you a case manager, social worker, or patient navigator who prefers to stay just below the radar screen, or do the patients whom you manage know you and know what to expect from you?

I’m a consultant who advocates for a better understanding of our roles, and a sister of a medically fragile man who has never met or spoken with the numerous case managers who coordinate his care. Here is a noninclusive list of tips to better promote and brand your role and functions:

• Engage patients and families. Before a registered nurse communicates to a third party, he or she must first engage and assess the patient to understand his or her unique story.
• Introduce yourself, and explain your role and what the patient can expect from you, I told patients that I was their WD-40. Case managers grease the wheels of the patient experience. I also told them that if I did not know an answer to a question, I would find someone who did.
• Create a brochure that describes what you do. Use simple words iand offer a brochure in the languages that reflect the populations you serve. This tool can also help other members of the healthcare team better understand your role.
  • Explain how you work with other members of the healthcare team, including social workers.
  • Explain how you work with episodic case managers, payer-based case managers, and any other liaison roles creeping into the organization.  .
• Give patients your contact information. Giving patients a business card is best, but writing your name and contact information on the whiteboard or providing it in via e-mail is even better.
• Follow up with patients. Case managers can be highly influential with respect to the patient experience. Visit patients just prior to their transition to ensure that all of the dots connected and follow up appointments are arranged. Every patient discharged to home should also receive a follow-up phone call. Some hospital administrators believe that staff nurses should make these calls.  I ask you, who better knows the post-acute environment, resources, and patient story than you?
• Be accountable. Follow through on what you say you will or can do. The best case managers I know don’t turn their pagers off at 5 p.m. or when they leave for the day. Remain available or explain who is available when you’re not.

This is not just a leadership issue to address, market, and brand. I believe it begins with each and every one of us. It is time to assertively establish our identity and be recognized for our influence on the patient experience.

Patient access is the key to VBP success

Medicare will begin paying hospitals for quality measures effective October 2012, CMS announced in a recent fact sheet. The new Hospital Value-Based Purchasing (VBP) program adopts performance measures in two areas:

1. Clinical process, consisting of 12 measures
2. Patient experience, consisting of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results

Hospitals preparing for VBP should realize that access to a strong network of post-acute providers is the secret to ensuring a positive patient experience, writes Jackie Birmingham, RN, MS in her Curaspan Connections column.

If hospitals don’t have access to a robust network of postacute providers, discharge planners have limited options to send patients for the next level of care. Patients may perceive that as a lack of quality, writes Birmingham, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group in Newton, MA,. “Even if you provided the best care possible, it won’t matter. Perception is reality,” she says.

Birmingham says hospitals with strong postacute provider networks, and thus best positioned for success with VBP, typically include the following elements:

• Post acute provider performance data regarding turnaround times for referrals and readmissions. This information allows hospitals to get to the root cause of issues and address them. Improvements lead to better outcomes, including a better patient experience.
• Technology that connects acute and postacute providers so they can more quickly share information. Such software improves throughput, lowers LOS, and leads to increased patient satisfaction.
• Time dedicated to strengthening relationships with the patient. With technology removing many administrative burdens, clinicians are now able to spend more time with patients and their families to identify their needs.
  

Patients need more than information alone to continue to heal after leaving a hospital. They also need access to the appropriate providers who can continue their care, Birmingham writes. When your hospital begins to concentrate on VBP, ensure there’s a plan to address how patients transition to postacute care, she suggests.