Jul

23

CMW News: Technology adds to growing healthcare costs

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Increased technology in most industries often leads to better, more cost-efficient results. But that maxim does not always hold true in the healthcare field, according to Business Week.

New technology, such as the da Vinci robot, may decrease patient recovery times, but can leave a hospital with an extremely high bill. The robot, which is operated by a surgeon and works well in very small spaces, facilitates surgeries by making extremely small incisions. But the cost of the machine is $1.5 million, and requires $2,000 worth of replacement equipment between every surgery for sanitation reasons. Patients often demand the machine and are unaware of the increased costs because their co-pay for the surgery is the same. Furthermore, there is no research that indicates the machine is any better at performing surgeries than a surgeon alone.

Although there is little or no competition available and consumer price insensitivity drives up the costs, technology can still be valuable in healthcare. Implantable cardiac defibrillators, for example, can decrease the risk of death from heart attack by up to 30%.

Source: Business Week

Jul

23

CMW Tip of the Week: Use these strategies for medical staff education

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This week’s tip comes from Deborah K. Hale, CCS, author of HCPro’s Observation Status: A Guide to Compliant Site of Service Designations. She offers us some insight in regards to educating medical staff:

There is no single magic bullet for effective medical staff education in regards to level of care designations, but here are a few suggestions:

• Get their attention with data. Use public report cards, colorful graphic data presentations, and tell a clear story that can be understood in a short time period.
• Small group or individual meetings with physicians over lunch will allow you time to get their interest and provide a portion of the information they need. Follow up to give feedback regarding improvements. Start small and expand the target audience as you experience success.
• Do not begin a one-on-one educational opportunity with “this admission does not meet criteria.” Show how an incorrect site of service determination affects their patient. Many physicians are amazed to know that an inappropriate outpatient surgery or observation status order will increase the cost to the patient when compared with their inpatient deductible. They often think the opposite is true, so this is a factor in their decision-making process.
• Most importantly, don’t give up. You may have failed to get a physician’s attention over and over and have become pessimistic that change will ever occur. If so, try another approach so the hospital can achieve accurate reimbursement for the care provided. A negative attitude toward the intended audience is palpable. Offer a carrot instead of a stick.

Have a question for our experts? Email it to jmcginley@hcpro.com.Your question could be featured in the next issue of Case Management Weekly!

Jul

23

CMW Sneak Peak: A brief assessment tool can improve productivity and patient care

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Until January 2007, the University of North Carolina (UNC) Health Care System in Chapel Hill was struggling with a case management assessment process that didn’t meet its needs. The majority of assessment data at the 728-bed academic tertiary care hospital was documented in handwritten progress notes that were time-consuming to create and cumbersome to navigate.

“We were doing assessments, of sorts, they just weren’t measurable or consistent or readily available to the rest of the healthcare team,” says Beverly Wagner, BSN, RN, CCM, clinical care management educator at UNC Health Care.

Wagner knew any assessment tool she created had to be easy and quick enough to use to ensure universal buy-in from all departments. So she focused on creating the brief assessment tool (BAT), an electronic form that guides staff through interviewing incoming patients and helps them easily document necessary information by simply clicking a mouse.

The paper BAT received excellent reviews from trainees for its:

• Question-and-answer format, which helps guide the interviews
• List of typical responses scripted to avoid repetitive documentation
• Consistency in topics covered and information documentation

“The staff is happy to use it. I expected for there to be some improvement, but not a 300% sustained increase in measurable assessments,” says Wagner. “To be able to have them like the process and feel like the tool works for them exceeded my wildest expectation.”

Check out the July 2008 issue of Case Management Monthly to get the full story, and check out all the benefits of being a Case Management Monthly subscriber!

Jul

16

CMW News: CMS develops program to prevent Medicare fraud

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After findings suggested that CMS has paid more than $92 million to fraudulent Medicare claims for durable medical equipment (DME), the organization recently announced it has implemented a system to eliminate the deception.

The fraudulent claims involved using deceased physician Medicare identification numbers to receive payment for DME, according to Fierce Healthcare. CMS discovered the fraud when they ran a check of the American Medical Association’s list of deceased physicians against the list of Medicare claims from 1992 to 2002. It found it had paid claims to 734 physicians out of a random sample of 1,500. Those 734 names had been used to file 21,458 claims.

CMS says that it will now match Social Security Administration deaths data against the new Medicare provider-identification number system on a monthly basis.

Sources: Fierce Healthcare, The Washington Post

Jul

16

CMW News: RAC program has saved CMS almost $700 million, report says

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Since its implementation in 2005, CMS’s recovery audit contractor program (RAC) has returned $693.6 million of improper Medicare payments to the Medicare Trust Funds, says a report issued in June by CMS. in     This number takes into account the cost of the program, the dollars repaid to health providers, and the money overturned on appeal.

The RAC is a tool CMS uses to ensure Medicare payments to providers are accurate and to reduce the amount of claims errors. Most of the errors RACs identified were due to claims that did not comply with Medicare’s coverage or coding, or involved providers billing for the same procedure multiple times.

The RAC was launched in California, Florida, New York, Massachusetts, South Carolina, and Arizona from 2005 to 2008, but will be implemented as a permanent program across the nation by Jan. 1, 2010.

Sources: Medical News Today, Centers for Medicare and Medicaid Services

Jul

16

CMW Tip of the Week: Clearing up concurrent coding

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This week’s tip is an ask the expert with a question provided by Case Management Weekly reader Josie McKorkle from Forrest General Hospital in Hattiesburg, MS. The answer is provided by Carol Everhart, RN, BA, the director of clinical informatics at Curaspan Healthgroup, Inc.

Q: Could you tell me if you are seeing a trend where case managers’ duties include coding the medical record concurrently during a patient’s hospitalization?

A: In my opinion and based on my experiences during the last nine years in case management, I am not seeing a trend of adding concurrent coding to the role of case management. Instead, I’m seeing the addition of the role of documentation specialist that includes coding functionality to the department of case management. 

I have also seen a trend during the last several years of adding concurrent coders to certain service lines. Additionally, I’ve seen the responsibility of determining the “working DRG” as part of the case management role, which would be different than concurrent coding.

Have a question for our experts? Email it to editor jmcginley@hcpro.com.Your question could be featured in the next issue of Case Management Weekly!

Jul

16

CMW Sneak Peek: Increase your facility’s access to healthcare while improving the bottom line

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When Joel F. Karman, MSW, LSW, MPH, senior director of social services and guest relations at the University of Illinois Medical Center (UIMC) in Chicago, first pitched his idea to hire a full-time staff member charged with finding nontraditional funding resources for the uninsured, he knew it would raise a few eyebrows.

Karman’s facility was spending $506,000 per year on a contract company to review the hospital’s charity care claims, but still saw its bad debt increase due to unpaid hospital bills and rejected claims.

In 2003, Karman convinced his facility to allocate a little more than $30,000 to hire one full-time program services specialist (PSS) dedicated to finding new funding resources, with a plan to develop an entire financial case management unit (FCMU).

The PSS was charged with reviewing patients as they came to the hospital and notifying them of resources available, including mental health coverage and reimbursement of lost wages. In the first nine months of the program, 180 patients were identified as crime victims, 124 of whom had no insurance. But, says Karman, 33 of the 124 self-pay patients were approved for CVCA funding totaling $146,365, or about 43% of the facility’s total outstanding balance for treating the patients.

Check out the July 2008 issue of Case Management Monthly to get the full story, and check out all the benefits of being a Case Management Monthly subscriber!