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Crouse Hospital in Syracuse, NY, had these goals in mind when it developed Care Express, an electronic online tool that allows home care agencies and SNFs to access patient records.
In January 2007, the University of North Carolina (UNC) Hospitals in Chapel Hill implemented a standardized, electronic assessment tool to aid its case managers in providing thorough and consistent patient assessments.
Beverly Wagner, RN, BSN, CCM, ACM, clinical care management educator at UNC Hospitals, and colleagues developed the tool with staff members to ensure their buy-in. The result was the brief assessment tool (BAT). The BAT made documentation easier and more consistent; patient assessment documentation rose immediately. “We had a nice surge from about 8% of discharges having measurable assessment documentation to about 30%,” says Wagner. “But we kind of hit a plateau there.”
Check out the September 2009 issue of Case Management Monthly to read the full article, and discover the benefits of becoming a Case Management Monthly subscriber.
There’s been a lot of buzz recently surrounding possible regulations restricting payments to hospitals for readmissions within 30 days of discharge. Many experts say it’s only a matter of time before there is legislation reducing or eliminating reimbursement to hospitals for preventable readmissions.
Case Management Monthly discussed this topic with several experts who have been involved in this issue since CMS first started working with it through the 9th Scope of Work; CMS continues to study it as the Transitions of Care pilot project. Among these experts were Alicia Goroski, MPH, the project director for the Care Transitions Quality Improvement Organization (QIO) support contractor at the Colorado Foundation for Medical Care, and Doug Brown, BS, MHS, the government task lead for the Care Transitions Theme.
Q. What is the basic background of CMS’ 9th Scope of Work?
AG: The 9th Statement/Scope of Work started on August 1, 2008. The Care Transitions Theme was a subnational theme, which means it was competitively bid and not awarded to every state. There were 14 QIOs, or 14 states, selected to participate in this project. For the project, the participating QIOs defined a community based on a set of ZIP codes.
One of the overall goals of this project is to reduce the 30-day readmission rate for Medicare beneficiaries residing in the identified ZIP codes.
There are more measures to this project than simply reducing 30-day hospital readmissions. We’re also looking at patient satisfaction using four of the questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
DB: One of the outcome measures at the 28-month mark is to evaluate whether the QIO’s work has had an effect on patient satisfaction. To do this, we have two measures. One looks at medication management and the other at discharge planning and whether the patient felt the hospital addressed his or her needs.
Check out the August 2009 issue of Case Management Monthly to read the full article, and discover the benefits of becoming a Case Management Monthly subscriber.
Case managers wear many hats. They identify problems or gaps in community resources that affect outcomes and strive to mitigate changes. They also work with the interdisciplinary team to anticipate discharge and plan for care needs.
However, when obstacles impede facilitating the identified plan of care, physician advisors (PA) can step in and assist case managers.
PAs can lend expertise and:
- Educate case managers about signs, symptoms, and how patients might progress along the trajectory of care for a certain disease;
- Suggest possible options for negotiating resources to assist meeting patient needs for discharge; and
- Discuss financial concerns that might affect the organization.
PAs also should work with attending physicians to understand the complexity of patient needs and identify barriers that could impede discharge of complex patients.
Editor’s note: This tip was adapted from HCPro’s book, Optimizing the Physician Advisor in Case Management: A Guide to Creating and Sustaining Measurable Program Results, available on HCMarketplace.com.
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A recent statement from U.S. Health and Human Services Secretary Kathleen Sebelius seems innocuous enough—many people seeking care in emergency departments are uninsured.
The nation's leading group of emergency physicians immediately took issue with her remarks, however. They chastised her for perpetuating a myth about hospital care and said she is oblivious to a much bigger problem.
In her statement, Sebelius cited statistics from a database managed by the Agency for Health Research and Quality. These statistics reveal that in 2006:
- One in 5 patients seen in emergency department settings was uninsured,
- Low-income patients accounted for almost one-third of patient visits,
- Residents of rural areas comprised one-fifth of emergency room care
Sebelius observed that uninsured patients often cannot afford primary care and must seek care in the ED. ED physicians, including Nick Jouriles, MD, president of the American College of Emergency Physicians, say this statement helps direct resources to managed care instead of emergency departments where they are most needed.
Source: HealthLeaders Media
When it comes to ED case management, it is possible to target certain populations for case management screening to determine involvement. These populations fall under the category of high-risk patients:
- Elderly fall
- Elderly extremity fracture
- Repeat visits for pain (back, abdominal, dental, migraines)
- Failure to thrive, frail elder
- Patients with multiple ED visits within the hospital-defined allotted time frame (e.g., more than two visits/month)
- Patients with readmissions within the time frames set by your facility (e.g., 48-72 hours from ED visit or inpatient admission, 30 days from inpatient admission, etc.)
- Patients with short- or long-term placement needs
- Patients with insurance red flags (e.g., managed care insurance plans, pay-for-performance insurance initiatives, uninsured/self pay)
To target specific populations, set up identifiers in the registration process to alert the case manager to targeted populations that may benefit from case management activities. Alerts can be set up and printed out as case manager worksheets.
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