Faced with increasing caseloads and the prospect of reduced reimbursements under health-care reform, emergency departments are seeking out improved strategies of capacity management. John Rossheim reports.
While the vision behind bundled payments promises to streamline care and reduce costs, providers are skeptical about effectively managing the risks of sharing reimbursement incentives among partner organizations. John Rossheim reports.
Hospitals that build and nurture relationships with post-acute providers, health insurers, pharmacies and even private employers are creating a network of resources that address preventable readmissions. Debra Gordon explains.
Final rules on health exchange pricing and payment mechanisms, EHB requirements and a new Medicaid payment structure take effect in Q1. Pamela Haughton-Denniston lays out the details as health-care reform moves forward.
The financial value of case management is increasingly under review. If case managers can't justify their own cost, hospital executives are willing to consider outsourcing case management, at least in part. John Rossheim reports.
When providing patient choice, case managers should be aware of adult day care. Guest author Mike Leebron says this level of care could be a good fit for patients with family support in the evenings and on weekends.
Keeping up with emerging models of care and new regulations adds to the growing demands of case managers. Curaspan VP Emeritus Jackie Birmingham, RN, MS, suggests five ways to meet these challenges.
Billions of dollars are at stake in Sebelius v. Auburn Regional Medical Center, a case that could swamp Medicare with appeals about Disproportionate Share Adjustments. Veteran legal reporter Lyle Denniston checks in from Washington.
Providers and payers are waiting to see if a federal judge approves a proposed settlement in a class-action suit about denials of coverage based on the “improvement standard,” which HHS denies using. Pamela Haughton-Denniston, Esq., explains.
Donald W. Fisher, Ph.D., president and CEO of the AMGA, says we’ve entered a new era where providers and payers can improve clinical and claims outcomes by leveraging shared data. It’s part of a shift from volume-based to value-based care.