A longtime requirement for Medicaid-covered home-health services may be changing. The Centers for Medicare & Medicaid Services (CMS) is seeking public comment on whether benefit recipients must be homebound or simply be at home after a hospital stay.
Today’s case managers face increasingly complex ethical and legal issues. They wrestle privacy, confidentiality and quality-of-care challenges amid health-care reform legislation, HIPAA compliance and social media.
To help produce optimal clinical and financial outcomes for their organizations while navigating ethical and legal boundaries, case managers must use unique strategies.
With increasingly acute shortages of nurses and medical social workers, it’s more important than ever to train new case-management staff more quickly and efficiently. There’s no longer the luxury of overlapping staff – not when in some organizations, budget challenges force cuts in staff development programs. This generally leaves mentoring, shadowing, observation, on-the-job training and other passive types of staff education to fill the void.
Patients’ use of the emergency department for non-emergent conditions is a well-documented problem that continues to show a troubling upward trend. This creates challenges for ED case managers, who scramble to achieve positive clinical outcomes while coordinating care. But by identifying and establishing communication with more appropriate primary-care options, hospital staff can improve ED patient throughput.
Hospital administrators, department chiefs, nursing supervisors and the staffs of teaching hospitals may face a challenging and unfamiliar task if they are to stay out of legal trouble – unless the U.S. Supreme Court takes it off its to-do list. The task: Before diagnosing how a patient reacts to a drug dose, someone may have to check the files of the U.S. Patent Office to make sure they are not intruding on some inventor's legal rights.
With health-care organizations more cost-conscious than ever, the remote case manager, consuming little office overhead, is gaining traction. Whether working from an off-site office or from home, experienced case managers are finding that productivity and flexibility can co-exist.
However, moving the case manager’s role to the home front isn’t as simple as setting up a dedicated PC and phone line. Let’s take a look at what is involved.
Remote Case Management: What it Takes.
Senior Director of Case Management Diana Rappa-Kesser, RN, MSN, CCM, CCP, and Director of Informatics Scott Fox, MS, MEd, have teamed up to produce notable results for Keystone Mercy Health Plan, the largest Medicaid managed-care health plan in Pennsylvania with more than 300,000 members.
Rappa-Kesser and Fox spoke with Curaspan Connections about how collaboration with health-care providers and predictive modeling are delivering better clinical and financial results.
With the final rule about value-based purchasing (VBP) published, work on preparing for its rollout intensifies. The incentive? For starters, an estimated $850 million in 2013, as the Centers for Medicare & Medicaid Services (CMS) begins to tie Medicare payments for acute care to the quality of care. Part of the equation is patient experience of care, the consumer’s perception of quality.
More than one year after the passage of the Patient Protection and Affordable Care Act, the future of health-care reform remains uncertain. While some believe PPACA should be implemented as passed and others think it should be repealed, few believe our health-care system is on the right track and most agree that change is necessary. Reform is happening even as we await the fate of the law.
When we introduced Synchronized Patient ManagementTM, I was as excited as when more than a decade ago I first heard about the idea behind Curaspan. Our vision for the future — “a fully integrated solution that connects hospitals, post-acute providers and payers with a user-centric view of patient-centric records, results and reviews” — is a natural progression from our initial focus on transition-management software and the post-acute provider networks it enables for hospitals.