RESUMO
This month, we have begun our discussion of the reasons why this is a very good time for hospitals to review and re-engineer their case management models and departments, including the Affordable Care Act and value-based purchasing, among others. Next time, we will discuss the elements you need to review when re-engineering your own case management department.
Assuntos
Administração de Caso , Aquisição Baseada em Valor , Humanos , Patient Protection and Affordable Care Act , Estados UnidosRESUMO
While the Two-Midnight Rule can be confusing to staff and patients alike, if you implement and hardwire your processes you will be more likely to maintain compliance going forward.
Assuntos
Centers for Medicare and Medicaid Services, U.S. , Serviço Hospitalar de Emergência , Mecanismo de Reembolso , Administração de Caso , Economia Hospitalar , Admissão do Paciente/economia , Estados UnidosRESUMO
The CCJR program is a complex one. It is important that case managers, social workers, and case management leaders educate themselves on the program and what they can do to be successful partners in this process. Use total joints as a pilot to prepare for future bundles. They are on the way!
Assuntos
Administração de Caso , Pacotes de Assistência ao Paciente , Papel Profissional , Centers for Medicare and Medicaid Services, U.S. , Estados UnidosRESUMO
Case management should be designed as a fully patient-centric model with all the roles and functions of the case manager and social worker performed as part of a package of services provided to the patient, not as a series of tasks that are disjointed and performed in isolation of each other. When case management models separate these roles, they create an environment in which these roles no longer interface and no longer are applied with the patient's current and long-term care needs in mind. Be very cautious when implementing such models and as you can see above, the argument that the collaborative model is less expensive simply does not hold true. Whenever possible, try to keep your case management roles and functions as integrated as possible for the greatest success and achievement of outcomes!
Assuntos
Administração de Caso , Recursos em Saúde/estatística & dados numéricos , Modelos Organizacionais , Estados UnidosRESUMO
The role of interdisciplinary care rounds has never been more vital to the success of healthcare institutions. As the Centers for Medicare & Medicaid Services continues to strive to equate reimbursement with quality of care, hospitals will need to find new ways to deliver care that achieve these goals and have a positive effect on the bottom line The notion of rounds is not a new one, but taking rounds to the bedside on all patient care units is. Critical care areas have used this format for years, but it is now time for this effective process to be taken to the bedside of each and every hospitalized patient.
Assuntos
Administração de Caso/normas , Comunicação Interdisciplinar , Melhoria de Qualidade , Visitas de Preceptoria , HumanosRESUMO
This month, we began our discussion of walking rounds with an overview of why rounds are important and how you might begin to structure rounds in your organization. Because IHI and TJC both identify walking rounds as best practice, we have focused our discussion on the elements needed for a successful walking rounds process. Next month, we will continue our discussion of walking rounds with strategies for preparing for rounds, as well as how to engage the patient and family in the rounding process.
Assuntos
Administração de Caso , Comunicação Interdisciplinar , Visitas de Preceptoria/métodos , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
We have now completed our review of the top 10 mistakes you may be making in your case management department. I've included tips and strategies for correcting these mistakes if you are facing them in your organization. If you follow these suggestions, you will help to keep your case management practice and your department on track and moving forward!
Assuntos
Administração de Caso/normas , Guias como Assunto , Administração de Caso/organização & administraçãoRESUMO
This month, we reviewed three additional mistakes that are commonly being made in case management departments in hospitals today. Next month, we will review the final three of the top mistakes that you may be making in your department.
Assuntos
Administração de Caso/organização & administração , Erros Médicos , Eficiência Organizacional , HumanosRESUMO
This month we have begun reviewing the top mistakes hospitals make within their case management department's infrastructure. As discussed, the biggest mistake is to not clearly and prospectively define the roles of the RN case manager and the social worker to optimize each discipline's skill sets. Associated with this mistake is to have inadequate patient ratios assigned to each discipline. These mistakes are related and when roles are not clearly defined, it becomes almost impossible to understand or advocate for appropriate staffing ratios. If it appears that nurses and social workers can all do the same things equally well, then the organization will likely choose to go with the professional group that will cost the organization the least amount of money. In the end, this logic is penny-wise and pound foolish. We do both disciplines a disservice when we don't apply their skill sets adequately and don't have each group functioning at the "top of their license!" Next month, we will continue to discuss the top mistakes hospitals make in their acute care management departments' design. We will discuss the use of clerical support staff, assessments, and days of coverage.
Assuntos
Administração de Caso/organização & administração , Eficiência Organizacional , Benchmarking , Administração de Caso/normasRESUMO
In order to sit at the table with your organization's leadership and make credible arguments and a sound business case for the resources you may need tomove your department forward, remember that you need to be as well versed as you possibly can be. Anecdotal thoughts and opinions will not get you the resources you need. Best practice information will be a much better tool for making the case and having it stick. With the changes that have been imposed by CMS and other regulatory bodies, the time has never been better for case management. Case management is one of the solutions to meeting the challenges to today's health care environment!
Assuntos
Administração de Caso , Administradores Hospitalares , Papel Profissional , Estados UnidosRESUMO
The CMS efficiency measure has once again raised the issues of length of stay management and cost reduction. These have always been a component of the role of the hospital-based case manager. In today's best practice models, these interventions must be correlated with the roles of coordination and facilitation of care, discharge planning and utilization management. The case manager's roles and functions, as well as staffing ratios, must be designed in such a way as to allow for this integration of roles. Be sure that your department is focusing on how to embed this important function in your everyday practice!
Assuntos
Administração de Caso , Eficiência Organizacional , Aquisição Baseada em Valor , Administração de Caso/economia , Controle de Custos , Eficiência Organizacional/economia , Tempo de InternaçãoRESUMO
Home care is an important intervention to consider for virtually every patient you discharge to home. By using the strategies discussed above, you can increase your percentage of patients going home with this important service. Remember to assess every patient on admission and to reassess every patient daily. Standardize your assessment questions using a tool that includes social work and home care referral criteria. Finally, consider home care as one of the most important tools in your readmission reduction toolbox!
Assuntos
Administração de Caso , Agências de Assistência Domiciliar , Alta do Paciente , HumanosRESUMO
The role of the family caregiver may not be for a short time period. It could go on for months or even years. As case managers, our role is to ensure that we have provided our family caregivers with all the information that they may need to care for their loved one at home or in another care setting. This will take some time, but it is time well spent and will reduce the likelihood that an unnecessary trip to the emergency room will take place. Remind caregivers to know their strengths, limitations and to always be flexible!
