 |
|||||
 |
 |
 |
 |
 |
 |
| Federal Class Action Suit | |||
 By now you've probably heard that the Center for Medicare Advocacy and the National Senior Citizens Law Center filed their petitions last month against HHS Secretary Kathleen Sebelius and names 7 Medicare patients as plaintiffs. They claim that Medicare wrongfully denies thousands of beneficiaries coverage of acute, post-acute, and prescription drug expenses each year because hospitals do not "admit" them as inpatients for at least 3 days as they should. Instead, the care of these patients is classified under the controversial "observation" category. In each case, the lawsuit says, patients "received a hospital level of care and should have been formally admitted." Link |
|||
|
|||
| ARE YOU READY FOR ICD 10? | |||
 Clinical documentation improvment (CDI) initiatives are often found under the case management program umbrella because of the importance of concurrent communication with the physicians and the overlap with document review for UR purposes. UR and CDI specialists often work together as a team and in a few instances, the roles have been integrated and embedded in the ED. |
|||
|
|||
|
|||
| Riverside Medical Center | |||
| Traveling to new places and meeting new colleagues is always a treat. We would like to extend a warm 'thank you' to the folks at Riverside for their gracious welcome and cooperative participation during our recent engagement. Riverside invited PMM to conduct a comprehensive evaluation of their case management program and will be using the findings to grow their program for the future. Kudos to John Jurica, MD, Dave Duda, and Brenda Menard for a job well done! | |||
|
|||
Medication Reconciliation
In 2006, The Joint Commission (TJC) accredited hospitals were required to "implement a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization".......and to communicate "a complete list of the patient's medications.....to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization". However, in 2009, The Joint Commission announced that they would no longer formally score medication reconciliation during on-site surveys due to the lack of proven strategies for a successful process.
That may change. Recently, a number of research studies have linked readmissions to two significant variables: lack of communication with the patient's primary practitioner after discharge and medication inconsistencies.
The former is often a result of the patients' failure to make an appointment or to keep a pre-set appointment due to forgetfulness, lack of transportation, or other social issues. Hospitals are reponding to this variable in many creative ways from providing transport to hospital clinics or practices to linking up with community support groups to providing a case manager transitionist to review the patient's post acute plan just prior to discharge and maintaining a telephonic connection for at least 6 weeks after discharge.
The purpose of medication reconciliation is to avoid inadvertent inconsistencies across transitions in care by reviewing the patient's complete medication regimen at each transition point. Interventions by clinical pharmacists may be the most promising according to a few studies. In one such study, Jack BW, Chetty VK, Anthony D, et al. Ann Intern Med. 2009;150:178-187, a pharmacist-led medication reconciliation process at discharge followed by a pharmacist initiated post-discharge phone call resulted in fewer ED visits and reduced 30 day readmissions.
Bottom line - If your organization has clinical pharmacists on staff, engage them in the process of progression-of-care from the outset and include them in all post acute preparation processes.
print this articlePalliative Care
A new report notes that the number of hospitals that have implemented palliative care programs has risen sharply. Palliative care programs can now be found in 63% of hospitals with 50+ beds and 85% in hospitals with more than 300 beds. Nationwide, prevalence of hospital based palliative care programs ranged from 10% in Mississippi to 100% in Vermont.Enormous resources are expended on the seriously ill, putting the hospitals that treat them - and oftentimes, the families - at financial risk if they cannot find a way to provide care that is both high quality and fiscally responsible. Since most patients are in the hospital due to a health crisis, it is often the time when patients and families confront the reality of illness and the decisions that need to be made. Palliative care provides a smooth transition for the patient between the hospital and appropriate services, such as hospice, home care, or nursing homes.
The hallmarks of a palliative care program - communication and coordination, combined with excellent medical care enable the patient to progress to the next phase of their care at their own pace and when medically advisable. Implementing a palliative care program largely depends upon the organizational culture: A physician led team may work more effectively in an academic culture while a nurse- or social counselor-led team may be ideal in a more private practice culture.
print this articleInnovation Center
Do you have an innovative idea about improving healthcare delivery to your patient populations? If you do, and you can fast track it with adequate resources, this may be just the opportunity you've been looking for! Last month, CMS announced that it would award grants to applicants who will "implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare." The challenge will fund projects that can start within 6 months and is open to public-private partnerships as well as providers, payers and local governments.
According to CMS, priority will be given to projects that focus on "rapid workforce development" and provide a "clear road-map to sustainability." They are especially interested in innovations that address the needs of high-cost, high-risk individuals, including "those populations with multiple chronic diseases, mental health, or substance abuse issues, poor health from socio-economic and environmental factors, multiple medical conditions, or the frail elderly."
If you've been working with local businesses, churches, or community providers to target high risk populations, this may an opportunity to fund your ideas. Check out InnovationChallenge@cms.hhs.gov
print this article
subscribe | forward to a friend | visit our archives | unsubscribe