Q: Beginning in July, prior authorization is needed for certain hospital outpatient services such as blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation. Going forward, how should hospitals approach this change?
The novel coronavirus (COVID-19) pandemic has created challenges for case management departments. They must balance protecting the health of case management staff while maximizing productivity. In this new environment, departments are closely examining the role of the utilization review (UR) case manager.
Q: Patients who leave the hospital against medical advice (AMA) have a much higher 30-day readmission rate than patients with non-AMA discharges. What strategies can case managers use to help patients who may be at risk for leaving AMA?
Patients who leave the hospital against medical advice are more likely than other patients to be readmitted to the hospital within 30 days, adding up to a sizable and costly problem, according to a study published June 11 in the Journal of the American Medical Association (JAMA) Network Open.