Pat, a nurse case manager, had noticed an increase in the number of uninsured patients at the hospital where she worked. She didn’t know why the past few months had seen so many uninsured come through the doors, but she wondered whether it had to do with her state’s healthcare reform.
Having performed discharge planning for many, many years, I’ve learned one key component is now more true than ever: Assessments must be very comprehensive. We are dealing with a wider variety and different mix of patients. For example, we are seeing an older population that is living longer, often with dementia. These are patients with multiple comorbidities who are living on a limited income. We also are dealing with a larger group of patients—again, with multiple comorbidities—who are living longer due to medical advances and require costly medications and repeated readmissions for complications or procedures. Additionally, we care for the homeless, who are often riddled with mental health or drug addiction problems as well as comorbidities.
This week's note from the instructor discusses new guidance released by CMS regarding the Medicare Outpatient Observation Notice (MOON) form for hospitals and critical access hospitals.
The 2017 OIG Work Plan is out, and there are a few areas that may affect case management, particularly with regard to the 2-midnight rule, skilled nursing facilities, ambulance services, and home health agencies. Regardless of the changes in each year’s Work Plan, the document as a whole should remind case managers that they need to comply with the rules.
