Every couple months, it seems questions arise about the 2-midnight rule and there are rumors that it may be going away. Below are some questions with answers from our expert Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at Accretive Health in Chicago, to clarify where things stand today with regard to the 2-midnight rule.
While some 26 million Americans have gained insurance since the Affordable Care Act (ACA) became effective in 2010, another 24 million U.S. adults are still living without coverage, according to a new report by the Commonwealth Fund, a private, nonprofit organization that supports health policy research and reform.
This is a concern because not only are uninsured adults likely to skip needed health services due to the cost, but a lack of insurance is also a risk factor for preventable hospitalizations and health declines due to chronic diseases, according to the Henry J. Kaiser Family Foundation (http://ow.ly/Bs3a304bJR7).
So who are these uninsured Americans? According to The Commonwealth Fund survey (http://ow.ly/I8uZ304cB2b), 88% are Latinos under the age of 35 who earn less than $16,243 and/or work for a small business. "Half (51%) of the remaining uninsured live in one of the 20 states that had not yet expanded Medicaid at the time of the survey," states a press release issued by the Commonwealth Fund (http://ow.ly/gqsB304bJZk).
Case managers should take note of the survey findings.
"The Commonwealth Fund analysis is beneficial to all case managers, because the uninsured population compromises our most at high-risk groups of patients," says June Stark, RN, BSN, Med, director of care coordination at St. Elizabeth's Medical Center in Boston. "Most hospitals today seem to be the primary source of healthcare provision to the patients in their communities. Expanding the case manager's understanding of this population can contribute to the development of successful strategies for managing this group."
The study, called The Commonwealth Fund Affordable Care Act Tracking Survey, consisted of 15-minute telephone interviews. Interviewers conducted the interviews in two languages, either English or Spanish, between February and April 2016. The data was collected by calling a random, nationally representative sample of nearly 5,000 adults ages 19?64.
Since the ACA went into effect, the uninsured population shifted from mostly white adults to Latinos, according to the Commonwealth Fund press release. Results also show that renewed efforts to help uninsured individuals gain coverage might also be in order.
"The ACA held promise for many, especially those with incomes that could bear new market sticker prices, and as can be seen from the study, diverse populations benefitted from targeted reform marketing efforts," says Shawna Grossman Kates, MSW, MBA, LSW, CMA, the director of case management and bed management for RWJBarnabas Health in Toms River, New Jersey. "Yet it is very apparent that while there has been success with some at-risk populations, those with the lowest incomes who do not qualify for Medicaid are still struggling."
Opening the lines of communication between clinicians and specialists to make care more efficient can be a sizable challenge.
At many facilities, hospitalists shuttle from floor to floor to see patients, each time trying to track down the nurse and other professionals working on each case. Information is typically transferred through an inefficient system of pages and phone calls, sometimes taking hours at a time to deliver crucial pieces of information.
Enter the accountable care unit, a new way of configuring care systems that can help to uncoil tangled communication wires between clinicians and support staff to provide care that is more efficient and streamlined.
In this model, hospitalists work with patients in a specified geographical area of the hospital in conjunction with interdisciplinary teams.
Having patients in one area helps make care more efficient, and as one hospital system in New Mexico learned, can also reduce length of stay and increase cost-efficiency.
Regionalization of hospitalist patients is becoming more common today, because of the benefits it's been shown to bring, says Stefani Daniels, RN, MSNA, ACM, CMAC, founder and managing partner of Phoenix Medical Management in Pompano Beach, Florida. Those benefits include:
Improved teamwork, care coordination, and communication
Fewer readmissions
Improved resource management to lower cost of care
Improvements in patient satisfaction
Reduction in inefficiencies
"I'm pushing accountable care units at all my hospital clients," says Daniels. But while the will is there in many cases to make the change, it's not always an easy conversion.
Sometimes these initiatives face pushback from physicians concerned about personnel or scheduling issues.
Other challenges include:
The lack of diagnostic diversity that results from having set teams on a unit
The challenge of deciding whether teams should be flexible or static
Hammering out logistical issues, such as how patients should be triaged and how beds are managed
When looking at the link between readmissions and hospital quality of care, it may be best to focus on patients who return to the hospital seven or fewer days after discharge, according to a recent Health Affairs study.
Case managers around the country are celebrating National Case Management Week, October 9–15, which recognizes the caregiving efforts of case managers throughout the year.
