Case managers have already become familiar with the Medicare Recovery Audit Program. In January, however, government Recovery Auditors began focusing on new territory: Medicaid claims.
Making sure patients are prepared for discharge can be a tricky process. When certain laws are considered, getting patients to their next destination becomes even more complex.
Leaders there established multidisciplinary barrier reduction teams (BRT) in late 2009, which are designed to increase efficiency and improve communication at the organization. The teams give staff members a way to speak up about issues that may hinder patient care and the discharge process.
Utilization review (UR) and case management are as traditional a team as peanut butter and jelly. But some facilities are asking whether this longtime duo is really the best combination.
One of the riskiest times for patients comes when they are leaving the hospital and heading home or to aftercare. This is the time when medications are mixed up, follow-up doctors' appointments are missed, or discharge instructions get lost in the fax machine. Poor handoffs with poor communication can lead to unnecessary readmissions.
When case managers are looking at patients who are frequently readmitted to their facility within 30 days of their last discharge, chances are they'll find a lot of chronic heart failure (CHF) patients among them. That's because CHF patients typically have a higher readmission rate than any other disease, says Jan Lear, RN, CMC, director of case management at MedStar Franklin Square Medical Center (MFSMC) in Baltimore.
