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.
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.
It's no longer a mere possibility; the Department of Health and Human Services HHS has confirmed its intent to delay the ICD-10 compliance deadline, according to its latest press release.
In November 2006, CMS published a final rule on the Conditions of Participation (CoP) for hospitals. Among the finalized provisions, there was a five-year window given during which CMS permitted orders (including verbal and telephone orders) to be signed by either the ordering physician or another physician responsible for the patient's care (e.g., a covering physician or practice partner). Those five years came to an end on January 27, 2012, meaning that, as of that date, hospitals needed to ensure that their orders were signed only by the ordering practitioner him- or herself. However, in October 2011, CMS released a proposed rule addressing the five-year sunset provision. Per the Federal Register:
