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.
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.
With the new year comes a new federal administration and a new president. How will case management be affected, and what should case managers do to prepare for the changes that may come? There are a lot of questions, but almost no answers.
The Medicare Outpatient Observation Notice is back and your organization should be ready to use it to comply with the NOTICE Act no later than March 8, roughly 90 days from the December 7 final approval of the form by CMS.
Mrs. Gray, a 93-year-old is in the ICU, has been diagnosed by her physician as having chronic heart disease that has progressed to “end stage.” The physicians set up a meeting at the patient’s bedside to discuss this prognosis with her and invite a representative of every member of the healthcare team to participate. Among those attending the meeting were the nurse case manager and social worker, who makes sure a representative from spiritual care is also present. Since the patient has told them that she has no family or friends, which the social worker validates after an extensive investigation, there are no significant others to attend. Mrs. Gray is truly the last living member of her family.
Hard to believe but this year the Commission for Case Manager Certification celebrates its 25th year of certifying case managers. Are you one of them? I hope so and I hope your management supports the need for its staff who serves in a case manager role to be certified.
