Compliance with the 2-midnight rule has been tricky for many organizations?and things aren't expected to get easier anytime soon. The 2016 OPPS proposed rule may bring some additional tweaks to the 2-midnight rule (see related story, "Proposed OPPS rule suggests tweaksto 2-midnight rule," in the September issue of CMM), and education and enforcement may change hands from Recovery Auditors to Quality Improvement Organizations.
Today's nurses have more demands on them than ever, with high patient loads and an increasing number of tasks to complete. Often, this increases the likelihood that certain aspects of care may be missed?whether it's needed education on insulin injections that weren't provided before discharge or a patient who develops a pressure ulcer because he or she wasn't turned often enough.
The 2-midnight rule may get a little tweak if the proposals in CMS' 2016 OPPS proposed rule comes to fruition. The rule proposes that physicians now be granted a little more flexibility when it comes to ordering inpatient admissions, even when the stay is expected to be less than two midnights?provided of course that the stay is justifiable from a medical standpoint and the physician clearly documents his or her thinking on the case.
Starting a population health program can not only help organizations improve patient health, but can also help a hospital's bottom line by reducing readmissions and cutting down on costly emergency department visits. But many case managers may wonder what it takes to get a population health program off the ground.
When you're starting a population health program, a critical component is information?the data you collect to assess patient risk factors. Having a computer system to sort through information and help you identify high-risk patients is a huge asset to any program, says Gavin Malcolm, LCSW, director of Population Health for Broward Health ACO Services in Florida. "You have to be able to access and manage data to be successful," he says.
Technology is everywhere, including hospitals and doctor's offices. Studies have found that in some cases technology can be an asset to patient management, with remote monitoring showing promise in helping to reduce readmissions.
Your success as a case manager often depends on how well you work with others in your organization. At any organization, ensuring high-quality patient care, accurate documentation, and regulatory compliance takes a team effort.
Case management in Alaska isn't for the faint of heart, according to Randi Ferrare, RN, BSN, interim director of case management and social work at Providence Alaska Medical Center. Some of the challenges force case managers at Providence Alaska to work a little harder and get a little more creative to meet the needs of its patient population. One innovative program at the hospital is its case management educator position.
At many hospitals the terms Utilization Management (UM) and Utilization Review (UR) are used interchangeably. Are they the same thing? No, they're not, according to Stefani Daniels, RN, MSNA, ACM, CMAC, and Ronald L. Hirsch, MD, FACP, CHCQM.
