In an effort to make physicians more accountable for proper documentation, CMS has been doing the transmittal shuffle as of late--and the process may have you thoroughly confused.
In the accountable care organization era, controlling costs and maximizing the efficiency of care has become a priority for many organizations, particularly when it comes to patients with high-cost, complex needs. The question is: How can organizations save money without sacrificing the quality of care or increasing avoidable readmissions?
If the 2-midnight rule keeps you up at night, it might help to add some PEPPER to your processes. CMS recently updated PEPPER, otherwise known as the Program for Evaluating Payment Patterns Electronic Report, to provide hospitals with insight into how well they're doing with 2-midnight rule compliance.
Many hospitals have been adding group rounds as a means of improving communication and care for patients. These rounds give case managers (CM) an opportunity to better understand the patient's condition, learn about any potential factors that might extend LOS, and prepare for any potential barriers that might lead to readmission after discharge.
Baylor Scott and White Health System (BSW) in Temple, Texas, has a new program in place to avoid this. Unlike many programs that just help patients schedule follow-up appointments with primary care physicians, the discharge team at this organization not only helps patients make follow-up appointments with physicians, but also with any specialists the patients need to see as well, including cardiologists, pulmonologists, or even follow-up radiology appointments.
There's bad news for case managers that were hoping that the 2-midnight rule would go away. It's not?at least not in fiscal year (FY) 2015. In the 2015 Inpatient Prospective Payment System (IPPS) final rule published August 22, CMS said while it may be willing to look into adjusting the payment methodology for the 2-midnight rule, the rule itself will stand.
Physicians have long treated patients knowing that some of the problems keeping them sick were problems that medicine couldn't fix--lack of food, electricity, or money to pay for medicine. These are the types of problems that often send patients back to the hospital after they are discharged home. Today, some physicians can write a prescription to solve these problems the same way they order medicine.
It's time to get the recognition you deserve and put the focus on your department by celebrating National Case Management Week, scheduled this year October 12-18.
Some hospital case managers may be breathing a small sigh of relief because a provision in the 2015 OPPS proposed rule would, if finalized, put an end to a burdensome physician inpatient certification requirement for most patients.
