It is an ongoing challenge for case managers to determine whether a patient is more appropriately placed as an inpatient or in observation. Below are some real-life examples provided by Deborah Hale, CCS, CCDS, in the HCPro book Observation Services: A Guide to Compliant Level of Care Determinations.
When patients leave the hospital, one key factor often determines whether they'll soon need to be readmitted: how well they follow their discharge instructions.
Many organizations across the country have learned that patient care is more effective when providers work together. One means of accomplishing this goal is by performing patient rounds using teams that include a number of different practitioners, from physicians and nurses to case managers and pharmacists.
Physician documentation must include sufficient detail to ensure that case managers can accurately estimate LOS, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, CCDS, an independent health information management consultant in Madison, Wis.
Ensuring detailed documentation isn't important only with respect to documenting medical necessity. Case managers should also ensure physicians are including enough information in patient records to help them accurately estimate LOS, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, CCDS, an independent health information management consultant in Madison, Wis.
Successful programs to reduce preventable hospital readmissions range from the transitional care model created by Mary Naylor, PhD, FAAN, RN, a nurse researcher at the University of Pennsylvania, to Project RED, created by the Commonwealth of Massachusetts. Kathleen Heery, MS, RN, CCM, and Cheryl Pacella, DNP(c), HHCNS-BC, CPHQ, the homecare consultant and quality advisor at CAP Consulting, LLC, discussed the secrets to their success during "Reducing Readmissions by Improving Transitions in Care," an HCPro webcast.
