There is little doubt that food plays a crucial role in health, but eating habits are often treated as a lifestyle, not a medical issue. That recently changed in Pennsylvania when a group of hospitals banded together to pilot a new program, The Healthy Food Access Pilot, which strives to help at-risk patients eat well in an effort to improve health outcomes.
Leah Jacoby, a veteran neonatal intensive care unit (NICU) nurse, recently interviewed for a case management position that she hoped would help her make the jump from the clinical world to care coordination and patient advocacy.
CMS has changed its selection process for medical records for short-stay reviews under the 2-midnight rule. This could be problematic for some organizations, says Ronald Hirsch, MD, FACP, CHCQM, vice president at R1 Physician Advisory Services in Chicago.
After a busy week, Gretchen, a manager of case management, is looking forward to the weekend. On Friday night she goes to bed early. By Saturday she still feels worn out, so she sets her cell phone on vibrate. All she needs, she thinks, is more time to recover and regain her energy for the upcoming week.
Working in case management for years has taught me to use the ABCs in at least two tasks I perform daily. Not only are the ABCs useful in developing patient discharge plans, but they also help in setting my daily caseload priorities. How do they work?
Let's look at one specific area where case managers can make a difference: reducing hospital-acquired anemia (HAA). This condition is often the result of blood draws performed cumulatively—and sometimes excessively—as part of laboratory testing.The prevalence of HAA can be exacerbated by another form of inappropriate medical care—in this case, laboratory tests. The goal is to ensure a patient only undergoes laboratory tests he or she truly needs.
Case managers may not be physicians, but they are still integral to the quality of patient care. Regardless of whether a case manager’s role includes clinical or medical case management, utilization review, discharge planning, or a combination of these and more, if the case manager can advocate for the patient during the medical encounter, he or she can influence good clinical care, says Jackie Birmingham, RN, MS, clinical leadership at naviHealth: A Cardinal Health Company, headquartered in Brentwood, Tennessee, and author of Discharge Planning Guide: Tools for Compliance, Fourth Edition.
Nancy is a manager of a hospital with a large indigent population. Nancy notes that immediately after the implementation of healthcare reform, many of her patients have obtained some form of health insurance, usually Medicaid. Often, the patients access Medicaid with the help of the hospital’s expert financial counselors. Recently, however, the number of uninsured patients in the community seems to be increasing. As a result, more uninsured patients are being admitted. Before healthcare reform, many uninsured people failed to seek timely, preventive healthcare. Therefore, they were quite sick by the time they came to a hospital. Nancy is now seeing a resurgence of uninsured indigent patients.
