Murer / Brick The Case Management Workbook

Defining the Role of Physicians, Nurses and Case Managers
Erscheinungsjahr 2011
ISBN: 978-1-4398-9119-3
Verlag: Taylor & Francis
Format: PDF
Kopierschutz: 0 - No protection

E-Book, Englisch, 138 Seiten

Case management has become one of the most effective means by which a continuum of care functions effectively and efficiently. A complete examination of the application of continuum of care, The Case Management Workbook: Defining the Role of Physicians, Nurses, and Case Managers defines the roles of the case management team and provides an overview of key post acute venues of care. It supplies an overview of the process, its structure, and the responsibility of each member of the team. The book discusses how managing the care of the patient in today’s healthcare environment will take a concerted effort from the entire case management team—not just a handful of case managers.
The authors demonstrate that the case management team includes many more individuals than simply those with the title of case manager. The team must consist of key clinical personnel including the nurse, the physician and the case manager, each of whom have specific roles in case management. The book also highlights the role administration plays in assuring each member of the team is on board with the hospital’s or health system’s goal in assuring the patient is at the right place at the right time in their episode of care.
In the words of the authors, case managers are … the unsung heroes of effective healthcare delivery. They push and they prod, they inform and they educate, they provide valuable information to physicians and families with a common goal—to assure the patient is provided care in the most appropriate venue correlative to the medical resources needed and provided. In their book they explore a key byproduct of an effective case management system— the realization of an effective integrated health system whereby physicians and hospitals are aligned as caretakers of future health resources.

Autoren/Hrsg.

Murer, Cherilyn G.

Murer, Michael A.

Brick, Lyndean L.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Pflege Krankenpflege
• Wirtschaftswissenschaften Betriebswirtschaft Management

Inhaltsverzeichnis

Who Is Responsible for Case Management?
Overview
What Is Uncompensated Care?
Moving the Patient in a Timely Manner
The Use of the Emergency Department
The Essence of Effective Case Management
Structure
Physician
Nursing
Case Managers
Administration
Everyone
Case Management Is Truly Everyone’s Responsibility

Financial Incentives
Aligning Incentives: Current Payment Structure
The Physician Payment
Hospital Payments
Post Acute Venue Payments
Fraud and Abuse
Recovery Audit Contractors Audits
Future Payment Structure
Bundling Physician and Hospital Payments
Post Acute Care Bundling Plan
Post Acute Care Bundling Proposal Details
Industry Reaction

The Watershed Years of the American Healthcare Delivery System
The Watershed Years
The Barrier Defined
Healthcare Reform: 2010—A Major Watershed Year

Key Obstacles in Reducing Length of Stay
Cajoling Can No Longer Be the Primary Methodology for Dealing with Physicians
The Largest Obstacle
Cultural Change
Social Issues
A Preference for the Intensive Care Unit
The Consulting Physician
The Attending Physician in the Role of Quarterback
How to Deal with a Difficult Physician
Other Obstacles
Obstacle: Physical Plant
Obstacle: Monitoring Equipment
Obstacle: We Wait and Wait for Approval
Obstacle: Staffing Shortage
Is the Postacute Venue Ready
Slow Down, You’re Moving Too Fast

Opportunities for Effective Use of Post Acute Venues
Venue Management
Centralized Case Management System

The Post Acute Venues and Their Roles in the Continuum
Introduction: The Post Acute Venues
Long-Term Acute Care Hospital
Overview
Regulatory
New Rules for 2010
Good News for LTACHs
Length of Stay
Benefits and Conditions
Physician Coverage
LTACH Payment Structure
Comprehensive Inpatient Rehabilitation Hospital/Unit
Overview
New Coverage Criteria
Three-Hour Rule
Criteria for Admission
60 Percent Rule (Previously the 75 Percent Rule)
Physician Coverage
Medical Directorship—20 Hours Per Week Rule
Product Line Specialization
Inpatient Rehabilitation—Payment Structure
Skilled Nursing Facility/Unit
Overview
Final Rules for 2010
Admission Criteria
Skilled Nursing Physician Care
Skilled Nursing Payment Structure
The difference between Comprehensive Inpatient
Rehab and Skilled Nursing
Outpatient Rehabilitation and Home Health
Outpatient Rehabilitation
Home Health
Hospice

Case Management at the Epicenter of an Integrated Health System
The Epicenter of an Integrated Health System
Models
The Hybrid Model of Case Management
Seamless Protocols
Discharge Triggers
Case Studies
Appropriate Movement of the Patient

Diagnosis-Related Group Review
Overview
Major Diagnostic Category
Diagnosis Related Groups
With or Without MCC and CC
Projecting the DRG
The Sticky Note
Assigning a Different DRG

Meaningful Data
Meaningful Data
Efficacy of Data
Electronic Medical Record
Benchmarks

Conclusion

Examination Questions

Class Exercises
Exercise 1: Develop a Venue Inventory Worksheet
Exercise 2: Identify the Parameters of Case Management in Your Organization
Exercise 3: Key Obstacles
Exercise 4: Opportunities for Effective Use of Post Acute Venues of Care
Exercise 5: Case Management in a Multivenue Setting

Appendix A:
Glossary

Appendix B:
Acronyms and Abbreviations

Index