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  • UR and Medical Necessity

    This article was recently posted by Glenn Kraus on HCPRO's CASE MANGEMENT WEEKLY. With his permission, it is essential reading for HCM leaders. It highlights the reasons why the UR function can no longer be an 'add on' activity to the hospital case managers' role.  Executives lax attention to the issues surrounding 'medical necessity' is no longer realistic if the hospital wants to financially thrive.
  • Laying the Foundation

    Designing and executing a clinical resource management program is not easy.  It’s not so much that any one part of the program is difficult to design and implement.  Rather, it’s the combination of all the parts that becomes untenable.

     
  • What gets Measured gets managed!

    When we started this newsletter back in 1994, we reported the difficulties in obtaining information about payer denials.  Hospitals simply could not provide actionable information to identify the source of their denials...
  • The Business Case for Hospital Case Management

    When case management was introduced in hospitals in the mid 80s, it was accompanied by a promise to control costs at the bedside.
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  • Elmhurst Memorial Healthcare

Elmhurst Memorial Healthcare

All of us at Elmhurst Memorial Healthcare want to thank you and your associates for getting us back on the right track for our case management program. The time you spent with us was invaluable in helping us identify the inefficiencies and redundancies in our processes that made our existing program ineffective with respect to the goals we are trying to achieve.

We appreciated the thorough analysis and the candor with which it was conducted and delivered. We are hopeful that we can implement your suggestions in relatively short order and will look forward to a further engagement with your firm to ensure that are moving in the right direction.

Those of us who read your book, The Leaders Guide to Hospital Case Management found it to be a wonderful companion to the on-site help you and your colleagues provided. I believe this "bible" will be quite useful as we continue on our journey.

Sincerely,

Matthew J. Lambert III, M.D., MBA
Sr Vice President for Clinical Operations
Elmhurst Memorial Healthcare



REFLECTIONS

Welcome to the February issue of REFLECTIONS, the new name for our monthly e-newsletter. The lead article is about 'leveling the playing field' between the hospital and its medical staff with the Federal prepayment processes adopted by the MACs and the RAC demonstration project.  We also feature a research stufy on meds that are responsible for ED visits and emergency rehospitalizations which supports our contention that the clinical pharmacist must take an active role in preparing patients and families for transition from the hospital.  As always, we welcome your comments and thoughts. 

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