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.
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.
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...
When case management was introduced in hospitals in the mid 80s, it was accompanied by a promise to control costs at the bedside.
The Leader's Guide to Hospital Case Management addresses the role of the hospital case manager from a business perspective, and speaks to the relationship the case manager has with the executive team, managed care contracting office, decision support specialists, medical records staff, medical staff, and clinical providers, and reveals the value of engaging all of them as allies in pursuit of global objectives on behalf of every patient.
This guide is co- authored by the partners at Phoenix Medical Management: Stefani Daniels and Marianne McHale Ramey.
Welcome to the May issue REFLECTIONS. This month we introduce our readers to the 'knowledge worker,' a term coined by management guru Peter Drucker almost 50 years ago. He presciently predicted that employees of the future will be be contributing information that materially affects the capacity of the organization to perform and to obtain results. He could have been speaking about the future hospital case manager. As always, we welcome your comments.
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"Thank you for a well organized, detailed, and comprehensive book. I appreciate that you took the time to put your knowledge and experience in writing."Deonna Villegas-McPetersCommunity Regional Medical CenterFresno, CA