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  • 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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Quality Pays

  • 5-12-2010

 

The new Affordable Health Care for America (AAHCA, March 2010) reform legislation, will probably impact hospitals in three main areas according to a report published by PricewaterhouseCoopers. 

1.  Starting October 2012, hospitals will be financially penalized by Medicare if they demonstrate 'excessive' readmissions within a 30-day period when compared to the "expected' risk-adjusted levels of readmissions.  The readmissions are based on the measures for MI, CHF and pneumonia.

2.  Starting in 2013, hospitals will be paid according to a Medicare VBP program schedule of outcomes including hospital efficiency, patient satisfaction, and quality of care.

3.  Beginning in 2015, 1% of payments will be subtracted from hospitals with the highest rates of HACs.  This could result in a nationwide reduction of $1.5 billion in payments over the next 10 years.


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CRM Update

The August issue of CRM UPDATE features an article about the Transition Case Manager, a new and evolving role under the case management umbrella.  Also in this issue, more about program outcomes. Read it now!

CRM UPDATE!

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