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.
President Obama used a July 4th recess appointment to install Institute for Healthcare Improvement President and CEO Donald Berwick, MD, as head of the Centers for Medicare and Medicaid Services. While recess appointments by presidents are not uncommon, they can be controversial—especially after healthcare reform has been debated publicly for the past year.
Berwick received hundreds of endorsements from medical, trade, labor, and consumer organizations. But he also has come under the scrutiny of numerous senators who had anticipated engaging him in discussion of over the finer details of healthcare reform.
In introducing Berwick to the press, Obama said it was “unfortunate that at a time when our nation is facing enormous challenges,” many in Congress have decided to delay critical nominations for political purposes. The recess appointment will allow Berwick to “get to work on behalf of the American people right away,” Obama added.
J. Fred Ralson, Jr, MD, president of the American College of Physicians, said in his statement that his group joined more than 700 stakeholders on the front lines of healthcare delivery—including business, consumers, insurers, and clinicians—to support Berwick’s nomination. “He is well respected in the healthcare community and [is] known for his desire to bring constructive change to healthcare delivery.”
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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!

The Leader's Guide to Hospital Case Management
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