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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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  • Hospitals Are Dangerous Places

Hospitals Are Dangerous Places

  • 11-16-2010

According to the audit released today by the Department of Health and Human Services' Office of Inspector General,  one in seven Medicare beneficiaries suffers an adverse event during a hospital stay, and those events, nearly half of them preventable, contributed to at least 15,000 deaths in a single month. 

Physician reviewers for OIG determined that 44% of adverse events were preventable, most commonly because of medical errors, substandard care, and inadequate patient monitoring. Additional hospital care necessitated by these events consumed an estimated 3.5% of Medicare's inpatient expenditures for the sample month—about $4.4 billion in Medicare costs annually. Two-thirds of these costs were the result of additional hospital stays, the study found. 

The adverse events included the National Quality Forum Serious Reportable Events; Medicare hospital-acquired conditions; and events resulting in prolonged hospital stays, permanent harm, life-sustaining intervention, or death.


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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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