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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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  • CHF admissions declines

CHF admissions declines

  • 11-2-2011

In the October 2012 issue of JAMA, was reported that being hospitalized for CHF was about 30% less likely in 2008 than in 1998.  The study, conducted by Yale researchers, examined 55,097 FFS Medicare beneficiaries discharged with a principle diagnosis of CHF, also found that risk adjusted 1 year mortality decreased by 6.6% with substantial variation by state.  The significant variation by state in CHF hospitalizations and 1 year mortality rates "represent marked differences in outcomes that are not explained by insurance status," says Dr Jersey Chen, lead author.(http://jama.ama-assn.org/content/306/15/1669.abstract)      


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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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