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.
Over the past twelve months, Saint thomas Health Services engaged the consultant group of PHOENIX: The Hospital Case Management Company to mentor and guide our health system through enterprise-wide case management reorganization. As the sponsoring corporate executive, I have been exceptionally pleased with the professionalism, knowledge, content expertise and the genuine care and concern Stefani Daniels and partners demonstratd toward our leaders and professionals across the health system.
Elizabeth Lemons, Vice President, Clinical Effectiveness
Saint Thomas Health Services
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