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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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  • Temple University Hospital

Temple University Hospital

I had the pleasure to engage Stefani Daniels and Marianne Ramey from Phoenix Medical Management, Inc. to assist with the restructuring of our Case Management Department. Phoenix demonstrated their experience and political sensitivity by memorializing our strategic vision and creating an organized structure, revising job descriptions, identifying measurable outcomes, and putting together an excellent education program for the staff.

With their guidance, we separated the functions of utilization management, created a resource center to perform the tasks related to discharge placement, and redefined the role of the case manager to focus on the progression of care of the patient. Our program has been very successful, and our length of stay was averaging 6.0 days is now averaging 5.3.

I highly recommend Phoenix to provide their expertise and professional approach to evaluating your case management program and implementing significant change with positive outcomes.

Susan Coull, MBA
Director of Operations for the Chief Medical Officer
Temple University Hospital
Philadelphia, PA



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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