The Case Management Workbook Defining the Role of Physicians Nurses and Case Managers 1st Edition by Cherilyn G Murer ISBN 143982777X 978-1439827772

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Product details: 

ISBN 10:143982777X 

ISBN 13:978-1439827772

Author:Cherilyn G.Murer

This workbook reflects a number of important regulatory changes that have occurred in the past 13 years, as well as the new landscape of healthcare reform. It serves as an important resource for case managers, administrators, physicians and others who play a role in the case management process.

Table of contents: 

Who Is Responsible for Case Management?
Overview
What Is Uncompensated Care?
Moving the Patient in a Timely Manner
The Use of the Emergency Department
The Essence of Effective Case Management
Structure
Physician
Nursing
Case Managers
Administration
Everyone
Case Management Is Truly Everyone’s Responsibility

Financial Incentives
Aligning Incentives: Current Payment Structure
The Physician Payment
Hospital Payments
Post Acute Venue Payments
Fraud and Abuse
Recovery Audit Contractors Audits
Future Payment Structure
Bundling Physician and Hospital Payments
Post Acute Care Bundling Plan
Post Acute Care Bundling Proposal Details
Industry Reaction

The Watershed Years of the American Healthcare Delivery System
The Watershed Years
The Barrier Defined
Healthcare Reform: 2010—A Major Watershed Year

Key Obstacles in Reducing Length of Stay
Cajoling Can No Longer Be the Primary Methodology for Dealing with Physicians
The Largest Obstacle
Cultural Change
Social Issues
A Preference for the Intensive Care Unit
The Consulting Physician
The Attending Physician in the Role of Quarterback
How to Deal with a Difficult Physician
Other Obstacles
Obstacle: Physical Plant
Obstacle: Monitoring Equipment
Obstacle: We Wait and Wait for Approval
Obstacle: Staffing Shortage
Is the Postacute Venue Ready
Slow Down, You’re Moving Too Fast

Opportunities for Effective Use of Post Acute Venues
Venue Management
Centralized Case Management System

The Post Acute Venues and Their Roles in the Continuum
Introduction: The Post Acute Venues
Long-Term Acute Care Hospital
Overview
Regulatory
New Rules for 2010
Good News for LTACHs
Length of Stay
Benefits and Conditions
Physician Coverage
LTACH Payment Structure
Comprehensive Inpatient Rehabilitation Hospital/Unit
Overview
New Coverage Criteria
Three-Hour Rule
Criteria for Admission
60 Percent Rule (Previously the 75 Percent Rule)
Physician Coverage
Medical Directorship—20 Hours Per Week Rule
Product Line Specialization
Inpatient Rehabilitation—Payment Structure
Skilled Nursing Facility/Unit
Overview
Final Rules for 2010
Admission Criteria
Skilled Nursing Physician Care
Skilled Nursing Payment Structure
The difference between Comprehensive Inpatient
Rehab and Skilled Nursing
Outpatient Rehabilitation and Home Health
Outpatient Rehabilitation
Home Health
Hospice

Case Management at the Epicenter of an Integrated Health System
The Epicenter of an Integrated Health System
Models
The Hybrid Model of Case Management
Seamless Protocols
Discharge Triggers
Case Studies
Appropriate Movement of the Patient

Diagnosis-Related Group Review
Overview
Major Diagnostic Category
Diagnosis Related Groups
With or Without MCC and CC
Projecting the DRG
The Sticky Note
Assigning a Different DRG

Meaningful Data
Meaningful Data
Efficacy of Data
Electronic Medical Record
Benchmarks

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Tags: Cherilyn G Murer, Case, Management, Workbook