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Monday, October 14, 2013
  Clinical Accuracy Spoken Here  

Principles of CM: Seven Variables Affect Access

At least seven variables can affect access-to-care functions:

  • Size of the hospital
  • Resource availability
  • Commitment from the executive team
  • The case manager's unique professional identity
  • Colleagues
  • Knowledge and skills
  • Tools available
The heightened industry attention to Case Management's value in the care coordination process means greater expectations for quality practice.

[Reference: Principles of CM, Module B, Access Management and UM]
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  Excellence in Case Mgmt  

National Case Management Week: October 13-19, 2013

The US Senate unanimously declared October 13-19, 2013, as "National Case Management Week," in recognition of the value of case management in improving healthcare outcomes for patients and to honor case management professionals for their contributions.

"All Americans deserve access to quality, affordable health care. Case managers play a critical role in providing patients the information they need to make responsible health care decisions," said Senator Boozman (R-AR).

[Reference: Tom Rasmussen, CEO & Publisher, Athena Forum, LLC]
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  Improving Patient Care...  

Monitoring Utilization: Contracts vs Regulations

Contractual obligations can be changed. Finance collects data on denials and case management collects data on avoidable days. The collected data must support the rational for the requested change.

Regulatory requirements pertain to Medicare and Medicaid requirements that must be adhered to by all hospitals that are participating organizations. These requirements are located in the Conditions of Participation (CoP) included in CMS regulations. Systems must be in place to monitor the patient. CMS rarely tells hospitals how to do this.

[Reference: Principles of CM, Module B, Access Management and UM]
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Tom RasmussenTom Rasmussen
Publisher
Athena Forum
Tom.Rasmussen@AthenaForum.com

 
 

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Cathy WrightCathy Wright, BSN, RN
Clinical Editor
Athena Forum

Cathy.Wright@AthenaForum.com

 

 

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