One of the key outcomes organizations hope to realize as a result of having case managers involved as members of the care coordination team is cost savings. Case managers are the one member of the team that should have a global view of the process as well as a personal interaction with the patient and their family. Understanding the patient’s goals and educating and empowering them to engage in their care is key to decreasing complications such as readmissions, duplication and fragmentation.
Today, calculating those activities is key to case managers and other providers to demonstrate their value and the return on investment that they bring to the organization. In addition, the Centers For Medicare and Medicaid Services has set various rules over the past few years that require hospitals to comply and provide documentation to support treatment provided. No longer can the defense be that “the doctor ordered it” and have it paid for without question. If there is not documentation to support treatment against evidence based guidelines, it is very likely that that care will be denied.
Our next Case In Point Webinar,
RACs, MACs, MICs, QICs, ZPICs: Know What They Mean and Limit Your Financial Risk, will address the critical role case managers, utilization nurses, clinical documentation specialists and other peer reviewer professionals play in reducing audits and denials. If your organization is struggling to meet these regulations, join us on February 29, 2012, to hear from a team of professionals who can provide information that will assist you in convincing your senior management team and engage champions within your organization to transform your system to meet the new auditing requirements so that you can maximize care and reduce financial risk.
The broad implementation of electronic health records will assist organizations and providers with ensuring accurate documentation and the ability to communication information needed to provide evidence-based care and a way to improve efficiency throughout the continuum of care.
Last week, I listened to a podcast from Institute for Health Care Improvement where Dr. Don Berwick drove this point home. The webinar was titled
Social Imperative to Demonstrate That Better Care = Lower. This message was that there is an urgency to demonstrate better care that will result in lower costs by all members of the care coordination team. Case managers have a critical role in ensuring each patient receive safe, quality and cost effective care. Take time to listen to the discussion and share with your team.
Have a good week!
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