While hospitals, healthcare professionals, and politicians are all desperately looking forward for a solution to improve the quality and financial aspects of healthcare in the United States, some health insurers and providers are looking back to the flat-fee reimbursement days of the 1980s and 90s. Blue Cross Blue Shield of Massachusetts, along with the state’s second-largest hospital network, Caritas Christi Health Care, believes...  Read More »

This week’s tip, an ask the expert, is provided by June Stark, RN, BSN, MEd. Q: What are some strategies to improve physician documentation of present-on-admission (POA) conditions? A: The strategic plan for capture of POA and accurate documentation can comprise one or more of the following interventions: Physician educational sessions to teach about POA diagnosis and documentation requirements. Physician query sheets left in the...  Read More »

In an effort to shift power to consumers in healthcare, both Google and Microsoft are seeking ways to combine online personal health records, vast Internet resources, and the power of search engines. Recent reports show that a venture in healthcare could pay off for the companies. A Harris poll published last month reported 52% of adults go to the Web for health information, up from 29% in 2001. After researching, 58% of those people discussed...  Read More »

CMS announced last week that the 2009 monthly premium for Medicare Part B will stay at $96.40, the same as it was in 2008. It’s the first year since 2000 there was no increase in the standard premium from the previous year. According to CMS, the standard Medicare Part B premium is set to cover one-fourth of the average cost of medical services incurred by beneficiaries over age 65. Even though medical expenses for the beneficiaries...  Read More »

St. Luke’s Episcopal Hospital in Houston had several problems in its ICU: LOS rates had risen, beds were being used inappropriately, bed availability was scarce, and multidisciplinary rounds were inconsistent. To turn things around, the unit took a collaborative approach to discharge planning.   Read More »

Today, hospitals are facing many challenges: Shrinking payer sources, increasing charity care, mounting bad debt, and the reduction of Medicare payments due to new initiatives—including recovery audit contractors and present on admission—give hospitals greater moti-vation to be on top of their game.   Read More »

When New Hanover Regional Medical Center (NHRMC) in Wilmington, NC, wanted to decrease LOS, increase Medicare compliance, and improve its bottom line, it needed a place to start. The case management department was the perfect spot. NHRMC implemented an initiative to make its case management department more efficient and effective. The changes resulted in a 0.28 difference in Medicare LOS, increased bed availability by 3,732 in 2007, and...  Read More »

If your case management program is like most, it focuses mainly on utilization review and discharge planning. Stefani Daniels, RN, MSNA, CMAC, ACM, says many case managers are getting bogged down by these duties and losing focus of what case management is really about: patient advocacy.   Read More »

As emergency departments are filled to capacity with patients who have no insurance or can’t afford care, fewer patients are visiting the hospital who do have the ability to pay. Because of the worsening economy, patients are opting to postpone non-emergency surgeries such as knee replacement or weight-loss surgery, according to The New York Times. These types of surgeries are normally the most lucrative for hospitals, but patients...  Read More »

The United States has difficulty penalizing or closing unsafe hospitals because it lacks a single federal agency in charge of overseeing them, says The New York Times. The Joint Commission sets basic safety standards, but has only 1,000 employees while it accredits more than 17,000 hospitals, nursing homes, and assisted-living facilities. Additionally, CMS’ new initiative to stop reimbursement for preventable errors, The Times argues,...  Read More »