Of all the industries in which technology plays an important role, healthcare is arguably one of the most crucial. In healthcare, technology can help solve staffing issues, improve efficiencies, enhance the relationship between medical professionals and patients and, ultimately, provide more effective healthcare solutions.
Here at Ensocare, we are excited to start another year of helping healthcare organizations advance their missions and work together to improve patient care. We’d like to start the new year off by looking back at our most appreciated blogs from 2019.
CMS is getting even more serious about keeping people out of the hospital, with each newly issued rule reflecting that commitment.
Starting at the beginning of this year, the Centers for Medicare and Medicaid Services sought to further incentivize providers by building in reimbursement for home health monitoring applications and the labor required to make these systems successfully operate. In a final rule issued last November, the CMS clarified their stance, highlighting the three CPT codes in question, along with their explanation and further information surrounding the decision-making process that led to the final ruling.... Keep reading.
Common wisdom suggests, when a person comes to the Emergency Room, they do so because they need emergency care. It’s up to nurses, physicians and available specialists and staff to provide the appropriate treatment as quickly as possible, with follow-up care tended to after the fact.
While this need to provide expedient care is certainly necessary when it comes to trauma and other serious medical emergencies, a large number of people who visit the ED may not need emergency care, and if a case manager can intervene to connect the patient with the more appropriate level of service and match their ensuing follow-up care to the actual level of acuity, patients and hospitals both benefit.
And that’s only the beginning. It turns out, a case manager can help the Emergency Department in three very specific ways.... Keep reading.
3. Targeting Populations Prioritized by Risk Factors: The First Attribute in a Modern Care Management Model
Though every healthcare leader likely has a care management or case management resource today, our current resources were not designed for managing populations under risk-based contracts. In fact, they were mostly created under a fee-for-service system and, as a result, addressed only specific needs of an individual care silo. Often missed is the totality of a given patient’s complex clinical and non-clinical care needs.... Keep reading.
The Centers for Medicare and Medicaid Services (CMS) released their long-awaited final rule for hospitals that fall under certain payment models in Fiscal Year 2020, and it’s a doozy.
Released at the beginning of August 2019, there’s a lot of information to sort through, and CMS has been kind enough to issue a summary and a Fact Sheet that looks at the high-level points. Still, even this information is somewhat unwieldy, particularly if all you want to know is: am I affected, how am I affected, and what do I need to know.... Keep reading.
5. Deploying a Model that Maximizes Staff Time and Patient Management: The Third Attribute in a Modern Care Management Model
Deploying your modern care management model successfully is contingent on two key areas:
1) Defining patient management priorities
2) Creating a process that maximizes care team members’ assignments and time.
Let’s take a closer look at how to support these two objectives.... Keep reading.
The majority of patients take for granted that they’ll be discharged either back home or to a post-acute facility capable of meeting their needs.
But perhaps no patients prove as great of a challenge as homeless patients who don’t have anywhere to go after their hospitalization or care episode ends. With this patient population, the bedrock of a person’s life that is used as a guidepost for appropriate discharge and care coordination isn’t available, which means adjustments must be made in the approach to meet specific needs.... Keep reading.
Typically, a healthcare organization’s rationale for stratifying the distinct segments of its patient population is closely associated with its modern care management model’s patient assignment decision-making.
But whatever the risk stratification option used to determine specific populations, the resulting patient segments enable the health enterprise or practice’s staff to tailor the provision of care to both the individual’s and population’s unique needs and challenges.... Keep reading.
8. Defining Care Team Roles According to Population Needs: The Second Attribute in a Modern Care Management Model
Does care management design mean more “boots on the ground” are needed immediately—or not?
Interestingly, many key transformation officers believe the answer to this question is a definitive “yes.” A few years ago, about 97 percent of health system leaders we surveyed were either already investing in or planning to invest in additional care management positions.... Keep reading.
Addressing Quality and Resource Use Data During Patient Discharge
On November 29, 2019, the Centers for Medicare and Medicaid Services will finalize a rule meant to ensure appropriate data is provided to patients and their families when they’re making their decision about a post-acute care (PAC) provider.
We expect numerous Ensocare customer hospitals to be impacted by the new rule. However, for the vast majority of organizations, we do not expect this to lead to a complete overhaul of current policy regarding patient steerage and post-acute care selection, especially if you’re a current Ensocare Choice customer. Remember, Ensocare Choice will enable you to:
- Provide relevant PAC data to patients
- Present and compare PAC facilities with the patient
- Document the patient’s choice of PAC provider
- Stay compliant with CMS’s Final Rule
Here are the top-level takeaways from the new rule that case managers, discharge specialists, and hospital policymakers need to know..... Keep reading.
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