Put an End to Missed Opportunities.

The ongoing transformation of America's health care system is bringing disruption in every sector of our industry. Hospital case management programs are similarly undergoing dramatic changes as care coordination for our most vulnerable patients becomes the focus of many hospital case management programs. As a result, case management leaders and human resource directors are disrupting legacy assumptions and expanding eligibility for the role of the hospital case manager.

Changes in hospital case management through the years.

"Going Forward: What Is Case Management?," a recent HeartBeat of Case Management column in this journal, set off a wave of positive comments to the author. Hospital case management has been at the forefront of many of the changes in the past several decades. Even today, these changes should be reevaluated to enhance what is best for the patient, the business of health care, quality, and evidence-based care.

Hospital case management and progression of care.

Progression of care refers to a three-pronged approach to managing the complexities of the fragmented care delivery that is commonplace in U.S. healthcare systems. Under this approach: Case managers-freed from the need to perform routine chart reviews-work with the physicians to manage progression of care Utilization review/clinical documentation specialists ensure complete and accurate documentation to support acute level of care Coordinators are dedicated exclusively to finding and arranging post-acute services

Introducing HCM v3.0: a standard model for hospital case management practice.

PURPOSE/OBJECTIVES: Like the professional definitions of case management, the practice of hospital management is a dynamic process. However, because hospital case management programs come in so many shapes and sizes, there is a widespread tendency to forego the process and instead focus on the static tasks associated with utilization review and discharge plan arrangements. As a result, the research identifying best practices is inhibited and hospital case management practice is constrained. This article speaks to the need for a standard approach to hospital case management and offers a model that positions the hospital case manager as the primary patient advocate and physician partner that are among the essential ingredients for successful participation in accountable care organizations, progression-of-care management, and transitions of care support. PRIMARY PRACTICE SETTING: Acute care hospitals, integrated delivery systems. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: 1. Hospital case managers must practice in accordance with the professional process of case management. 2. Hospital case management programs must be structured in such a way as to support the professional process of case management. 3. The roles and responsibilities of hospital case managers must be unmistakably defined to make certain that proactive advocacy is visible as the essential ethical obligation.

Faster than a speeding bullet: changes in medicare rules for the hospital case manager.

PURPOSE/OBJECTIVES: Compliance with the various Centers for Medicare & Medicaid Services rules and regulations is rapidly becoming a challenge in hospitals as the frequency and complexity of the new mandates have increased. Although compliance officers may oversee major elements emanating from the regulatory agencies, practical application during routine work activities requires current information and peer-to-peer reinforcement. This article addresses some of the more recent changes-or proposed changes-that may impact hospital case management practice and the case managers' role as patient advocate. PRIMARY PRACTICE SETTING(S): The settings include acute care hospitals, short-stay hospitals, long-term acute care hospitals, and critical access hospitals. FINDINGS/CONCLUSIONS: The more information hospital case managers have about the regulatory changes that affect the hospital, its patients, physicians, and associates, the better they can serve as sources of information, resources, and advocates. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Direct interactions between the case manager and the physician are the best opportunities to share information. Influencing medical documentation at the point of service will be dependent upon the case managers' ability to link documentation improvements with benefits for the physician. Hospital-Issued Notice of Noncoverage letters are tools that warrant the case managers' attention to protect the patient and the hospital against financial risk.

Hospitalists and case managers: the perfect partnership.

Part of every hospital case manager's strategic advocacy is the promotion of a consistent partnership with the patient's primary clinical player. The presence of hospitalists, a new and growing specialty, offers the case manager an opportunity to advance that partnership. Instead of having to wait for a doctor whose practice is outside the hospital to review a test result or order a procedure, hospitalists can do the same thing faster--leading to greater efficiency, better care, and shorter stays for patients. Unlike private attendings who visit their hospitalized patients once a day for a few minutes, hospitalists spend all their time at the hospital. It's a perfect arrangement for a dynamic point-of-care partnership.