Hospital Case Management
ACMA Leadership Webinar Series

Maximizing Patient Throughput Along the Continuum (Sponsored by The Advisory Board)

Wednesday, November 04, 2009
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Terri Yancey, RN, MSN
Senior Director · H*Works
The Advisory Board Company · Washington D.C.

ABSTRACT:
Capacity management is a complex issue that continues to challenge hospitals today. Almost all healthcare professionals are familiar with the symptoms, such as extended Emergency Department (ED) wait times, days on diversion, and increased pressure to manage patients with extended lengths of stay. Case management is at the epicenter of hospitals’ need to serve increasing volumes of patients with a limited supply of beds and resources.

This session will expand the notion of patient throughput from simply discharge planning strategies to a concept of movement along the hospital continuum. We will discuss strategies that not only improve the discharge planning processes but also develop efficiencies on the front end by improving the flow of patients in the ED, speeding bed placement for those requiring hospitalization, and maximizing existing resources in the facility. This session will share some of the strategies felt to be most effective in maximizing throughput along the hospital continuum, including:

  • Starting at the Front Door: Speeding Time to the Physician in the ED
  • Enhancing Access: Ensuring Appropriate and Timely Bed Placement
  • Optimizing Inpatient Capacity: Pulling Discharges Forward
  • Expediting Throughput for Complex Patients: Targeting Difficult Discharges

LEARNING OBJECTIVES:

  1. Identify the Five Phenomena shaping the face of healthcare today
  2. Discuss the limitations of improved discharge planning to impact patient throughput
  3. Identify and describe four effective strategies to enhance patient throughput

RAC 101: What You Need To Know To Ensure Your Organization Is RAC, MAC and MIP Ready (Sponsored by Executive Health Resources)

Tuesday, November 10, 2009
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Robert Corrato, MD, MBA
President and CEO
Executive Health Resources (EHR) · Newtown Square, PA

Joseph Zebrowitz, MD
Executive Vice President
Executive Health Resources (EHR) · Newtown Square, PA

ABSTRACT:
The RAC program – and the evolution of an auditing culture for governmental payers – has forced several paradigm shifts for hospitals and healthcare providers.

For example, during the RAC demonstration medical necessity proved to be one of the largest causes of overpayment determinations; inpatient hospitals saw medically unnecessary services or settings as the reason for 62% of identified overpayments. The paradigm that has existed – that the billing status of a procedure is established by the procedure itself – is no longer valid. Many procedures today can be done as either inpatient or outpatient, and consideration must be given to procedure-based risk factors, severity of illness and patient risk factors.

How can your hospital prepare to address this severe threat to hospital compliance and revenue integrity? What strategies are effective in appealing those denials that are worthy of appeal, and aggressive in preventing future denials by implementing a daily process to ensure compliance?

This session will provide case management leaders and hospital executives the insight they need on how to build and optimize an internal compliance program that leverages case management and physician advisement. This presentation will address what you need to know to ensure your facility is RAC ready, limit future risk exposure, and help to maintain revenue integrity. The discussion will also address the financial and compliance implications associated with misclassification, and provide expert counsel and first-hand experience on the areas most likely to expose a facility to risk with regard to accurate, consistent patient status classification.

ADDED VALUE – Attendees will have their questions answered. Attendees may submit a question during the registration process or during the webinar. The speakers will provide answers to all submitted questions and ACMA will assemble these into a RAC Session FAQ that will be distributed to all attendees after the webinar.

LEARNING OBJECTIVES:

  1. Analyze the evolving Medicare perspective on cost savings, accountability, and value
  2. Evaluate your facility’s current risks related to Medicare medical necessity compliance and revenue integrity
  3. Develop strategies necessary to mitigate exposures and implement proactive measures to payment retraction
  4. Analyze the operational requirements for a multidisciplinary, coordinated RAC denial appeal program and the critical role of the physician advisor
  5. Design a proactive Medicare admissions certification program that meets CMS regulations
  6. Recognize the importance of your medical staff’s participation in this process and how to obtain physician buy-in and participation

RAC 201: Managing the First Year of RAC Audits at Your Organization (Sponsored by Executive Health Resources)

Wednesday, December 02, 2009
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Robert Corrato, MD, MBA
President and CEO
Executive Health Resources (EHR) · Newtown Square, PA

Joseph Zebrowitz, MD
Executive Vice President
Executive Health Resources (EHR) · Newtown Square, PA

ABSTRACT:
Because of the phased national roll-out of the RAC program, organizations find themselves in various situations concerning this major change to operations and reimbursement. This session is designed to take participants to the step after solid preparation – what happens in the first year after audits begin. More specifically, what do you need to do to manage this process effectively and make adjustments as needed during this period?

This session will focus on four key elements that the RAC leader will have to manage during the first year after implementation:

  1. Key Decisions – What are the decisions that will have to be made during the first 12 months of RAC at your organization? This session will highlight some of the major decisions most organizations are likely to face, and discuss the factors that need to be considered.
  2. How to monitor – How do you keep your RAC management program effective? The session will highlight how to build a RAC Rapid Response Team, key metrics, where to find information, and how to interpret performance and take action if needed. Effectively tracking these metrics also helps validate case management’s effectiveness and justify additional resources when needed.
  3. Trends – From EHR's work helping many organizations manage RAC, what trends have become apparent? The session will give you the benefit of this experience by discussing trends such as rates and cycles of audits and record requests (and corresponding resources needed), diagnoses that gain the most RAC attention, responses to appeals, etc.

ADDED VALUE – Attendees will have their questions answered. Attendees may submit a question during the registration process or during the webinar. The speakers will provide answers to all submitted questions and ACMA will assemble these into a RAC Session FAQ that will be distributed to all attendees after the webinar.

LEARNING OBJECTIVES:

  1. Identify the major decisions a hospital will typically face related to managing RAC audits during the first year
  2. Describe the factors that influence these major decisions
  3. Identify trends gleaned from RAC implementations at other organizations around the country, and discover how these may impact your organization
  4. Explain how to gather, track and use data to ensure a RAC management program remains effective, and that case management efforts are validated
  5. Discuss RAC management solutions, how to assess them for your needs, and how they may benefit your organization

The Ties That Bind: Patient’s Decision Making With/In Their Families

Wednesday, December 09, 2009
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Anne Lederman Flamm, JD
Associate Staff · Department of Bioethics
Cleveland Clinic · Cleveland, OH

ABSTRACT:
Staff Training Session
Beginning with a case study, this session will examine ethical tensions arising when a severely ill patient defers decision-making to adult family members, who opt against medical recommendations. The discussion will focus on health care professionals' experience and ethical obligations under these circumstances. The typical emphasis in modern health care is on individual autonomy and independent decision-making. Does this emphasis, however, offer the best guidance in such situations? We will explore this question, and the potential value of recognizing a form of autonomy that incorporates a patients' interdependence with others.

NOTE - This session provides 1.5 Ethics Continuing Education Hours.

LEARNING OBJECTIVES:

  1. Describe health care professionals' ethical obligations to patients who defer decision-making to others
  2. Examine the ethical fitness of individual versus relational autonomy under such circumstances
  3. Identify practical strategies for health care professionals to consider when confronting similar situations

Leadership and Change - Future Changes in Healthcare and the Role of Case Management

Wednesday, January 20, 2010
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Moderator: Jan DeRoche, RN, LCSW-C, ACM
President , ACMA · Director, Case Management
Kaiser Foundation Health Plan of MidAtlantic States, Inc. · Rockville, MD

Panelist: Paul Arias, RN, BSN, MIS
Senior Director · Case Management
Inova Fairfax Hospital · Falls Church, VA

Panelist: Barb DeSilva, RN, MSN, MHA, CCM
Assistant Vice President · Clinical Care Management
Carolinas Medical Center · Charlotte, NC

Panelist: Brad Zebrack, PhD, MSW, MPH
Associate Professor · School of Social Work
University of Michigan · Ann Arbor, MI

ABSTRACT:
“Management is about coping with complexity….Leadership, by contrast, is about coping with change,” - Leadership author and Harvard Business School Professor John P. Kotter.

Healthcare is changing quickly, and case management is increasingly taking the role of catalyzing and leading change in provider organizations. To be effective in this role, case management must not only remain informed of the likely direction of future changes, but must also envision the impacts on both patients and the healthcare system.

This session will convene a panel of case management leaders to discuss the direction of healthcare change, how case management will be impacted, and how case managers may play a proactive –rather than reactive – role. The session will utilize data – gathered during the 2009 National Hospital Case Management Survey – on case management leaders’ thoughts regarding the future of healthcare, medicine, how care is delivered to patients, and how case management will change over the next decade.

LEARNING OBJECTIVES:

  1. Identify the three changes over the next decade most frequently predicted by case management leaders
  2. Discuss key ways in which future changes are likely to impact the practice of hospital case management
  3. Develop strategies to position case management at your organization to effectively manage future changes

Optimizing Benchmarking in Case Management – How to Develop and Use Benchmarks

Wednesday, February 03, 2010
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Linda Sallee, RN, MS, CMAC
Vice President · Case Management and Infection Control
Inova Health System · Falls Church, VA

ABSTRACT:
Benchmarking is a way of life in healthcare –almost as prevalent to hospital and case management leadership as speed limits are to driving. Benchmarks are often used to compare performance to a national standard, or are internally developed to facilitate ongoing process improvement or performance measurement. In either scenario, several factors contribute to whether benchmarks are effective. This session will discuss some of these critical factors, including how to select useful information from the often vast amount of available data, which benchmarks are most useful, evaluating and ensuring comparative validity, evaluating improvement opportunities, and how to make benchmarks understandable – and valuable – to others in the hospital outside of case management. The session will also discuss the effective use benchmarks from a leadership perspective – both as performance indicators for ongoing monitoring, and as tools to demonstrate the value that case management brings to the care delivery system.

LEARNING OBJECTIVES:

  1. Explain the process for selecting benchmarks and data points to compare, and identify some of the most effectively benchmarked metrics
  2. Discuss how comparative information can be presented to other leaders in an understandable way
  3. Describe how benchmarking information may be used to demonstrate case management’s effectiveness and value

Case Review: Teaching Assessment to Resolution

Wednesday, February 17, 2010
1:00:00 PM - 2:30:00 PM

(Start time shown is EST)

Facilitator: J. Suzanne Wilson, RN, MBA
Director · Resource Management
AnMed Health · Anderson, SC

Panelist: Beth Anderson, BSN, RN, MBA, ACM
Outcomes Manager · Care Management
West Virginia University Hospitals · Morgantown, WV

Panelist: Steven J. Meyerson, MD
Medical Director · Care Management
Baptist Hospital of Miami · Miami, FL

Panelist: Sharon L. Navazio, MSW
Complex Case Worker
Morton Plant Hospital · Clearwater, FL

Panelist: Alison Sakaguchi, BSN
Outcomes Manager · Care Management
West Virginia University Hospitals · Morgantown, WV

ABSTRACT:
Staff Training
Complex cases present ongoing, unique challenges to the skill set of case management staff members. Managing complex cases effectively often involves a high level of clinical competence and the ability to engage available resources and creatively overcome barriers to discharge. This interactive webinar is designed to enhance the case management skills necessary to manage complex cases.

The faculty for this webinar will include an expert panel of a nurse case manager, a social work case manager, and a physician. Participants will receive cases prior to the webinar, and the case management team from each organization may submit their proposed solution. The panel will review the solutions, and will discuss the cases during the webinar. Each case management team can compare their methodology and findings to those of the expert panel. The discussion will focus on key elements such as comprehensive evaluation, proactively recognizing potential barriers, and innovative approaches.

Compare your team’s solution to the experts, discuss various solutions, and ultimately enhance the skills to manage complex cases.

LEARNING OBJECTIVES:

  1. Develop a solution to each complex case scenario
  2. Identify critical evaluation elements for complex cases
  3. Describe innovative solutions for each complex case scenario discussed

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