1st Edition

The Case Management Workbook Defining the Role of Physicians, Nurses and Case Managers

    140 Pages 38 B/W Illustrations
    by Productivity Press

    138 Pages
    by Productivity Press

    This workbook reflects a number of important regulatory changes that have occurred in the past 13 years, as well as the new landscape of healthcare reform. It serves as an important resource for case managers, administrators, physicians and others who play a role in the case management process.

    Who Is Responsible for Case Management?
    What Is Uncompensated Care?
    Moving the Patient in a Timely Manner
    The Use of the Emergency Department
    The Essence of Effective Case Management
    Case Managers
    Case Management Is Truly Everyone’s Responsibility

    Financial Incentives

    Aligning Incentives: Current Payment Structure
    The Physician Payment
    Hospital Payments
    Post Acute Venue Payments
    Fraud and Abuse
    Recovery Audit Contractors Audits
    Future Payment Structure
    Bundling Physician and Hospital Payments
    Post Acute Care Bundling Plan
    Post Acute Care Bundling Proposal Details
    Industry Reaction

    The Watershed Years of the American Healthcare Delivery System
    The Watershed Years
    The Barrier Defined
    Healthcare Reform: 2010—A Major Watershed Year

    Key Obstacles in Reducing Length of Stay

    Cajoling Can No Longer Be the Primary Methodology for Dealing with Physicians
    The Largest Obstacle
    Cultural Change
    Social Issues
    A Preference for the Intensive Care Unit
    The Consulting Physician
    The Attending Physician in the Role of Quarterback
    How to Deal with a Difficult Physician
    Other Obstacles
    Obstacle: Physical Plant
    Obstacle: Monitoring Equipment
    Obstacle: We Wait and Wait for Approval
    Obstacle: Staffing Shortage
    Is the Postacute Venue Ready
    Slow Down, You’re Moving Too Fast

    Opportunities for Effective Use of Post Acute Venues

    Venue Management
    Centralized Case Management System

    The Post Acute Venues and Their Roles in the Continuum
    Introduction: The Post Acute Venues
    Long-Term Acute Care Hospital
    New Rules for 2010
    Good News for LTACHs
    Length of Stay
    Benefits and Conditions
    Physician Coverage
    LTACH Payment Structure
    Comprehensive Inpatient Rehabilitation Hospital/Unit
    New Coverage Criteria
    Three-Hour Rule
    Criteria for Admission
    60 Percent Rule (Previously the 75 Percent Rule)
    Physician Coverage
    Medical Directorship—20 Hours Per Week Rule
    Product Line Specialization
    Inpatient Rehabilitation—Payment Structure
    Skilled Nursing Facility/Unit
    Final Rules for 2010
    Admission Criteria
    Skilled Nursing Physician Care
    Skilled Nursing Payment Structure
    The difference between Comprehensive Inpatient
    Rehab and Skilled Nursing
    Outpatient Rehabilitation and Home Health
    Outpatient Rehabilitation
    Home Health

    Case Management at the Epicenter of an Integrated Health System
    The Epicenter of an Integrated Health System
    The Hybrid Model of Case Management
    Seamless Protocols
    Discharge Triggers
    Case Studies
    Appropriate Movement of the Patient

    Diagnosis-Related Group Review
    Major Diagnostic Category
    Diagnosis Related Groups
    With or Without MCC and CC
    Projecting the DRG
    The Sticky Note
    Assigning a Different DRG

    Meaningful Data

    Meaningful Data
    Efficacy of Data
    Electronic Medical Record


    Examination Questions

    Class Exercises

    Exercise 1: Develop a Venue Inventory Worksheet
    Exercise 2: Identify the Parameters of Case Management in Your Organization
    Exercise 3: Key Obstacles
    Exercise 4: Opportunities for Effective Use of Post Acute Venues of Care
    Exercise 5: Case Management in a Multivenue Setting

    Appendix A:

    Appendix B:
    Acronyms and Abbreviations



    Cherilyn G. Murer, JD, CRA , Founder, President, and Chief Executive Officer of the Murer Group, has long been an active voice in the advancement of quality, cost-effective healthcare. Ms. Murer received a juris doctor degree with honors from Northern Illinois University (NIU) and has coupled her background in law with her previous operational experience as the Director of Rehabilitation Medicine at Northwestern Memorial Hospital, Chicago, Illinois. Ms. Murer is a sought-after lecturer and educator whose focus is on assisting her clients navigate through the complex regulatory, strategic, and financial issues facing healthcare today.In May 2005, Ms. Murer received a gubernatorial appointment, with Senate confirmation, to a six-year term on the Northern Illinois University Board of Trustees. In 2007, Ms. Murer was elected Chairman of the Board of this state university with over 26,000 students. Ms. Murer and her husband, Michael, have provided a philanthropic gift to NIU to establish the Murer Initiative as a forum for scholarly discussion, policy analysis and cross-disciplinary integration of medicine, law, technology, and finance. In September 2007, Ms. Murer was selected by the university to present the first Annual Executive Speaker Series Presentation, Conversation with a CEO, co-sponsored by NIU College of Engineering and College of Business. In 2002, Ms. Murer was appointed to the Northern Illinois University Law School‘s prestigious Board of Visitors and was honored with its 2003 College of Law Distinguished Alumni Award. Ms. Murer holds an appointment to the faculty of the University of Illinois at Chicago College of Medicine as a Clinical Assistant Professor of Law in the Department of Family Medicine.Coinciding with the firm‘s 25th anniversary (February 2010), Ms. Murer was honored by both the University of Illinois at Chicago and Northern Illinois University. On February 25, 2010, she was inducted into the prestigiou