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Published byNathan McDaniel Modified over 9 years ago
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COST CONTAINMENT
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Outcome Management Karen Niner RN BSN Manager Outcome Management department
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Cost Containment Residents and MD’s Pay attention to correct inpatient orders “Admit as Observation” “Admit as Inpatient” NO SOCIAL ADMISSIONS ALLOWED! “D/C if OK w/ PT/OT” only works if going home—Not needed for ECF. Watch for Avoidable Delays. Write discharge orders 24hrs prior to planned D/C. Involve social work services early. Move to correct level of care when criteria changes. Business rounds helpful. Need D/C orders early Friday for W/E DC’s to precert before the W/E
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How Outcome Management can help
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Outcome Management Consists of Bachelor’s prepared Registered Nurses called “Resource Utilization Coordinators” (RUC’s)
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Outcome Management Licensed Social Workers and Social Work Assistants
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RUC’s role REVIEW CHARTS: Appropriate Inpatient orders (OBV vs IA) Appropriate use of resources Monitor and report Avoidable Delays (AVD’s) Report to SW/SWA any potential discharge needs Monitor Readmissions
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Collaborate with Licensed Social Workers and Social Work Assistants: Screening and Assessments for D/C needs Discharge Planning Crisis Intervention D/C Resource Experts
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Collaborate with many departments CEA/medassist Appeals/denials/revenue cycle/coding CNO/PA/MD’sRadiology/surgery Staff nurses/financial counselors/precert/
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OBV graph
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Hospital Acquired Conditions Complete the History and Physicals Remember to document what is present on admission: – UTI – Skin breakdown – pneumonia – Etc.
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Patient Communication Patient Satisfaction relies on good communication between you and: the patient & their families the patient’s nurse OTM GOOD PATIENT CARE BEGINS WITH YOU!
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ATTENTION TO ALL PHYSICIANS!!!! ADMIT ORDERS & MEDICARE COMPLIANCE Admission Orders need to be specific for STATUS of INPATIENT or OBSERVATION Appropriate Status Order: “ADMIT AS INPATIENT” – “ADMIT AS OBSERVATION” Inappropriate Status Order: – “ADMIT TO floor________” – “ADMIT TO Dr. ____________”
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