Case management directors: how to manage in a transition-focused world: part 2.

Purpose And Objectives: Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.

Case management directors: how to manage in a transition-focused world: part 1.

Purpose And Objectives: Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.

A framework of pediatric hospital discharge care informed by legislation, research, and practice.

To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process.

Preventing readmissions through comprehensive discharge planning.

Unlabelled: Case managers, including nurses and social workers, provide essential services to hospitalized patients, including mandated discharge planning that has been shown to impact patient safety and patient outcomes. The heightened attention to readmission is evident in both reimbursement and accreditation initiatives. The Centers for Medicare & Medicaid Services, Office of Clinical Standards & Quality/Survey & Certification Group, is revising worksheets to be used by surveyors to review how hospitals are complying with the Medicare Conditions of Participation with a focus on discharge planning as it relates to patient safety.

Patient choice in the discharge planning process.

Purpose/objective: To describe steps in offering a patient a choice of post-acute care providers during the discharge planning process that reflects the case management principles and compliance to regulations related to patient's rights to choice.

Primary Practice Setting(s): Nurses and social workers, particularly those who work in case management or care coordination settings; staff nurses who do discharge planning in acute care settings; and liaison or intake coordinators from post-acute care providers such as skilled nursing facilities and home health agencies who are involved in offering choice to patients during the discharge process; payer-based case managers, particularly those in Medicare Advantage plans.

Findings/conclusion: Patient choice is a right, including during the discharge planning process.

Understanding the Medicare "Extended Care Benefit" a.k.a. the 3-midnight rule.

Purpose: The purpose of this article is to discuss the overall features of the "Extended Care Benefit," also known as the 3-midnight rule for post-acute skilled nursing facilities (SNF) coverage. The goal is to support case managers in the effort to gain a better understanding of how the benefit applies to the Medicare beneficiaries with whom they are working.

Objectives: (1) Give a brief history of the purpose of the "extended care benefit," (2) describe the circumstances under which a patient may be eligible for coverage of skilled nursing or rehabilitation services following a hospitalization, and (3) apply new knowledge to practice by incorporating case management tips into practice.

Case management: two regulations with coexisting functions (utilization review + discharge planning = case management).

Some hospitals have maintained a balance of the two mandated functions, utilization review and discharge planning, that directly affect the work of case management. Others have leaned more toward the fiscally based utilization review over the needs-based function of discharge planning. This article examines the trends within case management that has resulted in an imbalance of the functions of utilization review and discharge planning, and makes recommendations on how to rebalance these coexisting functions.

The social worker and nurse roles in case management: applying the Three Rs.

There are different skill sets that nurse case managers and social workers need in order to have a good patient outcome. The issue is that there is a void in the relationship between social workers and nurses, and this void is founded on factors that can, and must, be addressed. This gap can be minimized by conscious effort, by addressing the issue, and by a willingness to maximize the energy expended in professional relationships to improve patient outcomes.

Discharge planning: a collaboration between provider and payer case managers using Medicare's Conditions of Participation.

Discharge planning is a legally mandated function for hospitals and is one of the "basic" hospital roles as outlined in Medicare's Conditions of Participation. This article will define discharge planning; describe the steps in the discharge planning process; list rules and regulations that influence discharge planning in hospitals; and compare hospital-based actions with payer-based actions when planning discharges. Case managers who work for payers interact with hospital-based case managers to facilitate the discharge planning process for patients.