Designing and executing a clinical resource management program is not easy. It’s not so much that any one part of the program is difficult to design and implement. Rather, it’s the combination of all the parts that becomes untenable.
When we started this newsletter back in 1994, we reported the difficulties in obtaining information about payer denials. Hospitals simply could not provide actionable information to identify the source of their denials...
When case management was introduced in hospitals in the mid 80s, it was accompanied by a promise to control costs at the bedside.
In the December issue of CRM UPDATE, we reported that elder law attorneys and advocates note what they call a "disturbing trend in the treatment of Medicare beneficiaries." They are referring to the increasing number of complaints from Medicare patients who report that their entire hospital stay was classified as observation and not as a hospital admission.
Phoenix has been writing about this issue for many years and continues to counsel our clients accordingly. Patients receiving observation services must be continuously informed about any implications, both clinical (none) and financial (substantial). Case management programs would do well to access the new patient-friendly brochure and use it as is or as a resource to develop one specific for your organization. Link to CMS
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The January issue of CRM UPDATE features an article on the importance of objectively demonstrating hospital case management value. Read it now!

The Leader's Guide to Hospital Case Management
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Deonna Villegas-McPetersCommunity Regional Medical CenterFresno, CA