CMSA Today - Issue 1, 2012 - (Page 10)

Information Technology Information Technology Takes on “Meaningful Use” for Case Managers BY LESLEE O’DAY, RN-BSN s health care reform takes shape, technology shines as a tool to remove barriers to providing high-quality, cost effective services to patients. Providers are beginning to determine which resources deserve consideration for upgrades and advances within a tough economy – they can hardly go wrong to add IT to the list. Hospital case management teams in particular are seeing great new IT solutions for discharge planners and utilization reviewers, which not only save time and energy but help contribute to the bottom line in terms of reimbursement. A as the programs allow for recording of days saved or lost for reasons logged by the discharge planner. These tools allow for review of physicians’ orders or other clinical situations, which may contribute to increased lengths of stay or misappropriation of resources. This information is available in a timely manner for quick identification and resolution within the facility. New technology available to the discharge planner allows for time to be spent in collaboration with patients/families and other partners on the health care team. TECHNOLOGY AND EFFICIENCY IN DISCHARGE PLANNING Discharge planners are the threads that hold the discharge plan together. Collaborating with providers, clinicians, patients and families, they are often the facilitator of the final destination for the patient — the buck stops with them. In previous years, precious time has been spent on the telephone or in front of the fax machine in order to get information from the hospital to other care providers and facilities. With the advent of the many electronic referral programs out there, information gets transferred digitally. The patient’s clinical picture arrives seamlessly, decreasing the review time and delays in care seen before as faxed sheets were lost in transfer. These programs provide an electronic information trail, easily accessible for a period of time if needed from both sender and receiver. In addition, length of stay tracking becomes easier CMSA TODAY TECHNOLOGY AND UTILIZATION REVIEW Appropriate use of resources might be the greatest hot button topic in health care at this time. Implementation of technology is a must for the utilization review nurse. As the Centers for Medicare and Medicaid (CMS) considers penalties for incorrect billing and excessive readmissions for Medicare patients in the coming months, hospitals look for ways to provide assurance of correct utilization of Medicare monies. At the same time, private insurance companies are expected to follow suit in terms of curbing excessive use of resources and are tightening their purse strings for reimbursement. Electronic programs used for referrals by discharge planners often began as a means to document criteria for inpatient, observation and outpatient stays. Hospitals will find that many of these programs offer direct links to criteria programs in order to compare symptoms and diagnostics which dictate the proper status of patients. High volume providers with a significant adult population will find that this is an efficient starting point for the correct placement of patients in their inpatient units, as well as means to impact throughput for emergency room patients. These programs allow for direct contact with insurance providers to track approval/ denial days, as well as provide a forum for contacting medical professionals who make the final determination of status, such as a medical director. Because the information is stored electronically, it remains available for a period of time for retrospective review as well. Barring the occasional power outage or temporary loss of function that accompanies computers and their programming, technology allows for instant access to information, the transfer of that information, and increased efficiency for both discharge planning and utilization nurses. MEANINGFUL USE OF TECHNOLOGY IN TRANSITIONS OF CARE Technology certainly has a place in the day-to-day environment of the 10 ISSUE 1 • 2012 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2012

Technology U se Transforming the System
President’s Letter
Case Managers and Telehealth – Avoiding Potential Liabilities
Information Technology Takes on “Meaningful Use” for Case Managers
Case Managers – The Biocomputers that Make the Biggest Difference
The Evolving Role of Care Coordination in an Acute Care Environment – An Introduction (Part 1 of 3)

CMSA Today - Issue 1, 2012