Key to Financial Responsiveness: Care Management

 

The Current Environment

 

Care Management is practiced by hospitals to coordinate care for patients to ensure health needs are met, proper usage of available resources and to promote high quality and cost effective outcomes. It is also the necessary front end of the Revenue Cycle that assures the financial health of the hospital, as well as the proper care plan for the patient.

 

Kohler HealthCare Consulting understands both the difficulties faced by Care Managers, as well as the financial impact—improvements needed throughout the entire process to ensure this dual success. Care Managers are instrumental in the coordination of care and resources, and are crucial in identifying areas of concern and thus precipitate change from the determination of care needed to the final disposition of the patient’s care. Success in these tasks requires a functional and focused approached with the right people and the right support.

 

We evaluate and implement—then monitor to assure lasting results.

 

Our Approach to Improvements

 

KHC is here to support the goals of Care Management, and the financial performance of the hospital, by facilitating the delivery of quality and appropriate care in a cost-effective manner while seeking to promote positive heath care outcomes. KHC will help you support these overall goals by:

• Reviewing and evaluating your current Care Management model, its effects on the organization, or the effects on patient outcomes, and compare the model to best practices.
• Assessing current practices, actual documentation, and decision making in the use of Observation status and identify steps for improvement.
• Evaluating methodology used in determining Observation hours to be billed.
• Reviewing patient flow and UM criteria/decision making and related documentation for all types of admissions.
• Evaluating data maintained and determine if data collection is sufficient to measure the effectiveness of the Care Management Program.
• Working with UM/CM staff and the physician advisor to evaluate issues faced and best practices to accomplish goals.
• Reviewing UM data that is collected by your facility – evaluate trends and recommend Care Management interventions to improve results.

 

KOHLER HealthCare Consulting, Inc. (KHC) has been a leader in improving hospital operations and regulations, and reimbursement for over 30 years.

 

Endeavoring to provide our clients the best of breed Kohler HealthCare Consulting has focused on clinical and operational improvement in these areas.

 

Care Management has been called Case Management and this is often true when Utilization Review is a separate department. Whether this is a good model is heavily dependent on factors found within the hospital. Although coordination and collaboration are foundational requirements for the two departments, we generally find that the best approach for both the hospital and the patient is the coordination found in a combined model.

 

We recognize the need to bring knowledge and understanding of how these tenets of Care Management need to be utilized by experienced care nurses as they provide the necessary reviews and interventions in the care plan of the patients. KHC stands beside them and guides them.

 

Our consultants are experienced in nursing, clinical, compliance, coding, billing, finance and regulatory issues. KHC has well-seasoned Care Managers. We find those who understand the conflicts existing within departments can best provide the solutions and tools to remedy the situation.

 

 

Contact us to help

put the pieces together

(410) 461 − 5116