Part Two: Beyond Basics of Case Management Five-Part Series (ODW5012PT)-Beyond Basics of Case Management Five-Part Series, Part Two Recording

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Video Summary

In a recent presentation on case management in healthcare, Dr. Sesta emphasized the importance of evaluating patient admission routes, particularly focusing on the emergency department (ED) and access points like the admitting office and transfer centers. She highlighted the need for hospitals to effectively manage these entry points to comply with the "two midnight rule," introduced by the Centers for Medicare & Medicaid Services (CMS). This rule requires that a patient is expected to need hospital care spanning at least two midnights to qualify for inpatient admission. Dr. Sesta outlined the historical changes that led to current case management practices and emphasized the necessity of aligning these with CMS guidelines. Key focal points include ensuring accurate levels of care upon admission, the crucial role of Emergency Department (ED) case management, and detailed physician documentation to adhere to the rule.<br /><br />Dr. Sesta also addressed the importance of ongoing monitoring of observation patients and reiterated that observation periods should generally not exceed 24 hours. The role of case managers includes expediting diagnostic tests and treatments while continuously reassessing patients to determine the need for possible transition to inpatient care. Moreover, the presentation discussed leveraging information systems for better tracking and communication among medical staff regarding patient care decisions.<br /><br />Additionally, Dr. Sesta touched upon exceptions to the two midnight rule, such as unforeseen improvements in a patient's condition and considerations around the Medicare inpatient-only list, which CMS is currently modifying. Overall, her discussion underscored the need for case management practices that facilitate patient flow, address challenges arising from ambiguous CMS rules, and improve both patient satisfaction and hospital reimbursement efficiencies.

Keywords

case management

healthcare

patient admission

emergency department

two midnight rule

CMS guidelines

inpatient admission

observation patients

diagnostic tests

information systems

patient flow

hospital reimbursement

physician documentation

Medicare inpatient-only list