New Medicare Guideline's Affect On Case Management

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    As a case manager, I am both curious and excited as to what the future will hold for us in our specialty. With changes in how the government will reimburse hospitals for things such as readmissions, a greater amount of responsibility will be put on hospitalists and case managers to do their job effectively. Diagnosis' that are notorious for high readmission rates such as heart failure and pneumonia will start being monitored much more closely by Medicare. A sign of things to come is the fact that hospitals are now looking at having a minimum of an RN to become a case manager because of the fact that they want people with strong clinical backgrounds and critical thinking skills making important decisions. I know of a couple hospitals in Northern California who are requesting that its case managers be masters educated or have a Case Management certification.

    What are your guys' thoughts on how our profession as medical case managers will evolve in the coming years?
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    Quote from illsince83
    As a case manager, I am both curious and excited as to what the future will hold for us in our specialty. With changes in how the government will reimburse hospitals for things such as readmissions, a greater amount of responsibility will be put on hospitalists and case managers to do their job effectively. Diagnosis' that are notorious for high readmission rates such as heart failure and pneumonia will start being monitored much more closely by Medicare. A sign of things to come is the fact that hospitals are now looking at having a minimum of an RN to become a case manager because of the fact that they want people with strong clinical backgrounds and critical thinking skills making important decisions. I know of a couple hospitals in Northern California who are requesting that its case managers be masters educated or have a Case Management certification.

    What are your guys' thoughts on how our profession as medical case managers will evolve in the coming years?
    I don't think there is any doubt that there will be a continued and accelerating demand for case managers. This demand will curb the requirement for advanced degrees to some extent, but the increased responsibilities will motivate organizations to seek nurses with proven professionalism. I think the demand will be more from the ASO model rather than reactionary hiring in response to the readmission rule. The readmission penalty is not done on a case by case basis but as a total percentage of admissions. American Medical News reported that it would affect about 2200 hospitals and many of them are the smaller ones in rural or innercity community hospitals. Readmissions in these hospitals are driven more by independent physician practice than medical necessity.


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