COST CONTAINMENT. Outcome Management Karen Niner RN BSN Manager Outcome Management department.
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Transcript of COST CONTAINMENT. Outcome Management Karen Niner RN BSN Manager Outcome Management department.
Cost Containment• Residents and MD’s• Pay attention to correct
inpatient orders• “Admit as Observation”• “Admit as Inpatient”• NO SOCIAL ADMISSIONS
ALLOWED!• “D/C if OK w/ PT/OT” only
works if going home—Not needed for ECF.
• Watch for Avoidable Delays.
• Write discharge orders 24hrs prior to planned D/C.
• Involve social work services early.
• Move to correct level of care when criteria changes.
• Business rounds helpful.• Need D/C orders early
Friday for W/E DC’s to precert before the W/E
Outcome ManagementConsists of Bachelor’s prepared
Registered Nurses called “Resource Utilization Coordinators” (RUC’s)
RUC’s role REVIEW CHARTS:
Appropriate Inpatient orders (OBV vs IA)
Appropriate use of resources
Monitor and report Avoidable Delays (AVD’s)
Report to SW/SWA any potential discharge needs
Monitor Readmissions
Collaborate with Licensed Social Workers and Social Work
Assistants:Screening and Assessments for D/C needs
Discharge PlanningCrisis Intervention
D/C Resource Experts
Dollars Lost by Category
$-
$20,000
$40,000
$60,000
$80,000
$100,000Ap
r-07
May-0
7Jun
-07 Jul-07
Aug-0
7Sep
-07Oc
t-07
Nov-0
7De
c-07
Jan-08
Feb-0
8Ma
r-08
Apr-0
8Ma
y-08
Jun-08 Jul-08
Aug-0
8Sep
-08Oc
t-08
Nov-0
8De
c-08
Jan-09
Feb-0
9Ma
r-09
MD Dollars Lost System Dollars Lost External Dollars Lost
OBV graphObservation Cases
FY 08
5159
5347 45
60 5775
40
5153
0
20
40
60
80
100
120
140
160
180
200
Nu
mb
er
of
Ca
se
s
Hospital Acquired Conditions
• Complete the History and Physicals
• Remember to document what is present on admission:– UTI– Skin breakdown– pneumonia– Etc.
Patient Communication
• Patient Satisfaction relies on good communication between you and:
• the patient & their families• the patient’s nurse• OTM• GOOD PATIENT CARE BEGINS WITH YOU!
ATTENTION TO ALL PHYSICIANS!!!!• ADMIT ORDERS & MEDICARE COMPLIANCE
• Admission Orders need to be specific for STATUS of INPATIENT or OBSERVATION
• Appropriate Status Order: “ADMIT AS INPATIENT”– “ADMIT AS OBSERVATION”
• Inappropriate Status Order:– “ADMIT TO floor________”– “ADMIT TO Dr. ____________”