Recently, the Centers for Medicare and Medicaid Services (CMS) released data which showed how it is cutting reimbursement rates for hospitals based on their performance relating to surgical site and bacterial infections and hospital readmissions. The goal of CMS is to raise the quality of patient care. Under the Hospital Readmissions Reduction Program parameters, hospitals…

An event 113 years ago would change the lives of factory workers forever. It was March 25, 1911 and the location was downtown Manhattan; specifically, the Triangle Shirtwaist factory located in Greenwich Village. It was there on that date that the deadliest industrial fire occurred in the history of New York City. In total, 146…

On March 25, 1911, a horrific factory fire claimed the lives of 146 workers at the Triangle Shirtwaist factory in New York City. Those lost included 123 women and girls as young as 14 years old, as well as 23 men.  They were earning between $7 and $12 for a 52-hour work week. The lives…

When used appropriately, telephonic case management can be extremely beneficial for patients. Numerous studies have documented its value in improving patient outcomes, decreasing preventable hospital readmissions, avoiding lengthy disability periods, and lowering healthcare costs. Knowing when early intervention for telephonic case management is warranted is the first step in achieving these goals. When Telephonic Case…

The U.S. healthcare utilization management industry is projected to reach $9.5 billion by 2028, but the industry will see some developments. (Source; Market Research.com, National Association of Insurance Commissioners). These include the heightened role of data, increased emphasis on patient engagement, and a greater focus on value-based care, which has long been a focus of…

Even before the pandemic, the nation’s hospitals, urgent care facilities, medical groups and physician practices were suffering from widespread shortages of healthcare professionals. The problem still exists particularly with nurses. Now industry innovators are offering a solution to this pervasive problem – remote clinicians performing a wide range of routine tasks. One such innovator is…

Today’s physicians continue to face many challenges including having less time to spend with patients. They report spending just 27% of their time with patients and 50% of their time entering data into electronic health records (Source: Annals of Internal Medicine). Also hindering their practices is the myriad of administrative burdens resulting from having to…

Historically, hospital case management has relied on two traditional models, the dyad (integrated) model and the triad (collaborative) model. In the dyad model, one case manager performs utilization management (UM) and discharge planning (DP). The triad model involves two case managers, one performing UM and another performing DP, as well as a social worker managing…

Specialty drugs and their high costs have been in the spotlights for the last several years.  And, while measures to address their escalating costs have been introduced, there still is much more that needs to be done. The Inflation Reduction Act is expected to change the healthcare landscape in the upcoming years; including changes relating…

The use of medical case management continues to grow in all settings. Offsite medical case management, in particular, is experiencing significant growth. According to data released by ReportLinker and reported by Yahoo Finance on August 1, 2023, the offsite medical case management market size is projected to grow from $4.97 billion in 2023 to $5.94…