By PETER MISKA, RT
The healthcare industry has witnessed a substantial transformation with the introduction of value-based payment models, aiming to enhance care quality while controlling costs. Among these, the Patient-Driven Groupings Model (PDGM) stands out as a significant development in home healthcare reimbursement under the Medicare program.
BY PAUL BORJA, RN, MBA, DNP, EdD, PhD, PHN, CCM, ACM-RN, CMAC, CMCN, CNML, CMGT-BC, CDONA, FACDONA, FAACM, AND TERESA CAPINA, RN, MSN
Ever wondered if you or your loved ones qualify for skilled nursing facility (SNF) for rehabilitation or skilled nursing services? This article summarizes the requirements and important considerations.
BY PATRICIA RESNIK, MJ, MBA, FACHE, RRT, CPHQ, CHC, CHPC
Quality, case management (CM) and utilization management (UM) are key to the financial success of a healthcare organization and play a vital role in the revenue cycle. This article focuses on important connections between quality, CM and UM, and the potential impact on organizational financial outcomes.
BY LAWANNA GADDY, MSN, RN
Quality improvement and accreditation are crucial in the healthcare continuum within a rapidly changing industry landscape. Care management programs and care managers ensure that healthcare delivery is not only effective but also maintains the desired levels of quality every time. This article delves into the essential role of care management in the quality improvement and accreditation journey.
BY VIVIAN GREENWAY, PhD, MSA, BSN, RN, PAHM, CCM, & SAJINI PAUL, MSN, RN
When defining quality management, one can think of it as overseeing all activities and tasks that must be done to support a desired level of excellence. This includes the determination of quality policies, creating and implementing quality planning and assurance, in addition to quality control and quality improvement.
BY GARRY CARNEAL, JD, MA, AND MELANIE PRINCE, EdD, MSN, BSN, RN, NE-BC, CCM, FCM, FAAN
During the rise of payer-sponsored case management programs in the 1990s, the Case Management Society of America (CMSA) and URAC (Utilization Review Accreditation Commission) began working together to help standardize key workflows associated with case management programs.
By Dr. Colleen Morley-Grabowski, DNP, RN, CCM, CMAC, CMCN, CMGT BC, ACM-RN, IQCI, FCM, FAACM
As I transition from my role as president of the Case Management Society of America (CMSA) to becoming the immediate past president and chair of the CMSA Editorial Board, I am filled with a deep sense of pride and gratitude for the incredible journey we have shared.
As we begin National Case Management Week (October 13-19, 2024), it’s time to honor and celebrate the heroes of healthcare—our dedicated case managers. This annual celebration has grown into a powerful movement that shines a spotlight on the vital role case managers play in delivering patient-centered care and improving health outcomes.
BY GLENN P. ALLEN, MSOD
I’ve spent nearly 40 years in learning and organization development. The past five years of my career have been spent working in healthcare.
BY MICHAEL NORDÉ, LICSW
When receiving care from your provider, how important is informed consent? What if you learned that, statistically, people in your group, be it race, ethnicity, gender, gender identity or religion were not being offered informed consent? How would you feel? Most importantly, what would you do?