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Validity : 21st Oct'21 to 31st Oct'21
Review of key stakeholders in physician and case manager collaboration:
3.High volume admitters
2.Critical strategies for working with both internal and external physician advisors
3.Auditing physician advisor activities
4.PA role and Utilization Review
1.Specialized hospitalist roles
2.Critical strategies for hospitalist and case management collaboration
1.Conditions of Participation: Utilization management and discharge planning
2.2 midnight rule
3.Inpatient only list
4.Alternative payment models, such as bundles payments
1.The avoidable day process and physicians
Physicians are key in case management departments that achieve optimal outcomes. Certainly, the key physician roles are the physician advisor and the hospitalist. This webinar will focus on these two roles specifically, as well as the roles of high volume admitters in general.
The role of the physician advisor in hospital case management is a varied role. Not every hospital has an internal physician advisor. If a hospital does not have an internal physician advisor, it usually has an external physician advisor. Rarely are physicians prepared to this role. Additionally, rarely are case managers or case management leaders prepared for implementing and/or collaborating with physicians in this role. The collaborative role of the physician advisor and those in the case management department is one of the lynchpins to assist the department and practicing physicians to positively impact hospital outcomes.
The past twenty years hospitalists have been integrating into acute care hospitals with the initial goal of decreasing length of stay. As the role of the hospitalist has evolved there has been an increased attention to collaboration with case managers and social workers to ensure not only a decreased length of stay, but compliance to federal and state regulations, as well as following contractual agreements with commercial payers
The success of any case management department is dependent on a robust and collaborative relationship between case management professionals and the physicians with whom we work. These key stakeholders include physician advisors, hospitalists, ED physicians and many others. A lack of a working and effective relationship with these individuals can mean a lower achievement of the department’s outcomes as well as the outcomes of your patients.
Your ability to engage with these physicians is necessary for a truly working interdisciplinary care team. Your skill set is this area is vital.
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department’s efficiency and effectiveness.
The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
Dr. Cesta has presented topics on case management at national and international conferences and workshops. Her books include “Nursing Case Management: From Essentials to Advanced Practice Applications”, “The Case Manager’s Survival Guide: Winning Strategies in the New Healthcare Environment”, “The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice”, “Survival Strategies for Nurses in Managed Care” and “Core Skills for Hospital Case Managers”.