COVID-19 may seem under control as thousands of  people have become vaccinated and boosted. Its variants, however, call for continued caution and safe habits. Additionally, for many individuals who did become infected with the virus, remaining symptoms are cause for concern. For these individuals, who have developed post-acute sequelae of COVID-19 (PASC) or in layman’s…

When a patient is discharged from the hospital, there is no more critical role than that of the medical case manager. This Registered Nurse, with extensive clinical experience and who often holds the designation of Certified Case Manager (CCM), has many responsibilities to fulfill. All of these duties are performed to help ensure the best…

On March 18, 2022, President Biden signed new legislation designed specifically to help address the increasing incidence of healthcare professionals’ mental health problems and related suicides. The Dr. Lorna Breen Health Care Provider Protection Act requires the Department of Health and Human Services (HHS) to “award grants to hospitals, medical professional associations, and other health…

Preventable readmissions remain a problem for many hospitals. There have been various measures implemented to help reduce preventable hospital readmissions. One, which was established in 2010 by the Patient Protection and Affordable Care Act (ACA), is the Medicare value-based purchasing program, the Hospital Readmissions Reduction  Program (HRRP). It was designed to encourage hospitals to improve their…

The Centers for Disease Control and Prevention estimates that each year, the United States spends $41.3 billion on hospital readmissions. Many of the readmitted patients enter through  Emergency Departments (ED). According to the CDC, there are approximately 139 million ED visits annually with up to 37% of those deemed non-urgent. Reducing preventable hospital readmissions and…

As the final phase of our rebranding initiative, the Amalgamated Family of Companies has updated the websites of its member companies. Upon visiting the new sites, you will see a fresh, new look that reflects more user-friendly navigation, functionality, and images.  You will see the increased use of icons, larger images, and larger font sizes….

For health care providers, as well as private and public employers, selecting the right case management firm when transitioning a patient from an inpatient setting to another level of care or determining when an employee can return to work is critical. While there are many organizations that provide case management services, not all have attained…

While there is no replacing the human component in effective healthcare utilization management, advanced technologies can deliver significant improvements. Artificial Intelligence (AI) used in combination with clinical evidence has been seen as one such technology.  Data-driven medication utilization management tools are another. AI in Utilization Management Leveraging AI, medical care managers and providers can process…

While care management is an integral component in patient care, there still remains a lack of real understanding as to its role and value. To help increase awareness, a comprehensive resource was developed, titled, Care Management – An Implementation Guide for Primary Care Physicians. The guide was produced with funding by the Agency for Healthcare…

Data from Statista, which specializes in market and consumer data, demonstrates that many hospitals are still experiencing high rates of readmission. Statista found that as of Fiscal Year 2022 (FY2022), 2,920 hospitals have been penalized by Medicare at least once for hospital readmissions that exceeded the 30-day risk-standardized readmission rates. Furthermore, 1,288 were penalized for…