Healthcare Business Week in Review: Care Coordination, Oncology Nurse Navigators, Readmissions, ACA

Friday, December 13th, 2013
This post was written by Cheryl Miller

Primary care outside the doctor’s office is getting its due. According to a final ruling from CMS, payment rates and policies for 2014 are focusing on improved care coordination, including a major proposal to support care management outside the routine office interaction.

The ruling also includes other policies to promote high quality care and efficiency in Medicare. CMS officials consider the care coordination policy a milestone, demonstrating Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015.

But there is a time and place for face-to-face visits: namely, between nurses and newly diagnosed cancer patients. According to a new study from the Group Health Research Institute, cancer patients who received support from a nurse navigator or advocate soon after being diagnosed had better experiences and fewer problems with their care, particularly in the areas of health information, care coordination and psychological and social care. Patients reported feeling that the healthcare team had gone out of its way to make them feel better emotionally. The extra help is especially welcome with new cancer patients, given that they and their caregivers need help translating medical jargon and navigating the healthcare maze, researchers say.

While the covering of catastrophic illnesses like cancer is one of the key issues behind healthcare reform, it is not enough to sell the nearly 30 percent of Americans opting out of coverage. According to the latest tracking poll from Gallup, one out of four uninsured Americans are planning on paying the government penalty rather than buy health insurance. The reason? Not what you think; details inside.

An automated prediction tool that identifies newly admitted patients at risk for readmission within 30 days of discharge has been successfully incorporated into the EHR of the University of Pennsylvania Health System.

The tool predicts at-risk patients as those who have been admitted to the hospital two or more times in the 12 months prior to admission. Once it identifies these high-risk patients, it creates a flag in their EHR, which appears next to the patient’s name in a column titled “readmission risk” once the patient is admitted.

We’d love to hear how your organization is working to reduce hospital readmissions by taking HIN’s fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. Respond by January 3, 2014 and receive an e-summary of the results once they are compiled.

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