1. COST CONTAINMENT

2. Outcome Management Karen Niner RN BSN Manager Outcome Management department

3. Cost Containment Residents and MD’s Pay attention to correct inpatient orders “Admit as Observation” “Admit as Inpatient” NO SOCIAL ADMISSIONS ALLOWED! “D/C if OK w/ PT/OT” only works if going home—Not needed for ECF. Watch for Avoidable Delays. Write discharge orders 24hrs prior to planned D/C. Involve social work services early. Move to correct level of care when criteria changes. Business rounds helpful. Need D/C orders early Friday for W/E DC’s to precert before the W/E

4. How Outcome Management can help

5. Outcome Management Consists of Bachelor’s prepared Registered Nurses called “Resource Utilization Coordinators” (RUC’s)

6. Outcome Management Licensed Social Workers and Social Work Assistants

7. RUC’s role REVIEW CHARTS: Appropriate Inpatient orders (OBV vs IA) Appropriate use of resources Monitor and report Avoidable Delays (AVD’s) Report to SW/SWA any potential discharge needs Monitor Readmissions

8. Collaborate with Licensed Social Workers and Social Work Assistants: Screening and Assessments for D/C needs Discharge Planning Crisis Intervention D/C Resource Experts

9. Collaborate with many departments CEA/medassist Appeals/denials/revenue cycle/coding CNO/PA/MD’sRadiology/surgery Staff nurses/financial counselors/precert/

11. OBV graph

12. Hospital Acquired Conditions Complete the History and Physicals Remember to document what is present on admission: – UTI – Skin breakdown – pneumonia – Etc.

13. Patient Communication Patient Satisfaction relies on good communication between you and: the patient & their families the patient’s nurse OTM GOOD PATIENT CARE BEGINS WITH YOU!

14. ATTENTION TO ALL PHYSICIANS!!!! ADMIT ORDERS & MEDICARE COMPLIANCE Admission Orders need to be specific for STATUS of INPATIENT or OBSERVATION Appropriate Status Order: “ADMIT AS INPATIENT” – “ADMIT AS OBSERVATION” Inappropriate Status Order: – “ADMIT TO floor________” – “ADMIT TO Dr. ____________”