cost containment

COST CONTAINMENT

Outcome Management

• Karen Niner RN BSN

• Manager Outcome Management department

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

How Outcome Management can help

Outcome ManagementConsists of Bachelor’s prepared

Registered Nurses called “Resource Utilization Coordinators” (RUC’s)

Outcome Management

Licensed Social Workers and Social Work Assistants

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

Collaborate with Licensed Social Workers and Social Work

Assistants:Screening and Assessments for D/C needs

Discharge PlanningCrisis Intervention

D/C Resource Experts

Collaborate with many departments

Dollars Lost by Category

$-

$20,000

$40,000

$60,000

$80,000

$100,000Ap

r-07

May-0

7Jun

-07 Jul-07

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7Sep

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t-07

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7De

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8Ma

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8Ma

y-08

Jun-08 Jul-08

Aug-0

8Sep

-08Oc

t-08

Nov-0

8De

c-08

Jan-09

Feb-0

9Ma

r-09

MD Dollars Lost System Dollars Lost External Dollars Lost

OBV graphObservation Cases

FY 08

5159

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60 5775

40

5153

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Hospital Acquired Conditions

• Complete the History and Physicals

• Remember to document what is present on admission:– UTI– Skin breakdown– pneumonia– Etc.

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!

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. ____________”