ACMA Case Management Certifican study help

ACMA Case Management Certifican study help When does care coordination begin and end Prior to admission for elective procedure - 30-90 days after discharge. Pay for performance models have a greater emphasis on Value based purchasing, readmission, Hospital acquired conditions What factors effect value based purchasing? quality of care,, reduce adverse events/safety, improving patient experience, efficiency/delivering low cost care. What does the Acronym LACE stand for in the Lace Assesment tool.. LENGTH of Stay, ACUITY of Admission, COMORBIDITY, EMERGENCY Deoartment Visits. What are the 8 ps in The Society for Hospital Medicines Project Boost Risk Assesment - Readmission Assement Problems with Medications, Psychological, Principal Diagnosis, Physical Limitations, Poor Health Literacy, Patient Support, Prior Hospitalization, Palliative Care Components of RED ( Reengineered discharge) Asses need for translator, sched f/u appointments, f/u on outstanding test results, coordinate post d/c out-patient services, obtaining medications national d/c guidelines, d/c teaching, educate on what to do if problems arise, assess pt understanding, d/c summary to outside providers, d/c follow up call. After Hospital Care Plan (AHCP) In regards to Value Based Pricing/payments, What factors weigh heavily in clinical care outcomes? mortality In regards to Value Based Pricing/payments, what factors are considered in Patient experience of Care staff communication, receiving written d/c information, warning signs, explanation of medications, pain management, overall experience. In regards to Value Based Pricing/payments, what factors are used to determine payout based on efficiency. spending per beneficiary, 3 days prior to admission to 30 days post d/c. Resource utilization, length of stay, post acute services. In regards to Value Based Pricing/payments, what factors are used to determine payout for safety? Various patient safety factors and infection rates What is the definition of health literacy ? the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. What are social determinants of health? The structural determinants and conditions in which people are born, grow, live, work, and age which have a significant impact on health outcomes. What are the components of a psychosocial history family composition, education, occupation, psychological and/or psychiatric functioning, living siuation, support system, transportation concerns, life changes or stressor, cooing skills, social/ community involvement, spiritual aspects and concerns, self care, cognitive or perception problems, financial concerns. What is the required assessment for admission to a nursing home for a patient with a diagnosis of mental retardation or mental illness to assure appropriate placement Federal Pre-Admission Screening and Resident Review. Some states may require additional screening tools. What factors effect social determinents of health? economic stability, neighborhood and built environment, education, food, community and social context, health and health care. Required assessment for admission to a nursing home for a patient with a diagnosis of mental retardation Federal Pre-Admission Screening and Resident Review. Some states may require additional screen in ng tools. What is utilization and review? reviewing patients clinical condition and providing decis I on support to MD on bed and billing status. ie observation, Out Pt, In-Patient. and being prepared to justify medical necessity. Additional certification is required for admission Ions longer than 20 days. components of the psychosocial history family composition, education, occupation, psychological and/or psychiatric functioning, living siuation, support system, transportation concerns, life changes or stressor, cooing skills, social/ community involvement, spiritual aspects and concerns, self care, cognitive or perception problems, financial concerns. Physician certification or recertification for admissions longer than ____ days requires what documentation? 20 days. Reason for hoslitalization estimated length of continued stay, post acute plans, if patient is only waiting on SNF placement must indicate reason for delay. What is a condition code 44? For Medicare services, when a UM review team has determined that an order for inpatient admission is not medically necessary. Order can be changed to observation. The admission will be billed under part B Medicare only What requirements must be met to bill a Condition Code 44? The change must be made prior to discharge. The claim has not been submitted, The MD concurs with the UM decision, occurrence is documented in the medical record. What are the key elements of CM planning? Patient engagement, dynamic process (ability to change plan as needed), patient centered, collaborative (team), fiscally responsible. Patient Goals Clinical treatment and diagnosis, Comfort and Supportive Care, Restorative/rehabilitative care, Discharge or transitional planning. What does the acronym IDEAL stand for? INCLUDE the patient and family as full partners in the discharge planning process. DISCUSS with the patient and family key areas to prevent problems at home. EDUCATE the patient and family in plain language about the patients condition, the discharge process and next steps at every opportunity throughout the hospital stay. ASSESS how well doctors and nurses explain the diagnosis, condition, and next steps in the patients care to the patient and family. Use teach back. LISTEN to and honor the patient and family's goals preferences, observations, and concerns. What assessments are required to be reported under the IMPACT act of 2014 skin integrity, functional status, medication reconciliation, falls, forwarding of HIM upon transfer, estimated spending per beneficiary, dc to community, preventable readmission. What is the IMPACT act? a 2014 act that requires submission of standardized data by long term care hospitals, SNF, home health agencies, and rehab facilities. improving Medicare post acute care transformation act More social determinents of health employment/work conditions, education and literacy, childhood experiences, social support and social skills, access to health services, gender, biology and genetics, healthy behaviors, social environment, physical environment, income social status How is value based pricing scored? 2 scores- Performance compared to other hospitals, improvement in their own performance Common risk stratification models Hierarchical condition categories (icd-10), Adjusted clinic groups (Johns Hopkins) projects use of medical resources), Chronic Comorbidity counts (AHRQ) 6 categories), Elder Risk Assesment (risk for hospitalization and ED visits), Charlton Comorbidity Measure (predicts risk of 1 yearmortality based in diagnosis), Minnesota Tiering (tiers patients on complexity of major conditions) Population Specific Assessment Considerations - Workers Comp Asses what Pt can and cannot do in their essential job functions and an occupational history. Population Specific Assessment Considerations - D/C from acute care Elderly cognitive abilities, ADLs (selfcare), physical limitations, ADLs functional ie banking, cooking etc. Other Assessment details that are helpful Home support, physical and environmental barriers, occupation, educational level, accessibility to resources, experience with Healthcare, previous accidents, learning barriers, language barriers, Pt goals experiences of care, fearfrustrations etc. What did the HITECH portion of the American Recovery and Reinvestnent Act of 2009 promote in regards to Healthcare? Conversion of paper based charting to computer based systems. Population Specific Assessment Considerations - ED Identify high ED services users and developers plans to when patients present to ED with same symptoms as previous visits. Pts are often asked to sign them Population Specific Assessment Considertions - Newly Hospitalized patients Determine appropriate level of care. Tool often used - MCG, InterQual (McKesson), Centers for Medicare & Medicaid Services National Coverage Database Population Specific Assessment Considrrations - D/C planning all equipment, medications, and supports for safe dc to lower risk for readmission. Authorization of insurance etc.