4005 – Developing a Regional Case Management Model in LTC
Lara Cline Director of Care Coordination
Patsy Tschudy Director of Managed Care
With the shift of Medicare FFS to Medicare Advantage and the new Patient Driven Payment Model (PDPM) for Medicare FFS, LTC facilities are being challenged in ways they have never been before.
Reimbursement continues to decline. Skilled census mix declines. Shorter Lengths of Stay. Penalties for Return to Acute. Staffing turnover. Push for increase clinical capabilities. Increased regulatory compliance, fines, and penalties. Collaboration at all levels: hospitals, post-acute providers, payors, etc.
This presentation will explore how one organization is surviving the new world order, through the development of a Regional Case Management Model. This will include: setting up Central Intake to manage referrals through the precertification process, hiring the right staff, development of a Care Coordination Pathway to move patients through the continuum of care, discharge planning, meeting metrics of the payors and hospital systems, managing outside the four walls to reduce Return to Acute, and following the case all the way through claims payment.
The speakers have collaborated for 6+ years to create organizational changes in this fast pace health care environment. This includes being involved in state and national activity to influence change politically, utilizing the right EMR system, using innovative ways to accomplish patient goals and objectives while maintaining company profitability.
This session will encourage participants to go outside the box to discover how they can meet these challenges in their own environment.
1) Identify skill set required, training needed and case load for LTC Case Managers in a Regional Model
2) Improve payor/hospital system metrics based on the establishment of a Care Coordination Pathway
3) Assess, evaluate and discern changes that need to be made based on data, payor demands, and community needs