Rural Spotlight

Reducing Avoidable Readmissions

PubHub has made the following report available:

Health Care Leader Action Guide to Reduce Avoidable Readmissions

Outlines a four-step approach to reducing avoidable hospital readmissions. Suggests interventions during hospitalization, at discharge, and post-discharge, including patient and caregiver education, multidisciplinary care coordination, and home visits.

CDC Annnounces Guidelines for Handling H1N1

EMS workers and other medically trained individuals don't always have time in the field to get a patient's medical history before making decisions about their care. The Centers for Disease Control has set up guidelines they suggest be followed in situations that involve suspected H1N1 flu. Read more here.

Quality Care During Patient Handoffs

With rules about how long physicians can stay on the clock making for better patient care, also comes some problems with the transfer of information from one doctor to the next. The New York Times published an article about some of the issues that need to be addressed to keep patient handoffs from going wrong. Click here to read the full article. 

Iowa Hospital Gets Attention for Settlement

Waterloo, Iowa's Covenant Medical Center is out $4.5 million dollars after agreeing to pay that much to settle a controversy over the payment to five doctors. The hospital has admitted no wrong doing. It was accused of violating the Stark Act by overpaying medical specialists to work in their hospital in an effort to entice more patients. Read more here.

CMS Facts About Swing Beds

CMS recently released a Swing Bed Fact Sheet (revised April 2009).  The fact sheet outlines the requirements for hospital and critical access hospital swing bed arrangements. They vary a little between the two.

Click here to view the fact sheet and registration flyer.

RAC Reviews & Strategies

While Missouri critical access and rural hospitals aren’t currently scheduled for RAC Reviews, now is the time to prepare.  During a Rural Health Resource Center conference call on this topic, some helpful tips were relayed.  View the RAC federal website here.  Click here to view a list of common errors being found in RAC reviews. The following is a list of helpful guidelines to follow.

• Review the ABN process (ABNs may shield from a RAC Review)
• Internal and external audits need to be conducted prior to a RAC review (coding reviews, documentation to support medical necessity)
• Focus on pharmacy and therapy and the billing of “units” of service
• Review appropriateness of place of service, i.e. observation, inpatient short stays, 3 day hospital stay requirement for swing bed and SNF admission
• Think about establishing a reserve fund
• Someone needs to be dedicated to log, respond, follow-up and understand RAC reviews.  Deadline for responding is 45 calendar days.
• Watch remittance advise for code N432, which indicates an adjustment based on RAC review
• Monitor any previous reports from Medicare, track denials (by service, physician, etc.).  Fix errors once recognized
• Review Office of Inspector General and Government Accountability Office reports on their website.
• Review policies of UR, Case Management, and Discharge Planners
• Be sure hand-written notes are legible.