Pathway Medical Staffing

Revenue-cycle case study: Reducing denials requires team approach

August 27th, 2010

Source:  Fierce Healthcare

A recent article from Fierce Healthcare highlights how one healthcare system uses a team approach toward reducing denials.  The case study examines a three-hospital healthcare system that had a dramatic improvement in results from 2008 to 2010 after implementing effective team approach steps.

Here are the highlights:

2008

  • 77 days in accounts receivable on average
  • Low cash on hand
  • 99% percent of the hospital’s claims rejected on the first try

2010

  • 37 days in accounts receivable on average
  • Tripled cash on hand
  • 3% denied claims on first try

Some of the steps they took to achieve these results:

  • Counting errors
  • Tweaking health information system
  • Adding new scrubbing software
  • Training revenue-cycle staff
  • Educating the clinical team

For details of this remarkable case study visit Fierce Healthcare: Revenue-cycle case study: Reducing denials requires team approach

What steps does your healthcare organization take to help reduce denials?
Include your response in the “Leave a Reply” section.


580,000 Nurse Jobs by 2018 and Other Nursing Workforce Statistics

July 28th, 2010

Source: Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation has released a site that keeps track of nursing statistics including:

  • How many nurses are at work today
  • Nurses’ educational background
  • Diversity of the nursing population
  • Nurse employment trends
  • Size of the nursing gap now and in the future
  • and more..

The information is presented in a fact sheet and several slides on a site from the Robert Wood Johnson Foundation that will be updated periodically to incorporate new government employment data and projections.

For the complete set of nurse statistics and data visit:
Nurse Numbers Tell the Tale: New RWJF fact sheet and slideshow put recent data on nursing workforce in meaningful context.

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What  sources for nurse statistics have you found useful? Please share in the leave a reply section below.


Top 10 Case Management, Non-Bedside Nursing and Healthcare Headlines – July 2010

July 26th, 2010

At Pathway Medical we are constantly searching for news and information that is most interesting to the case managers,  non-bedside nurses and healthcare employers we work with.  Check out this month’s Top Nursing and Healthcare Headlines; giving you insight into news trending in popularity among your nursing and healthcare peers.

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Click on the headline for the complete story.

Tips on becoming a Certified Case Manager (CCM)
One of the most popular articles this month is a post from a while back.  Hundreds of nurses and healthcare employers have been reading this article that covers tips and suggestions for nurse case managers seeking the certified case manager (CCM) designation. - Pathway Medical

Case manager’s dilemma during electronic health record (EHR) implementation
Learn about a major limitation that surfaced a week after an EHR implementation “go-live” date.   One case manager experienced an unexpected challenge. - HCPro

Nurse Hiring Guide: A guide to hiring non-bedside nurses for hospitals, managed care and other healthcare organizations
If you work for a hospital, managed care or other healthcare organization and you’re looking to attract top nursing talent in case management, utilization review, appeals, pre-certification, quality improvement, HEDIS, CDI and other non-bedside nursing professionals, check out the Nurse Hiring Guide to help you find the best nurses. - Pathway Medical

Top tips to enhance case management communication
A key competency case managers must be proficient in is being an effective communicator. This is a challenge as case managers communicate with a number of people and professionals on a daily basis. In addition, a good deal of communication is telephonic, which presents its own set of challenges. Follow these tips for best-practices in case management communication. - Case In Point

Software to help nurse case managers simplify medical jargon for patients
A new federal program called the Health Literacy Action Plan is promoting simplified language nationwide. And some health insurers, doctors’ practices and hospitals have begun using specialized software that scans documents looking for hard-to-understand words and phrases and suggests plain-English replacements. Find out how you can help your patients decipher the medical jargon so that they receive better care. - Wall Street Journal

Patients who e-mail with doctors see health improvements
Patients with diabetes or hypertension or both who communicated with their doctors via e-mail got better care and better health outcomes.  Learn more about the results from this new research. - USA Today

100 blog posts that will make you a better nurse
No one starts off their profession being perfect at everything they do. It takes time to learn the ropes and often years of hard work to truly get the hang of everything. No matter where you are in your career as a nurse, there’s likely an aspect of your job that you could work on improving. Here are some blog posts to guide you towards a brighter, more successful career in nursing and help you be the best nurse you can be. - NursingSchools.net

Evidence-based care poorly understood by patients
Only 1 in 3 patients said a physician had discussed what research showed about the best way to manage treatment. – American Medical News

Free networking group just for non-bedside and non-clinical nurses
If you have questions about nurse case management or non-bedside nursing ask your peers in a new LinkedIn Group for nurses working in non-bedside or non-clinical jobs.  Join over 125 nurses across the country that share your interest in non-bedside nursing where you can ask questions, share information and find great career tips and opportunities.  - Pathway Medical

Patients receiving email notes from dr visit serve as helpful reminders for preventative care
Check out this interesting story of a patient who finds that participating in email notifications from his physician reminds him to follow up on pre-cancerous skin condition that he would have forgotten about otherwise. - e-patients.net

Do you have an article that you would like to share with the nurse case management an non-bedside nursing community?  Please share it in the “Leave a Reply” section below.

Pathway Medical Congratulates Clients Ranking Among Top 10 in U.S. News Best Hospitals Report

July 21st, 2010

Source: U.S. News

Pathway Medical Staffing congratulates its clients that ranked among the top hospitals in the U.S. News Best Hospitals Report for 2010 – 11. Five of Pathway Medical’s New York clients ranked among the top ten of 16 specialties ranging from cancer and endocrine disorders to gastroenterology and urology.

U.S. News recently released these hospital rankings in their annual report.  Out of 4,852 hospitals, 152 were ranked in one or more of 16 specialties.  For more information about the rankings and the report visit the U.S. News website at U.S. News Best Hospitals Report for 2010-11.

Six Steps to Ensure New Nurse Manager Success

June 25th, 2010

Source: HealthLeaders Media

Nurses are usually promoted to managerial positions for being excellent clinicians, critical thinkers and great communicators, but a recent HealthLeaders Media article points out that many new nurse managers are lacking some essential managerial skills.

Nurses often have little training and preparation for the new managerial responsibilities including finance, budgeting, quality improvement, patient safety concerns and disgruntled employees.  The HealthLeaders Media article, authored by Rebecca Hendren, points out six key principals for hospitals and healthcare organizations to help nurses adjust to their new management roles:

1. Have realistic expectations

2. Provide time for orientation

3. Plan for the first 30 days

4. Offer manager support

5. Establish leadership principles / training

6. Assign a mentor

Read the full article from HealthLeaders Media at Six Steps to Ensure New Nurse Manager Success.

For additional information on the subject of nurse management here’s another informative article from Nursing ManagementThe Makings of a Good Nurse Manager.

New Study: Healthcare Leaders Survey Across Seven Industry Segments

June 21st, 2010

Source: Health Leaders Media

HealthLeaders Media just released “HealthLeaders Media Industry Survey 2010.”

“The report is based on seven concurrent surveys sent to healthcare leaders in seven segments across the industry: CEO, finance, technology, physician, health plan, marketing, and quality leaders. In addition, data has been extracted based on community and rural status. The surveys included some common questions for all respondents and some questions directed to leaders in specific segments.”

Here are some of the highlighted findings:

49% Surveyed said the nursing shortage will negatively impact their organization in the next three years
- Overall Cross-Sector Survey

54% respondents say that patient feedback is the best source for process improvement

Majority of respondents (65.33%) said that quality and patient safety is among their top three priorities for the next three years.
- Quality Leaders Survey

30% respondents say that revenue is a major consideration when ordering tests or procedures.
-Physician Leaders Survey

You can find the complete set of studies and results from HealthLeaders Media at Healthcare Leaders Industry Survey 2010.

40% Inpatients Make Mulitiple Visits to Hospital, Study Finds

June 2nd, 2010

Source: Agency for Healthcare Research and Quality

A new report from the Agency for Healthcare Research and Quality finds that, “About 40 percent of patients who sought acute hospital care from 2006–2007… made multiple visits to the hospital, for an IP stay or ED visit, during the two-year period.”

The AHRQ study is unique because, “Most readmission studies only report information on patients who have multiple hospital IP stays; they exclude patients who sought care in the ED. “  This study includes, “patients who accessed hospital care in either or both acute care settings (IP and/or ED) over the two-year period.” By including this group the AHRQ study found an “increased rate of multiple visits by more than a third” of patients; ranging “from an average of 1.5 to 2.1 acute care hospital visits per patient.”

Report Highlights:

  • Two out of every five patients who sought acute hospital care (either an inpatient stay or an emergency department visit) from 2006–2007 in the selected states made multiple visits to the hospital during the two-year period.
  • More than a quarter of patients with an inpatient (IP) hospital stay in 2006–2007 in the selected states had multiple inpatient hospitalizations during the two-year period.
  • Factoring in ED visits increased the rate of multiple visits by more than a third, from an average of 1.5 IP readmissions to 2.1 hospital visits per patient.
  • Medicare patients had the highest IP readmission rates (1.9 visits per Medicare patient) while Medicaid patients had the highest ED revisit rates (2.5 visits per Medicaid patient).
  • Looking across both IP and ED settings, patients living in the poorest communities had 26.5 percent higher hospital revisit rates compared to patients from the wealthiest areas: 2.2 versus 1.8 visits per patient, respectively.
  • Accounting for ED visits increased the percentage of patients seeking repeat hospital care for asthma (31.3 percent increase), uncomplicated diabetes (22.8 percent increase) and high blood pressure (20.9 percent increase).

Click this link from the AHRQ to view the complete 10 Page PDF report at:
Hospital Readmissions and Multiple Emergency Department Visits

Top 5 Interview Tips for Healthcare Employers

May 26th, 2010

The applications have been culled out, the phone screenings are done and now the top candidates are arriving for the interview.  If you are new to conducting interviews this list cuts through the mounds of advice you can find on the Internet and drills down to the top 5 tips you’ll need for a successful interview with nurse candidates. Even if you conduct nurse interviews often, this list is a great refresher in best-practices.

1) Make the Candidate Comfortable

We have all been on the other side of the table in an interview so we know how stressful the process can be for candidates.  Remember that it’s important to make the candidate feel comfortable and welcome.  Although obvious, these things are often forgotten when conducting an interview:

- Be on time.  This  shows respect for the candidate and makes them more comfortable.

- A pleasant smile, firm handshake, and warm introduction are all important.  Don’t forget, you’re making a first impression too.

- As an interviewer you are representing your organization and how nursing professionals will be treated once they become employees.  It’s not just the candidate that has to put their best foot forward, they are evaluating you too.

- Outline the interviewing objectives with the candidate so they know where you plan on heading with the interview.  For example you may say, “In the short time we have I’d like to speak with you for 30 minutes and then I’ll introduce you to my supervisor Jane who will want to talk with you for another 30 minutes or so.  Then, if we have time, I’d like you to meet Barbara, who currently works in the same role that we are trying to fill.”

- Tell the candidate a little about yourself  and your role as it relates to the open position.  This helps provide a context for the position and helps to put the candidate at ease.

- Make the candidate feel wanted.  Grilling a candidate and making them feel like they are defending their resume, rather than sharing their experiences, is a sure fire way to make them uncomfortable.  Make the candidate feel as if they would fit into the organization and that their skills are wanted.  Even if you do not select the candidate, this type of action fosters good will.  The candidate will be left with a positive impression of your organization that may be shared with their friends and colleagues.

Often we get busy and forget these pleasantries in the midst of the hiring process, but they are critical in establishing the tone and the light in which the candidate views your organization.

2) Beware of Illegal Question Landmine

Anything that elicits a response regarding age, religious beliefs, marital status, nationality, health status, etc. is off limits!  Be careful not to get too comfortable in your conversation and slip up by asking questions such as:  “Oh, do you have kids too?” “Where does your husband work?” “Where do you go to church?” These innocent questions in a normal everyday setting can easily be misconstrued as discriminating questions when asked in the context of an interview.

When interviewing it’s extremely important to beware of these innocent mistake because they have legal consequences.

Here’s a refresher list of questions that are completely off limits:
•    Are you married?
•    What is that accent you have?
•    Where is your spouse from?
•    Are you engaged?
•    Do you have children?
•    Where are you from?
•    Were you born here?
•    What is your ethnic heritage?
•    What church do you go to?
•    How old are you?
•    When were you born?
•    When did you graduate from high school?

If you would like more detailed advice on this subject visit the U.S. Equal Employment Opportunity Commission website.

3) Don’t Make Assumptions

Don’t assume that just because a certain skill or experience isn’t listed on a candidate’s resume that you shouldn’t bother asking about it.  Often times candidates will have the background that is needed for the job but the qualifications aren’t overtly apparent on the resume.   Be sure to have a list of all the skills and experience that are critical to the position you are trying to fill and ask the candidate for examples of  how their background relates to what you need.  Don’t neglect to ask a specific question because you assumed something about the candidate’s resume.

On the flip side, don’t assume that because it’s on the resume, the candidate has the level of skill you are looking for.  One example of increasing importance in non-bedside nursing is computer skills.  A candidate may list that they are “computer literate” on their resume, but don’t assume that they have the level of proficiency you need.  Don’t neglect to ask the questions that will reveal whether their level of skill is comparable to the needs of the open position.

Asking behavioral questions usually helps to confirm or repudiate any assumptions you may be making about a candidate’s qualifications. One common behavioral question that gets to the heart of the candidate’s actual experience is:

“Tell me about your most complex (case, problem, issue, etc.) and how did you handle it.”

If you need to jog your memory for ideas on behavioral interview questions, you can find many helpful suggestions on the following sites:

Behavioral Interviews: Use Behavioral Interviewing to Select the Best
About.com

Tips for Conducting Behavioral Interviews
HCPro

4) Listen, Listen, Listen!

Remember to listen.  In most cases, during an interview you should only be doing 20% to 30% of the talking at most. This is your chance to know as much about the candidate as possible.  If you feel yourself going over that 20% to 30% mark, you’re probably not getting as much information from the candidate as you could be.  Be cognizant of how much time you spend speaking during the interview.

5) A Solid Closing

When you come to the end of an interview, tell the candidate what the next steps will be.  It is helpful to provide candidates with a time line of your decision making process to manage their expectations.

However, it is best to avoid the statement “We have quite a few more interviews before we make a decision.” For the candidate this translates as, “We want to see who else is out there because you aren’t really what we’re looking for.” If you just interviewed a great candidate chances are someone else is interviewing them too.  Candidates are evaluating you just as you are evaluating them in the interview process.  A statement like this may bump your organization to the bottom of a candidate’s list. A better option would be to tell a candidate that you will be making a decision in a few weeks and you will get back to them at that time.

If you decide not to continue the interviewing process with a candidate, it is extremely important that you inform them of this decision. Neglecting to get back to a candidate will surely result in bad feelings and ill will.  Not following up is just bad public relations for your organization.

You may also be interested in our blog post: Top 5 Interview Tips for Non-Bedside Nurses.

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Marianne DiMola – National Vice President
Pathway Medical Staffing

If you would like to learn more about this topic,  Marianne Dimola will be presenting additional information at a FREE workshop during the Case Management Society of America annual conference in June.  For more information visit http://www.cmsa.org/career.

This article is taken from Ask Marianne; a monthly newsletter that answers career and employment questions from nurses and healthcare organizations.  Sign up for the monthly newsletter if you would like to receive more tips.

Top 10 Nursing and Healthcare Headlines – May 2010

May 26th, 2010

At Pathway Medical we are constantly searching for news and information that is most interesting to the nurses and healthcare employers we work with.  Check out this month’s Top Nursing and Healthcare Headlines; giving you insight into news trending in popularity among Pathway Medical’s nursing and healthcare network.

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Click on the headline for the complete story.

Preventable readmissions cost the health care system about $25 billion every year
PricewaterhouseCoopers

Report examines what is motivating nurses to look for new jobs
Pathway Medical Staffing

An associate’s degree in nursing is not good enough
HealthLeaders Media

More bad news for nonprofit hospitals
HealthLeaders Media on Moody’s Report

Discharge Planning Checklist for Patients and Caregivers
CMS

Study finds Healthcare Organizations Are Expanding Case Management Services
BeyeNETWORK and ASG Software Solutions

Non Bedside Nurses Gather to Share their Experiences in Non Clinical Nursing
Pathway Medical Staffing

Project RED. Re-Engineered Discharge Helps Reduce Cost of Hospital Readmission
Boston University Medical Center

Hospital Check-ins May Slow Heart Failure Readmissions
USA Today report on Journal of American Medical Association Report

Hospitals Feel Pressure to Maintain Quality Improvement or be Penalized
HealthLeaders Media article on new Pricewaterhouse Coopers Health Research Institute Report

Case Manager Trends Uncovered in CCMC Study

May 17th, 2010

Source:  Commission for Case Manager Certification

“The role case managers play in health care is expanding with new team-based delivery models. To meet the challenges of their expanding role, case managers are becoming better prepared educationally and professionally to meet the requirements of employers, consumers and payers, according to a study by the Commission for Case Manager Certification (CCMC).

CCMC surveyed nearly 30,000 case managers and analyzed the results from 6,909 completed surveys to create a detailed profile of the role of case managers today, and the functions they perform across care settings.”

Here are some highlighted findings from the study:

  • More case managers hold bachelor or higher degrees (65 percent in 2009 compared to 60 percent in 2004)
  • Certification in case management is required by more employers (36 percent, compared to 26 percent in 2004)
  • More employers offer additional compensation for certification (27 percent in 2009 compared to 20 percent in 2004)
  • The case manager role represents a career advancement opportunity for nurses
  • The case manager role is becoming more challenging, and more important within the health care system

Read the complete press release from CCMC:  Survey Finds More Case Managers Professionally Credentialed, Hold Higher Degrees

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