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Home > Accountable Care Organizations
The Case Manager's Guide to Readmissions: Blueprints and Best Practices for Acute Care, Health Plans, Long-Term Care & More
The Case Manager's Guide to Readmissions: Blueprints and Best Practices for Acute Care, Health Plans, Long-Term Care & More
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Description

On October 1, 2012, the Centers for Medicare and Medicaid Services officially began its program to penalize hospitals that see high numbers of readmissions for patients with specific disease states. With real money on the table, the effort to get a handle on the readmissions challenge has become a priority across the system.

The Case Manager's Guide to Readmissions: Blueprints and Best Practices for Acute Care, Health Plans, Long-Term Care & More has been approved for 4 CE credits for the following disciplines: Nurses, Certified Case Managers, Disability Management Specialists, Psychologists.

Table of Contents

Chapter 1: Managing Unplanned Readmissions: A Collective Perspective
3 Guiding Principles That Set Organizations on the Path to Readmissions Success
By Sherrie Smith, BS, CPHQ and Brian Pisarsky, RN, MHA, ACM  

Chapter 2: 30-Day Readmissions for Chronic vs. Acute Conditions, 2008
By Jennifer Podulka, M.P.Aff., Marguerite Barrett, M.S., H. Joanna Jiang, Ph.D., and Claudia Steiner, M.D., M.P.H  

Chapter 3: Root Cause Analysis: Laying the Foundation for Enhancing Care Transitions
By the Colorado Foundation for Medical Care  

Chapter 4: Capitalizing on Community Collaboration to Achieve Positive Outcomes
Powering Transitions of Care Across Underserved Populations
By Pat Kramer, Ed.S., CCM, CSW, NCC and Judith Sands  

Chapter 5: Chronic Disease Self-Management Program: A Toolkit for Hospitals
Helping Patients Help Themselves
By Sarah McKechnie, MA, AHFS and Kim Crilly, RN, MS  

Chapter 6: Calling Skilled Nursing: Securing the Transitions of Heart Failure Patients
How Case Managers Promote Continuity of Care After Discharge
By Emily Mullin  

Chapter 7:The Aging of America: Home Adaptions Help to Lower Readmissions
By Mike Dodd, MCR, CKBR, GCP, CAPS  

Chapter 8: Health System's Transitions Intervention Reaps Massive Benefits
By Jan Van der Mei Rn, MS, ACM  

Chapter 9: High-Touch Readmissions Strategy Guides Health Plan Into the Future
Targeting Heart Failure Patients, Teamwide Intervention Reaps Results
By Linda Wick  

Chapter 10: Cutting Through the Buzz: An Incisive Look at Readmissions
A Firsthand Look at the Quandary of Readmissions
By Stephanie L. McCrary, RN, MSN, CCM, CPHM  

Glossary

Section 1: Readmissions Reduction Program

Section 2: Details for Title: CMS-1588-F

Section 3: Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents

Section 4: Community Based Care Transitions Program

Section 5: Readmission Rates for Specific Conditions

Publication Date: October 2012
Number of Pages: 75
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