Healthcare reform is introducing CMS's transition from being a passive payer to that of an active purchaser. With this transition, we see both public reporting and pay for performance as "big ticket" items for hospital executives.  Reimbursement has been completely related to billing.  Now reimbursement is completely related to processes, patient satisfaction and outcomes.

Where does the case manager fit into this new reimbursement model?  

Part one of the 90-minute webinar “The Case Manager’s Role in Reimbursement and Healthcare Reform Series,” case management experts Dr. Toni Cesta and Bev Cunningham, RN, MS will introduce the concept and plan for value-based purchasing, as well as strategies for the case management department. Both staff case managers and case management leaders must very quickly understand and plan for the new way we will be paid.  The recently published 2012 IPPS Rule will be discussed, as will rules CMS is contemplating for the future.

Learning Objectives:

• Discuss the history, present and future of hospital healthcare reform challenges on case managers.
• Explain the case manager's impact on reimbursement in value-based purchasing.
• Identify strategies for optimal public reporting metrics.

Target Audience:

• Case Management Directors and Managers 
• Discharge Planning Directors and Managers 
• Patient Care Services Professionals 
• Quality Assurance Directors and Managers 
• Social Workers and Social Service Directors 
• Utilization Management Directors and Managers 

Level: All levels

Meet Your Experts:

Toni G. Cesta, Ph.D., RN, FAAN is Senior Vice President for Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York.  Additionally, Dr. Cesta serves as Health Care Consultant and partner in Case Management Concepts, LLC, a consulting company assisting institutions in designing, implementing and evaluating case management models, new documentation systems, and other strategies for improving care and reducing cost. Dr. Cesta has presented and published extensively on case management topics. She has presented at national and international conferences and workshops, and is the author of "Nursing Case Management: From Essentials to Advanced Practice Applications" and the best selling book - "The Case Manager's Survival Guide: Winning Strategies for Clinical Practice". In 2009 Dr Cesta co-authored a new book "Case Management Core Skills" with Beverly Cunningham. Dr. Cesta has also been active in the research and development of case management for 20 years. She is Consulting Editor of "Hospital Case Management Journal" and serves as editorial advisory board member of several case management journals and publications including "Strategies for Healthcare Excellence" and "The Journal of Care Management."

Bev Cunningham, RN, MS is a Vice President, Clinical Performance Improvement at Medical City Dallas Hospital.  Her responsibilities include Case Management, Health Information Management, Documentation Integrity, Quality Management, Patient Access and Transplant Financial Services.   

Bev is a well-known speaker in the Case Management field and she has presented internationally.  Her area of expertise includes denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process.  She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also a partner and consultant in Case Management Concepts, a company that provides international support to hospitals regarding effective Case Management model development and evaluation. Bev's publications include a chapter CMSA's Core Cirriculum for Case Management Certification and most recently, co-author of the book, Core Skills for Hospital Case Management.  She is on the advisory board for American Health Consultant's publication, Hospital Case Management.

Accreditation Statement:

AHC Media is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Credit Designation:

This activity has been approved for 1.5 nursing contact hours using a 60-minute contact hour.

Provider approved by the California Board of Registered Nursing, Provider # 14749, for 1.5 Contact Hours.

This activity has been approved by the Commission for Case Manager Certification for 1.5 clock hours.

Sponsor:

The sponsor of this educational activity is AHC Media.

Recorded: Tuesday, November 8, 2011