Toni G Cesta
Toni G Cesta

Toni G Cesta Bio

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, educating case management professionals and assisting in implementation of case management departmental changes.

The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.

Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.

Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement.

Dr. Cesta has also held positions as Corporate Vice President for Patient Flow Optimization and Director of Case Management.  She also  designed and implemented a Master’s of Nursing in Case Management  Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

Compliance Measures for RN and Social Work Case Managers

Description: As case managers we must be aware of the myriad of compliance issues that we must adhere to in our daily practice.  Never has this been more important to our work as case managers then it is now.  Our ability to remain compliant has become an element of audits from accrediting bodies such as the Joint Commission ...

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Best Practices in Optimizing the Skill Sets of RN and Social Work Case Managers

Topic Background: The role of the case manager and social worker is dynamic and constantly changing in response to the changes in health care delivery and reimbursement at the federal, state and local levels.  While change remains a constant, there are certain core roles and functions that apply to the work of the social worker an...

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The CMS Efficiency Measure: Case Management Strategies for Managing Cost and Length of Stay

Description: As one of the elements of health care reform, The Centers for Medicare and Medicaid Services (CMS) has implemented a course of action aimed at bringing Medicare to a break-even budget.  The elements that we are now familiar with include the ‘clinical processes of care’, ‘outcomes’ (which includ...

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Fundamental Utilization Management Practices for Value Based World

Key Points: Utilization management definition Difference between utilization review and utilization management Medical necessity defined UM processes for, and components of, medical necessity When a patient meets medical necessity When a patient does not meet medical necessity Compliance components of medical necessity

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Improving Care Transitions: Discharge Planning from Admission to Community Transfer

Key Points: Foundation of effective transitional planning Current rules, regulation, and standards for transitional planning Preparing for a CMS survey with the Conditions of Participation for discharge planning Barriers to effective discharge planning Case Management department strategies for effective discharge planning

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Fundamental in Hospital Case Management: A Boot Camp Series

Overview The rapidly changing healthcare world is altering the role of case management in terms of value-based reimbursement, the Affordable Care Act, the continuum of care, bundled payments, transitions in care, or accountable care organizations, case management. This jam-packed five-part series will be the answer to all your queries

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Case Management Outcomes Measurement for Effective Practice

Key Points: Case management outcomes definition Quality, financial and productivity outcomes affected by a case management department Each set of outcomes, how they are measured and how to select benchmarks for them How to integrate these outcomes into a useful case management report card How to report case management outcom

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Interdisciplinary Care Rounds: A Key Strategy for Improving Case Management Outcomes

Key Points: Joint Commission Safety Standard 2 Vertical versus horizontal communication Crucial conversations Patient care conferences Huddles Internal patient transfers Walking rounds Walking versus bedside rounds Key members of the rounding team Key structural points Scripting Daily goals Engaging patients

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Best Practice Utilization Management: 10 Tips for Success

Key Points: Business of case management Difference between utilization review and utilization management Compliance of utilization management Access points for utilization management Types of utilization management Denial management Incorporating utilization management into case management rules and functions Physician

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Acute Care Case Management: Roles, Functions, Models and Staffing Ratios

Key Points: Why change your structure now Model of care definition Contemporary case management roles Comparison of two models Integrated model Access point case management in the integrated model Collaborative / Triad Model Departmental structure Staffing ratios in both models Key differences between models Simi

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Priming Acute Care Reimbursement: From DRGs to Bundled Payments

Key Points:     Diagnosis-related groups (DRG)     Medicare     Medicaid     Managed care definition     Managed care contracting     Case rate, per diem and % of charges contracts     Managed

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Care Coordination: Strategies for Managing Cost and Length of Stay

Key Points: Discuss how to improve your length of stay and cost per case through better care coordination Discuss how cost across the continuum affects your hospital’s cost per case Understand where your case management department may have the biggest impact on reducing your cost and length of stay

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Transitions In Care: A Key Role For RN Case Managers And Social Workers

Key Points: Understand transitional planning as a process, not an outcome Discuss the new CMS changes related to transitional and discharge planning and how they can impact your practice Identify best strategies to transition patients across the continuum of care, including how to align with those case managers in the post-acute

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