- Recorded Webinar
- From : Jun 27, 2019
- To : Jul 05, 2019
- 01:00 PM EST
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.
Background: Case managers and social workers need to maintain compliance in a number of areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments fBuy Now
Key Points: Discharge planning Transitions Conditions of Participation: Discharge Planning Discharge planning compliance IMPACT Act Patient Choice Proactive discharge planning Multidisciplinary roundsBuy Now
Description: This program will discuss the Standards of Practice for social workers and nurse case managers as defined by the Case Management Society of America as they were updated in 2016. We will then apply those Standards to the contemporary roles of the nurse case manager and social worker. Finally, we will apply thoseBuy Now
Key Points: Value-Based Purchasing Efficiency Measure Length of stay Cost of Care Care coordinationBuy Now
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 necessityBuy Now
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 planningBuy Now
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 queriesBuy Now
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 outcomBuy Now
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 patientsBuy Now
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 PhysicianBuy Now
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 SimiBuy Now
Key Points: Diagnosis-related groups (DRG) Medicare Medicaid Managed care definition Managed care contracting Case rate, per diem and % of charges contracts ManagedBuy Now
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 stayBuy Now