Teamwork: Reduced Medicare FFS LOS by 0.88 day in one month

Teamwork goes a long way. I am very proud of the hospital in Southern CA  for the teamwork shown to reduce Medicare FFS length of stay (LOS) by 0.88 days in one month. We started Interim Work in last week of October 2018. Hospital had not much success to reduce LOS in this area for […]

Nurses’ Role In Reducing Length of Stay At The Hospitals

    Most of the hospitals have tendencies to look at the case management department to reduce the length of stay (LOS) at the hospitals. Most of the hospitals we have worked with, LOS is one of the key measurements used by the hospital leadership to measure the success or effectiveness of the case management […]

No Payment For A Non-emergent Use Of The Emergency Department (ED)

    Emergency Room utilization per 1,000 population has increased by 21% from 1999 to 2015 as per data published by The Henry J. Kaiser Family Foundation. The foundation has done a great job to show the utilization of ED by the ownership (the State/Local Government; Not-for-Profit or For-Profit) of the hospitals. You can review […]

The Secret To Consistently Successful Results In Case Management

Even after the successful orientation, training, and annual re-training programs in place, many of the leaders and the organizations are still struggling to get the favorable outcomes to achieve desired goals. Why is that? One of the reasons could be that they rely on a job description to tell their employees of the job expectation. […]

The Cost Of Medicare Inpatient Care And The Reimbursement Trends

      When we reviewed the national trends for the hospitals’ cost and reimbursement using MedPAR (Medicare Provider Analysis and Review) data from Federal Fiscal Year 2011 to 2015, it is clear that many hospitals suffered a financial loss in FY 2015 in this area. The cost per case for treating the inpatient level […]

Medicare 2016 Inpatient List Effective January 01-01-2016

Happy New Year. If you have not updated your Medicare Inpatient list by now then here is a file you may want to use to check Medicare Inpatient list effective Jan 1, 2016. You can refer to CMS website for detail explanation and information. CMS Medicare Inpatient list 1-1-2016

A proven simple Case Management Approach that Delivers Outstanding Results

 Are you frustrated with higher length of stay, denials, readmissions, late discharges in the evening or sluggish patient throughput and CMS compliance  issues (2-midnight, CMS Probe & educate results are 30% or more error rate)  or some combinations of the list of issues identified here?  Does your case management staff usually feels that hospital is […]

What Do Case Managers Know To Reduce Readmissions?

Hospitals have focused on reducing acute care length of stay (LOS) and improving patient throughput for many years. Most of the Directors of Quality Improvement or Directors of Case Management do not know the financial penalty of readmissions. Even if they can figure out to reduce the impact, most do not have a solid plan […]

Who is watching over Utilization Review Committee?

Volkswagen AG  chose not to learn from the independent study completed by Daniel Carder, an engineer with a small team of five people.  Initially, the group questioned the findings, as it was hard for them to believe what they had discovered.  Volkswagen had known the audit results about 18 months before we learned the announcement […]

A Reduction in Length of Stay (LOS) & Team Work

  Credit goes to the organization and Case Management staff for reducing Medicare Length of Stay by 0.8 days. Case Mix Index also went up during this time and helped to reduce CMI adjusted LOS below the target of 2.9 days. Filled open positions; 2 RN case Managers, 2 Per Diem Case Managers, 2 Per […]


Half Of Nation’s Hospitals Fail Again To Escape Medicare’s Readmission Penalties as per Kaiser Health News. KHN article shows the average penalty by state and number of hospitals impacted by it. There is a nice article and infographic information that one may want to look at it when it comes to readmissions by Thomas Renshaw. I found […]

Senate Approves: Impacts ICD-10, Therapy Cap extension, Ambulance, Two-midnight rule

U.S. Senate Approves: Impacts ICD-10, Therapy Cap extension, Ambulance, Two-midnight rule U.S. Senate Roll Call Votes 113th Congress – 2nd Session As compiled through Senate LIS by the Senate Bill Clerk under the direction of the Secretary of the Senate Vote Summary Question: On the Motion (Motion to Waive All Applicable Budgetary Discipline Re: H.R. […]

The Trusted Advisor

The book titled “The Trusted Advisor”  has really made a great impression on me. I read this book a few years ago and I refer to it from time to time. This book was published in 2000. My gut reaction was that it might have outdated information. I am very pleased and impressed with the […]

Hospital Case Management Scorecard Suggestions

We get requests to offer suggestions for CM scorecard and list of things hospitals should included in scorecard. There is no one scorecard that meets all the hospitals needs. This document summarizes the list of things to consider as guidelines. We have also included the suggestions to make it clear how to display some of […]

CMS Medicare 2-­Midnight Rules and Lessons Learned – Participants Survey

Speaker: Mike Todai                                                   Date: March 6, 2014 A question was asked to Webinar participants: What could we do to improve your level of satisfaction with this program? This was awesome […]