Session 1: How the Death Shapes the Grief and the Case Manager's Role
David Kessler, MA
· Studio, CA
Death in our modern world is complex with lasting effects on the family. The case manager plays a vital role in the patients's last chapter of life. From hospice to palliative care as well as the hospital, the case manager will learn tools and techniques to help the patient and family.
- Understand how death shapes the grief
- Learn ways to personalize care in the hospital
- How to recognize and address anticipatory grief
Session 2: CMS Updates: CY 2016 OPPS and What It Means to Your Hospital
Kurt Hopfensperger, MD, JD
Vice President; Compliance and Physician Education (ACE)
Optum Executive Health Resources · Newtown Square, PA
The Centers for Medicare & Medicaid Services’ (CMS) release of the 2016 Hospital Outpatient Prospective Payment System (OPPS) final rule solidified updates to the “Two-Midnight” rule regarding inpatient admissions, leaving hospitals to evaluate their current compliance programs. With a renewed emphasis on physician judgment and medical necessity – not hospital level of care – providers must demonstrate a legitimate, defensible, and consistent Utilization Review process to determine and support an appropriate admission status.
The best way to defend against inappropriate denials is to ensure a compliant process for review and certification of admission status on every patient that enters the hospital. Providers across the country may be struggling with this shift, given the time-based recommendations implemented in 2014. Further complicating the issue is the challenge for hospitals to anticipate projected enforcement under the QIOs with their extensive referral possibilities.
This session will provide guidance on the implications of 2016 OPPS final rule and the potential impact it could have on your medical necessity admission review program.
- Review evolving roles and responsibilities of the QIO, RAs and MACs and Potential QIO enforcement ramifications and the extensive referral opportunities that could impact hospitals
- Discuss updates to the two-midnight rule, and how to determine if your current program will align with a renewed emphasis on physician judgment and medical necessity for inpatient hospital admissions
- Learn about modifications to CMS’ “rare and unusual” expectations policy for inpatient admissions that do not satisfy the two-midnight benchmark
Session 3: End-of-Life Option Act: Policy Considerations
President & Chief Officer
The Elizabeth Hospice, Inc. · Escondido, CA
The End-of-Life Option Act law, which Gov. Jerry Brown signed into effect on June 9, 2016, allows patients with terminal conditions nearing the end of life to request medication from a physician to end their life. This presentation looks at the laws eligibility criteria and prescription process. An examination of patient demographics in Oregon who invoked their right, patient concerns, and death statistics will occur to aid you in considering what your level of organizational or personal involvement shall be and what policies to consider.
- Identify the eligibility criteria for End-of-Life Option Act as defined in the California law
- Restate the key characteristics of individuals who utilized act to end their lives based upon Oregon data
- Describe key policies to consider developing for this legal option
Session 4: If Only Someone Had Warned Us: Talking with Patients About Risk
Daniel R. Hoefer, MD
CMO Palliative Medicine
Sharp Healthcare · La Mesa, CA
In this session, attendees will learn about the importance of identifying a patient’s values prior to traditional interventions - especially in the advanced elderly - and when a patient is at risk for cognitive functional decline. Additionally, the speaker will discuss why overtreating pre-terminal patients with traditional care strategies can cause harm.
- Define stages of the geriatric life cycle
- Understand patient centered quality metric
- Identify markers of a pre-terminal patient
Session 5: Bridging the Care Transitions Gap
Joe Parker, MSN, CNL, RN
Palomar Health · Escondido, CA
The purpose of this presentation will be to describe the pitfalls that occur when a patient transitions from the acute care setting to the post-acute arena. It will also cover strategies that organizations can implement in order to address those pitfalls. The presentation will also cover measurement strategies on how to measure success.
- Discuss three common gaps in care transitions
- Identify at least three strategies on how to address the gaps in care
- Understand the importance of measuring the impact appropriately
ACM™ Certification Review: Case Management Process and Practice
The scope of services and standards of practice provide social worker and nurse case managers with a guide by which they can engage in the practice of case management. Understanding the parameters within which the case manager practices assures a uniformity of services delivered to patients in need and assists the case manager in performing the duties required within health care delivery systems.
This workshop is designed to provide the practicing case manager with a review of case management practice standards in accordance with American Case Management Association guidelines and ACM certification It will provide intensives for focused review in four domains of case management practice: screening and assessment, planning, care coordination/intervention/transitions and evaluation. The workshop will also include discipline specific clinical and psychosocial scenarios presented in an interactive format allowing attendees to apply information gathering, assessment, decision-making and problem solving skills.
- Describe the four domains of practice utilized by the health delivery system case manager
- Apply the essential job functions to the role of a health delivery system case manager
- Describe clinical and psychosocial assessment and intervention methods used in case management
- Utilize analytical skills to assess and plan care for the health delivery system patient