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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy As Medicare Advantage (MA) continues to grow, hospitals have faced growing challenges in navigating complex policies, payer friction, and financial pressures. These changes will impact how hospitals approach their contracts and denial strategies.

Hospital 130
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STRONG HF – A Positive Trial that Does Not Help Clinical Medicine

Sensible Medicine

The Trial STRONG-HF studied two treatment strategies after a patient was discharged from the hospital after treatment for heart failure. The primary endpoint (of hospital readmission for HF or death) occurred in 15.2% One group gets extra attention in the hospital than 4 extra visits in the first 6 weeks with a cardiologist.

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Choosing a Control Group

Sensible Medicine

Patients may develop a disease that requires admission to the hospital, mostly because of lung problems, such as the need for oxygen. Indirect organ damage is common in medical conditions that are severe enough to warrant admission to the hospital. The disease might affect other organs—either directly or indirectly.

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CNOs Share Their Hopes (And Fears) for Virtual Nursing

Scrubs

Trinity Health announced it will introduce virtual nursing at its hospitals in Michigan and Ardent Health Services plans to do the same in New Mexico. It can also reduce the workload at the bedside by having remote nurses do admissions, discharges, and answer questions virtually.

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Understanding DRG Codes and Their Impact on Hospitals

EvidenceCare

In our efforts to empower hospital clinicians to provide better care by having real-time transparency to cost and benchmark utilization data, we’ve learned that one of the core code systems that defines modern hospital resource management – Diagnosis-Related Groups (DRG) – is misunderstood or even unknown. What is a DRG?

Hospital 130
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Highs and Lows

Sensible Medicine

Luciana Luciana’s discharge day was getting close. Her outpatient follow-up appointments were scheduled; we had reviewed her safety plan; she felt well and ready to leave the hospital. Her hospital course was uneventful, and she made good therapeutic use of her time on the unit. Her door was open, and she waved me in.

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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

This comprehensive guide provides hospital and revenue cycle leadership with vital insights on preparing for CERT audits and establishing processes for compliant documentation. Hospitals need to be aware of these state-specific rules as well. Think of your documentation as the ironclad defense for your hospital admissions.