Discharges and Readmissions: A Quality Mandate

presented by Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN and Nancy Skinner, RN, CCM, CMGT-RN, ACM-RN, CMCN, FCM

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Disclosure Statement:

Financial: Colleen Morley receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Nonfinancial: Colleen Morley has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Financial: Nancy Skinner receives compensation from MedBridge for this course. She is a consultant/educator at Encompass. There is no financial interest beyond the production of this course.

Nonfinancial: Nancy Skinner has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 44 Minutes; Learning Assessment Time: 34 Minutes

The Centers for Medicare & Medicaid Services has indicated that 100% of traditional Medicare reimbursement will be value based by 2025. Healthcare professionals may not possess a clear understanding of value-based reimbursement strategies and the regulations adopted to support those strategies. Any gap in that knowledge and/or execution related to current healthcare reimbursement initiatives may negatively impact the financial viability of an organization and/or compromise the status of that organization within the community of practice.

This course will provide an overview of current quality metrics that are associated with value-based purchasing and alternative payment models introduced by the Centers for Medicare & Medicaid Services. Obtaining an understanding of these initiatives is important as reimbursement in the form of both incentives and disincentives is associated with both provider and payer accountability for the quality as well as the cost of provided care. This course is applicable to physical therapists, occupational therapists, speech-language pathologists, nurses, social workers, and case managers.

Meet Your Instructors

Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN

Dr. Colleen Morley has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management, and social services for more than 12 years and piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication, and population health…

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Nancy Skinner, RN, CCM, CMGT-RN, ACM-RN, CMCN, FCM

Nancy has, for the past 30 years, served as a case manager, director of case management, and international case management educator. In her current role as principal consultant for Riverside HealthCare Consulting, she advances programs that promote excellence in care coordination and other transitional care strategies. She has presented more than 400 on-site programs and…

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1. A Foundation for Quality Healthcare Delivery

In this chapter, we will define the key elements of quality and safety in healthcare delivery, referencing the seminal work Crossing the Quality Chasm from the Institute of Medicine. The discussion continues with a review of policy and regulatory mandates that advance quality of care across the care continuum. This also features an overview of the National Quality Initiative and the Triple Aim.

2. A Mandated Approach to Quality

In this chapter, we continue the quality discussion, focusing on legislative actions that impact healthcare delivery along the care continuum. Legislative actions that feature prominently in this section include the Affordable Care Act (ACA) and the IMPACT Act.

3. A Measured Approach to Quality

We will wrap up the discussion of quality in healthcare delivery with the identification of key metrics that are used to evaluate the quality of provided care through each transition of patient care. The discussion includes regulatory, accreditation, and consumer assessment models, with discussion regarding the ramifications of negative outcomes (readmissions, mortality, morbidity) and the importance of patient experience perspective at the varied settings of patient care.

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