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May 05, 2024
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MHCM 5010 - Designing an Effective Care Continuum
Credit Hours: 1
This on-campus seminar focuses on patient transition from acute (e.g., community hospital, regional hospitals) to sub-acute (skilled nursing, rehab, LTCH) to home (home health, hospice, medical home model, outpatient services). It is an examination of challenges in care continuity, starting with basic access to primary care to ultimate issues dealing with length of stay, benefit days, and discharge planning to an appropriate level of care, as well as,the issues involved: family dynamics, physician/specialist coordination, and effective resource utilization by key healthcaremanagers and staff. A patient with at least 5 chronic health conditions (blood pressure, diabetes, lung disease, infection, kidney, etc.) can see up to as many as 10 different physicians directing care and not always in a coordinated fashion. A typical hospitalized inpatient (elderly, fragile) will have an admitting physician and at least 4 or 5 consulting specialists. Understanding the basics of the continuum of care at various levels, as well as impact of managed care on choice, length of stay, and where service is approved is addressed. The current directives for bundled payment initiatives and penalties for hospital re-admission will be discussed. This seminar covers post-acute services and how they are financed, and why coordination of patient transfer or handoff must be done so that readmission to the acute care hospital within 30 days does not occur.
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