Monday, September 8

Main Conference Registration Check In • Exhibits • Continental Breakfast

Developing Key Outcome Measures for Hospital Case Management
Toni G. Cesta, PhD, RN, FAAN
One of the greatest challenges we face is how to best demonstrate case management’s value to our organizations. This session will review a variety of quality and financial outcomes affected by case management interventions. A case management report card will be included.

Documentation Liability for Case Managers
Elizabeth E. Hogue, Esq.
The old saying, “If It Wasn’t Documented, It Wasn’t Done,” still has important legal implications for case managers because they often have the burden of proving that legal and regulatory requirements have been met. What are some general principles related to documentation that should govern all case mangers? What are special documentation concerns for case managers/discharge planners? What are some potential pitfalls related to documentation for administrators? These are the questions to be addressed in this session.

Refreshment Break • Exhibits

The Relationship Between Discharge Planning and Utilization Review: Updates on Rules and Regulations and Implications for Case Management
Jackie J. Birmingham MS, BSN, RN, CMAC
Federal Rules continue to impact both the financing of health care and the delivery of health care services. The goal of appropriateness of health care delivery has never been more important for case managers. This session will address regulations that are promoting the intersection of utilization review and discharge planning into the case management day-to-day operations.

Reimbursement Update
Deborah K. Hale, CCS
The CMS’s ongoing changes to their reimbursement methodologies may leave you asking, “Now what??? This session will provide a high level overview of changes to CMS reimbursement policies for 2009.

Questions and Discussion
Faculty Panel

Lunch Break

Case Presentations of Patient Throughput/Patient Flow
Lee Ann Liska, MBA, FACHE
“With expected growth in patient volumes and limited ability to add additional space, University Hospital faced a challenging dilemma. See how this hospital transformed their approach to managing patient flow to overcome this challenge. The session will review| the systematic project taken to improve patient flow across the hospital with a focus on the modification of roles for Case Managers and Social Workers.”

Admission by Case Management Protocol
Deborah K. Hale, CCS
The Florida Case Management Protocol keeps cropping up across the country but lacks broad support from hospitals and regulators. This session will address the Pro’s and Con’s of the Case Management Protocol, who supports the protocol and who doesn’t.

Refreshment Break • Exhibits

The Case Manager’s Role in Core Measures
Karen Games, BSN, RN
Ronald L. Kaufman, MD, MBA, FACP, FACHE
As healthcare providers, we are clinically and fiscally responsible to protect our patients. Risk issues increase exponentially as the length of stay increases. Length of stay is a quality issue and not just a reimbursement concern. The objective for this topic is to demonstrate that length of stay is a core measure. We will examine the processes in place at several hospitals to incorporate length of stay into the quality program for the core measures.

Questions and Discussion
Faculty Panel

Adjourn

Tuesday, September 9

During each Concurrent Session, 5 topics are presented simultaneously in separate rooms. Sessions are limited in size. Choices are assigned in the order received. Indicate your selections on the Registration Form.

Hospital Finance 101
Brian Pisarsky, BS, RN, ACM, CPUR
Target Audience: Hospital Case Management Administrators and Case Managers
This joint session, offered in both programs will review the key financial elements that every Case Management Department should be monitoring. Included topics are how to design a nimble department that can roll with the ever-changing economic climate, demonstrate innovation in case management practice to support your organization’s key financial targets, and create a business case that demonstrates a return on investment for Case Management services.

Communicating with Your Physician Advisor
Karen Games, BSN, RN and
Ronald L. Kaufman, MD, MBA, FACP, FACHE
Target Audience: Hospital Case Managers
If you work in a case management department that has a physician advisor, this session is for you! Hear directly from a working physician advisor’s point of view, what information the PA needs to hear, when they need to hear it, and how best to use your PA to achieve success in your role as a case manager.

The Role of the Case Manager in Patient Safety
Hussein A. Tahan, DNSc, RN, CNA
Target Audience: Case Managers, Social Workers, Quality Professionals, and Managers of Case Management Programs
Case management activities are human-dependent, and humans are not infallible. Because errors are inevitable, safety of the patients we care for is a case manager’s priority. This session will discuss a set of case management activities that ultimately enhance/ensure patient safety. Examples will include transitions of care, handoff communication, multidisciplinary collaboration, and partnering with patients and their caregivers.

What Every Case Manager Needs to Know About Managed Care Contracts
Beverly Cunningham, MS, RN
Target Audience: Hospital Case Managers
Case managers and contracts … absurd? NOT in today’s healthcare industry. You must know what is expected to properly case manage your patients within the constraints of your contract. We will discuss the recitals in template contracts and whether or not you can efficiently manage the utilization of resources within contractual agreements as well as your involvement in contract negotiations.

Discharge Planning for Case Managers
Jackie J. Birmingham, MS, BSN, RN, CMAC
Target Audience: Hospital RN Case Managers, Discharge Planners and Social Workers
Federal rules on discharge planning apply to the transitioning of a patient to the next, most appropriate level of care. The Social Security Act §1861 (ee) will be discussed with practical tips on how to be patient centered and compliant at the same time.

Assessing Patients for Specific Post-Acute Levels of Care
Michelle Tipton-Burton, MS, OTR/L
Target Audience: Case Managers, various work settings
It’s important to ensure that patients progress through the continuum of care in a seamless, coordinated manner. Assuring that the “next” level of care is appropriate may help prevent readmission or a return visit to the emergency room. This session offers guidelines and tools that will help identify the individual’s needs and options to expedite transition to the most appropriate level of care. Various postacute care options and criteria will be discussed.

Understanding and Managing Readmissions
Brian Pisarsky, BS, RN, ACM, CPUR
Target Audience: Hospital Case Managers
This session will focus on describing the impact of readmissions on the healthy management of the hospital. Key topics will include how to identify your readmission rates, develop measurable readmission goals, examine the role of the “hospital to home” case manager and methods to track and celebrate your success.

Leadership Skills: Case Management Applications
Hussein A. Tahan, DNSc, RN, CNA
Target Audience: Case Managers, Social Workers, Managers of Case Management Programs, Educators
Case managers often find themselves managing teams, influencing others’ behaviors, resolving conflict, negotiating services and dealing with challenging people. To ensure effective performance, these responsibilities require outstanding leadership skills. This session will describe an effective model of communication, discuss tactics for handling toxic behaviors and conflict management, and identify tips for successful communication.

Telework Forum: Case Management from Home
Susan Erickson, MPH, RN
Target Audience: Case Managers, Social Workers and Directors of case management from any setting who telecommute, or who are interested in telecommuting
An increasing number of nurses now provide case management services telephonically from home. This session will explore how to optimize this form of case management practice, and will provide strategies for implementing and managing virtual communities. Case managers who are seasoned teleworkers and those who are new or interested in this practice are encouraged to share their experience and questions in an interactive forum.

The Revenue Cycle: Managing Your Denials and Appeals
Beverly Cunningham, MS, RN
Target Audience: Hospital Case Managers
A key component to the revenue cycle is effective management of denials. Assuring a low denial rate is an outcome of effective case management and patient access processes, as well as understanding payer strategy in assigning denials. This session will give the case manager tools to both identify causes of denials, as well as to develop a plan for addressing ineffective processes which result in denials.

Engagement, the Behavioral Side of Positive Patient Outcomes
Craig R. Wiese, PhD
Target Audience: Any
This presentation will address an integrative approach to engage and empower our most challenging patients to be better involved in their treatment. Meeting patients where they are in relation to their acceptance of their illness, allows us to more appropriately stage them in a behavioral change process. Our choice of language shapes the process of change and leads to better patient self adherence outcomes. Practical strategies, examples and case discussions in smaller groups will help demonstrate the points.

IM-DN-HINN: Untangling The Overlapping Regulations
Jackie J. Birmingham, MS, BSN, RN, CMAC
Target Audience: Hospital-Based Case Managers and Social Workers
The important message (IM) and detailed notice (DN) regulation has a specific purpose and is tied to the Hospital Issued Notice of Non-coverage (HINN related to a patient’s potential financial liability). This session will cover the IM and the Detailed Notice as they relate to HINNs.

Recovery Audit Contractors: What Are They and How Will They Affect Your Practice?
Deborah K Hale, CCS
Target Audience: Case Managers, Utilization Review Nurses, Case Management Administrators, Compliance Officers, Revenue Cycle Managers
Recovery Audit Contractors have successfully returned $371 Million to the Federal Government by identifying billing errors during a three state pilot project. By 2010 RAC’s will be in place nation wide. Target areas include admission necessity, 3-day stays with transfer to SNF, Inpatient versus Outpatient surgery. This session will help the hospital perform a RAC risk assessment and develop a plan of action.

Documentation Strategies for Case Managers: What Do We Document and How Often
Karen Games, BSN, RN
Ronald L. Kaufman, MD, MBA, FACP, FACHE
Target Audience: Case Managers, any setting
The objective for this presentation is to clarify what case managers must document to meet regulatory guidelines and ensure compliance. Also, what needs to be documented to ensure prompt and accurate payment from payers. Today’s ever evolving healthcare industry mandates clear, concise and complete documentation … documentation is here to stay … so know what is needed? If not, join us!

Case Management for the Uninsured
Donna J. Zazworsky, MS, RN, CCM, FAAN
Target Audience: Case Managers, any setting
The uninsured population continues to grow at alarming rates. This session will discuss the complex issues that case managers face when working with individuals and families who are uninsured. This session will review the demographics and identify resources and strategies that are available to help the uninsured obtain services.

Community Case Management: New Reimbursement Structures
Donna J. Zazworsky, MS, RN, CCM, FAAN
Target Audience: Case Managers working in the community and outpatient settings
This session will explore new reimbursement models for case managers who are addressing chronic disease issues in the community and outpatient settings. This session will discuss the clinical applications and business aspects needed for sustainability.

Melding the Roles of Social Worker and Nurse Case Manager
Richard J. Zaino, LCSW
Target Audience: Case Managers and Social Workers
This presentation will focus on how the changes and challenges of case management impact on discharge planning today. The discussion will explore different processes that discard the old dichotomy theories and practices and highlight the new synergy of collaborative practice.

Emergency Department Case Management
Karen Games, BSN, RN
Target Audience: Hospital Case Managers, ER Managers, Discharge Planners
Discharges begin on admission … or before? Call it what you will “Gatekeeper”…“Bed Czar” Case management review for medical appropriateness to ensure all patients meet criteria and are placed in the appropriate admit status improves patient care, encourages appropriate admissions and decreases lost revenue. We will review how Emergency Department Case Management ensures compliance with federal and state mandates and monitoring programs that today’s hospitals are facing. We will discuss how Emergency Department Case Management reduces costs, promotes quality of care and enhances patient satisfaction.

Depression Recognition, Screening and Case Management
Craig R. Wiese, PhD
Target Audience: Behavioral Case Managers and other Case Managers addressing chronic condition populations.
Major depressive disorder affects approximately 10 % of the general population in any given year, and between 20-40% of the population challenged with one or more chronic conditions. Often the symptoms of depression are overlooked in medical settings but with identification and treatment, we can achieve an 80% remission rate. These contrasts point to the need for early screening and appropriate referrals. This presentation will use discussion and case presentations to address types of screens, secondary gains from screening and how to engage in a discussion with various types of patients who show signs of depression.

Case Management Roles and Functions
Toni G. Cesta, PhD, RN, FAAN
Target Audience: Hospital-Based Case Managers
Case managers take on a variety of roles and functions in their organizations. This session will explore the various functions we perform and how best to apply them. Also included will be the roles and functions of the social worker within a case management model.

Wednesday, September 10

Nurse Navigators, Clinical Nurse Leaders and Other Emerging Nursing Roles: Implications for Case Management Practice
Susan Erickson, MPH, RN
New nursing roles have emerged over the past few years that have job functions that are related to closely held tenets of case management practice. This session will explore the potential impact of these new roles on case management, and describe how case managers can partner effectively with nurses in these roles to ensure that they enhance key aspects of case management practice.

The Chronic Care Model: Managing Chronic Disease Across the Continuum
Donna J. Zazworsky, MS, RN, CCM, FAAN
The Chronic Care Model provides a blueprint for addressing chronic disease management in our health care systems. The session will discuss the principles and applications of case management across the continuum in this evidence-based model.

Refreshment Break

Need for Speed...Technology As a Tool to Energize Case Management Practice
Jeanine M. Tome, MSN, RNC, ACM, CPHQ
Technology adoption in health care is gaining momentum as the “need for speed” in processing clinical information accelerates and health care is debated on the national agenda. Traditional means of paper based work flow conflict with the needs for intense focus on cost, quality and patient safety. Discuss strategies for case managers to discover a new found expertise with technology support, and a future view for this “return on investment” in case management practice.

Clinical Challenges: Creative Solutions for Difficult to Discharge Case Scenarios
Toni G. Cesta, PhD, RN, FAAN
Jackie J. Birmingham, MS, BSN, RN, CMAC
Karen Games, BSN, RN
Richard J. Zaino, LCSW
Donna J. Zazworsky, MS, RN, CCM, FAAN
This exciting session allows the participants to come prepared to share their most difficult and challenging patient discharge scenarios! With the use of the panel’s expertise, creative solutions to your most challenging patient situations will be provided!!!!

Questions and Discussion
Faculty Panel

Conference Summary and Evaluation

Adjourn