2013 CMS Oct 24 Enduring

Self Study Course Description

Hospital Utilization Review & Discharge Planning Standards

Course Faculty
Sue Dill Calloway, RN, MSN, JD, CPHRM, CCMSCP
President, Patient Safety Education and Consulting
Dublin, Ohio

Type of Activity: Enduring Event/Web-Based Training
Release Date: October 25, 2013
Expiration Date: May 30, 2014
Estimated Time to Complete Course: 1.5 hours

There is no fee associated with this educational activity.

Target Audience: Physicians, Nurses, Administrators, QM Staff, Risk Managers, and other interested Health Care Providers

Course Overview
This program will cover the CMS (Center for Medicare and Medicaid Services) hospital Conditions of Participation regulations on Utilization Review and Discharge Planning. Every hospital that accepts Medicare and Medicaid reimbursement must be compliance with these standards.

Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmission now receive less money from CMS which started October 2012. In fact, hospitals forfeited 280 million dollars because of having higher than expected readmission. This is why there will be increased surveillance activity in the area of discharge planning.

It is important to establish medical necessity especially in light of the RAC program so hospitals do not have to pay back money. So what’s in your UR plan? Does your hospital have a contract with your state QIO? What are you doing in the area of discharge planning especially to reduce unnecessary admissions?
CMS has also issues three revised worksheets (third revision) that would be completed if they show up at the hospital. One of the worksheets covers extensively the area of discharge planning. It covers discharge policies and procedures, discharge planning process, discharge plans, discharge planning evaluations, and more! This is a very important document for hospitals.

Do you make sure the primary care physician has a copy of the discharge summary before the first post hospital visit? Was the patient’s follow up appointment scheduled before the patient left the hospital? Come learn what other important things CMS has in their revised worksheet on preventing hospital readmissions!!

Learning Objectives
After completing this activity, the participants will be able to:
1. Recall that CMS has utilization review standards that hospitals should be aware of.
2. Discuss how Joint Commission has changed their leadership standards to require a UR plan and UR committee.
3. Discuss how one in every five Medicare patients is readmitted within 30 days of discharge and many suffer adverse events.
4. Describe recommendations for hospitals to reduce unnecessary readmissions.
5. Recall that CMS has discharge planning standards that every hospital must follow.
6. Discuss CMS recommendations for discharge planning teams to use a checklist to make transfer more efficient.
7. Discuss the published CMS proposed worksheet on discharge planning.

Criteria for Successful Completion
• Registration is required for verification of attendance.
• Attend the webinar in its entirety.
• Complete the web-based Course Evaluation.
• Complete the online Post-Test with a passing score of 75%.
• CSC will send you a CE Certificate upon successful completion. Note: you will be notified to retake the post-test if your score is below 75%.
Accreditation: The Indian Health Service (IHS) Clinical Support Center is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The IHS Clinical Support Center designates this enduring educational activity for 1 hour of AMA PRA Category 1 Credit™ for each hour of participation. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The Indian Health Service Clinical Support Center is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is designated 1.5 contact hours for nurses.

Accreditation applies solely to this educational activity and does not imply approval or endorsement of any commercial product, services or processes by the CSC, IHS, the federal government, or the accrediting bodies

Faculty Disclosure Statement: As a provider accredited by ACCME, ANCC, and ACPE, the IHS Clinical Support Center must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course directors/coordinators, planning committee members, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. The course directors/coordinators, planning committee members, and faculty for this activity have completed the disclosure process and have indicated that they do not have any significant financial relationships or affiliations with any manufacturers or commercial products to disclose. There is no commercial or non-commercial company financial support for this educational activity.

Email ihscsc@ihs.gov if you have any questions or need assistance.

You may review the IHS Privacy Policy at http://www.ihs.gov/privacy_policy.asp and the Survey Monkey Privacy Policy for details on how user information submitted in the evaluation is protected (http://www.surveymonkey.com/mp/policy/privacy-policy/). Your information will be kept confidential when you participate in a CE Internet based program. The information collected is necessary to provide you with the appropriate CE credits for your participation.
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