Care Transitions Today

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, the physicians discuss two complex medical cases involving patient transitions and payer denials. The first case involves a 66-year-old male with significant eye trauma and multiple comorbidities, leading to a complicated hospital stay and subsequent denial from the payer. The second case focuses on a patient with atrial fibrillation undergoing drug loading, where the necessity of inpatient care is debated. The discussion highlights the challenges of navigating payer requirements, and the importance of thorough documentation and peer-to-peer appeals in ensuring appropriate patient care.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field. APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, the participants discuss two medical cases and the decision-making process for inpatient versus outpatient care. The first case involves a patient with cord compression and the need for surgery. The second case involves a patient who was scheduled for a TAVR procedure but it was aborted. They also discuss the billing and coding implications of these cases.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, the physicians discuss two cases and whether they should be classified as inpatient or outpatient. The first case involves an 86-year-old patient with bilateral lower lobe pneumonia and hemoptysis. The team believes it meets the criteria for inpatient status, but the medical director denies the claim due to the lack of hypoxia. The consensus is to suggest appealing the denial and having a peer-to-peer discussion to present the case's complexity. In the second case, a six-month-old with short gut syndrome and a viral illness is admitted for observation and antibiotic treatment. The team calls it inpatient, but they anticipate potential denial due to the short length of stay. They emphasize the need to educate payers on the unique considerations for pediatric cases.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this episode, Dr. Rebecca Severe brings two interesting cases to the conversation. The first case involves an 87-year-old patient with slurred speech and dizziness. The patient was admitted for further monitoring and neuro workup. The second case is also an 87-year-old patient with untreated lymphoma who presented with generalized weakness and multiple falls. The patient had hypercalcemia and acute kidney injury. Both cases were initially denied, and the discussion revolves around the appropriateness of inpatient care and the challenges of appealing denials.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

This conversation features a complex case involving a 56-year-old man with chronic pancreatitis and multiple comorbidities, admitted for intractable pain. The case highlights the challenges in obtaining inpatient designation and navigating insurance denials, even when clinical judgment suggests the need for hospitalization. The episode underscores the complexities of managing patients with chronic conditions, the challenges of working within insurance guidelines, and the importance of persistent advocacy for appropriate patient care.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this episode, we delve into a multifaceted case involving a 76-year-old patient with a history of coronary artery disease, heart failure, and multiple comorbidities. The discussion highlights the intricacies of managing Medicare Advantage plans, justifying extended inpatient stays, and addressing payer resistance. Additionally, the episode shifts focus to the challenges of handling out-of-network denials, illustrated by a case of a 43-year-old female with a complex ankle injury and subsequent cardiac issues. The podcast shares insights on navigating out-of-network claims and ensuring appropriate care despite payer restrictions.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, two medical cases are covered, each with complex patient care and payer denials. The first case is a 57-year-old male with a severe rash and lower extremity edema, while the second case involves a 64-year-old male with Huntington's disease presenting with acute confusion and elevated blood sugars. Both cases required careful consideration of medical necessity and utilization of resources to justify inpatient stays.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School

In this conversation, the physicians focus on two patient cases. The first case covers a 42-year-old female who had a total knee replacement and developed a wound dehiscence and infection. The question arises whether the patient should be admitted as an inpatient or placed under observation. The second case is a riveting dialogue regarding a 75-year-old female with relapsed IgG lambda multiple myeloma who requires 48 hours of monitoring after each dose of a new immunotherapy medication. The dilemma is whether this patient should be admitted as an inpatient or placed under observation.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School

In this conversation, the physicians focus on two patient cases. The first case is of a 66-year-old female with a history of COPD and ovarian cancer who presented with increased shortness of breath. The physician advisor had to argue for the medical necessity of the hospital stay, focusing on the treatment of pneumonia. The second case discusses a 74-year-old female with hyponatremia and dizziness. The physician advisor had to argue for the inpatient level of care based on the severity of illness, utilization of resources, and medical necessity.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by two physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health and Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School.

In this conversation, Rebecca and Sweta discuss two patient cases and the determination of level of care. The first case is a 36-year-old male with a history of spinal cord injury and bilateral above knee amputation. The patient presented with weakness and flank pain and was found to have a high white blood cell count. The speakers discuss whether the patient should be classified as inpatient or observation status. The second case involves an 82-year-old male with a history of abdominal hernia repair. The patient presented with increased abdominal pain and respiratory distress after a CT scan. The speakers discuss whether the patient should be admitted as inpatient or observation status, considering the possibility of an allergic reaction to contrast.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.