Hello, and a very happy National Case Management Week to all of you!
Every case manager out there, nurse or social worker, has had to deal with a difficult discharge or two along their paths. Some days I think I could write a book about these cases, because honestly, you cannot make this stuff up!
There are two kinds of difficult discharges: medically fragile patients who are hard to place due to their complexity, and then what most of us know as social admissions.
Let’s tackle both: medically fragile patients are not easy to place, especially since most never appear stable enough to get to a least restrictive clinically appropriate next site of care. Many times we need to think about what will happen down the road for these patients and make sure we have had the appropriate goals of care discussions.
Sometimes you may think that such discussions will help us from kicking the can down the road, but honestly, when given an option to families, most are not in the medical field and just simply do not understand what “do everything” means. One of the more recent experiences we have had in attempting to combat this was actually a great campaign about patient wishes. Having those conversations before there is an emergency is the single most effective strategy there is. Because after all, the emergency room is just that – for an emergency, meaning no one planned to be there, and this sends minimally functioning families into dysfunction.
Now, let’s move on to the social admissions. I am not speaking about behavioral health here; those patients could be a whole other article!
Almost all of the social admissions we have seen were cases where patients were put in a bed because the emergency department (ED) is not equipped to handle the situation. We cannot blame the ED for this; they are the department that should be used to rescue emergent situations. They are not the department that should have to deal with social issues.
So, what can they do? They can try to find even a glimmer of a medical issue so that they can place the patient in a bed up on the unit. And then the clock starts ticking, the doctor is coming and will want the patient out!
My heart breaks for these patients, as do most hearts in case management. But the fact of the matter is: we cannot put these patients in a hospital bed! The beds need to be kept for those who need medical attention. So, what’s an ED to do? This is where I cannot advocate enough for social work in the ED and community health workers in the field.
They know their resources and are so resilient in creating a plan for these high-risk patients. And of course, each hospital really needs to work with its advocacy groups to get better community services out in the community to “catch” these patients.
I also want us to be very careful: many times the doctors in the ED and nurses are quick to say “social” admits. But please make sure that the caregivers truly listen to the family that brings in the so-called social admit.
Even a very minor urinary tract infection (UTI) can turn an elder’s life upside down! Some questions to consider: What happens when the family just drops grandma off and ghosts the hospital? All the while, we know that the family is spending her money!
Also, how do you suggest the case management teams get more involved at the state and national level, to advocate for these patients being affected?
EDITOR’S NOTE:
The opinions expressed in this article are solely those of the author and do not necessarily represent the views or opinions of MedLearn Media. We provide a platform for diverse perspectives, but the content and opinions expressed herein are the author’s own. MedLearn Media does not endorse or guarantee the accuracy of the information presented. Readers are encouraged to critically evaluate the content and conduct their own research. Any actions taken based on this article are at the reader’s own discretion.
Healthcare has been transitioning toward a more digital, interconnected ecosystem for many years, but the pace and magnitude of current changes represent a fundamental shift.
Among the many responsibilities of hospital case managers, none is more critical or more impactful than the initial discharge planning evaluation. Often referred to as
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
