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 returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with ACMA President Patti Velky who joins us for Season 4, Episode 1 to share her insights on navigating complex patient transitions.The conversation revolves around three case studies highlighting the complexities of patient care transitions, medical necessity decisions, and systemic barriers in healthcare. The first case examines an elderly dementia patient experiencing frequent hospitalizations, emphasizing the challenges of coordinating care and determining the most appropriate long-term setting. The second case features a 30-year-old patient with severe neurological impairments and bowel obstruction, focusing on inpatient versus outpatient treatment decisions and the role of caregivers in medical management. The third case explores a medically complex patient facing insurance denials for a necessary procedure, underscoring the impact of documentation, coding issues, and advocacy in securing appropriate care. The discussion highlights the critical role of interdisciplinary collaboration, proactive care planning, and system navigation in optimizing patient outcomes.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, the conversation revolves around two case studies focusing on the complexities of patient care transitions, particularly in cases of urinary tract infections (UTIs) in patients. The first case discusses a 45-year-old female with a complicated medical history who required inpatient care due to severe symptoms and treatment complications. The second case involves an 80-year-old female with vague symptoms and a history of UTIs, raising questions about the necessity of inpatient care versus observation. The discussion highlights the challenges of medical necessity determinations, peer-to-peer reviews, and the importance of follow-up care in managing patients with UTIs.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 complex medical cases involving a tonsillar carcinoma patient and a refractory epilepsy patient. They explore the challenges of medical necessity determinations, the importance of thorough documentation, and the peer-to-peer process with insurance payers. The conversation highlights the intricacies of patient care transitions and the need for effective communication among healthcare providers to ensure optimal patient outcomes. 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, the conversation revolves around two complex medical cases, focusing on the challenges faced in patient care, particularly regarding insurance authorization and clinical decision-making. The first case discusses an elective arthroscopic knee procedure that led to complications and the subsequent management decisions regarding inpatient versus outpatient care. The second case highlights the struggles of a patient with severe cardiac issues seeking TAVR (transcatheter aortic valve replacement) and the hurdles faced in obtaining insurance approval for a medically necessary procedure. The discussion emphasizes the importance of collaboration among healthcare professionals to navigate these challenges effectively. 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, the conversation revolves around the complexities of case management, particularly focusing on a case involving a 14-year-old heart transplant patient and a 32-year-old male with a dental abscess. The discussion highlights the challenges in determining inpatient versus observation status, the importance of monitoring post-transplant complications, and navigating insurance requirements for medical necessity. The participants share insights on clinical decision-making, risk assessment, and the implications of payer policies on 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 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.