Abstract
Purpose/Objectives: This article responds to issues raised to M. E. VanGelder and E. Coulter (2013). Focused areas of this article include (a) a review of the gatekeeper role in the postanesthesia care unit (PACU) at the Mayo Clinic Hospital in Phoenix, AZ, (b) clarification of the Medicare Inpatient Only list, (c) a review of how the Mayo Clinic Hospital schedules a Medicare same-day procedure, (d) preadmission orders, (e) postadmission procedure orders for outpatient in a bed and observation status and inpatient, (f) case examples, (g) amplification of the Medicare Two-Midnight Rule, and (h) emerging hospital billing issues.
Primary Practice Setting: Hospital PACU.
Findings and Conclusions: The increased yearly savings demonstrated by the PACU case management gatekeeper role has substantiated this essential hospital role.
Implications for Case Management: The PACU case management position will become more important in the future because of rapid changes regarding surgical reimbursement to hospitals. Unit case managers must collaborate with PACU case managers to become familiar with new reimbursement models. The development of new strategies for accurate compensation will be mandatory throughout the hospital continuum.