Abstract
Cost-effective strategies must be developed to address the rapidly rising number of hospitalized older adults. Medicare cost outliers represent substantial unrecovered cost to hospitals caused by limited reimbursement based on diagnosis-related groups. A predictive model is used to identify potential cost outliers during admission, and a registered nurse inpatient case manager with geriatric expertise is the intervention to tailor the care to the unique needs of older adults. Community follow up is provided by social workers to complete the continuum. Positive outcomes from this project suggest that nursing can identify and successfully intervene with high-cost Medicare patients.
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