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Recent Changes in the Innovative Postanesthesia Care Unit Gatekeeper Role

Coulter, Elaine RN, BSN, MHA, CNE; VanGelder, Mary Elizabeth RN, BSN, MRE

Professional Case Management:
doi: 10.1097/NCM.0000000000000048

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.

Author Information

Elaine Coulter, BSN, RN, MRE, is a Case Manager in the PACU at the Mayo Clinic Hospital in Phoenix, AZ. Her experience includes a variety of nursing roles that encompass ICU/CCU, Home Health, UM, and Case Management. In addition, she is an adjunct Nursing Instructor in the College of Nursing at the Grand Canyon University in Phoenix, AZ.

Mary Elizabeth VanGelder, RN, BSN, MHA, CNE, has nearly 30 years of recent operating room nursing experience in both scrubbing and circulating and brings a strong surgical background to the PACU Case Management team at the Mayo Clinic Hospital in Phoenix, AZ. Prior to this role, she worked as a Case Manager at St. Luke's South in Overland Park, KS.

Address correspondence to Mary Elizabeth VanGelder, RN, BSN, MRE, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ 85 054 (

The authors report no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.