title: Recent changes in the innovative postanesthesia care unit gatekeeper role.
abstract: OBJECTIVE
  This article responds to issues raised to . 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.
  
  
  METHODS
  Hospital PACU.
  
  
  CONCLUSIONS
  The increased yearly savings demonstrated by the PACU case management gatekeeper role has substantiated this essential hospital role.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Elaine
authors.initials: E
authors.lastname: Coulter
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: VanGelder
mesh_terms: D000556:Ambulatory Surgical Procedures; D001130:Arizona; D019090:Case Management; D004496:Education, Continuing; D006278:Medicare; D009936:Organizational Innovation; D010343:Patient Admission; D010351:Patient Discharge; D016528:Postanesthesia Nursing / Q000191:economics; D012017:Referral and Consultation; D014481:United States; D000078329:Workforce