Case Management Report Cards Keep it Simple, Keep it Clear
By Toni Cesta, PhD, RN, FAAN
Senior Vice President
Lutheran Medical Center
Brooklyn, NY
The report card that begins below is an example of a method for aggregating and reporting all the measures that we have reviewed in the last two issues.
The sections included in this exemplar are length of stay, denials, avoidable delays, and discharge planning. The first column includes the categories with detail below each label. The next column includes the baseline, target, and month's data. The baseline should be the prior year's performance in that metric. The target should be this year's goal, and the month's data is the actual metric achieved for the month being reported.
This report card serves as an example only. You should consider adding or deleting from this as needed based on the data you are collecting.
You might also want to consider an executive summary of the data that explains those outcome metrics that performed poorly for the reporting month with an explanation as to why.
Regardless of which measures you use, be sure they are clear, measurable, and accurate.
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HOSPITAL NAME |
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BASELINE |
TARGET |
MONTH |
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LENGTH OF STAY |
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ALOS |
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Medicine |
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Surgery |
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# of Patients with LOS 7-10 days |
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% of Total Discharges |
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# of Patients with LOS > 10 days |
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% of Total Discharges |
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DENIALS BY REASON IN DAYS PENDING |
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BASELINE |
TARGET |
MONTH |
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CONCURRENT |
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Medical necessity on admission |
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Continued Stay |
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Delay in service |
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Late notification |
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Clinical info not provided |
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Appropriateness of setting |
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| RETROSPECTIVE | |||
| Medical necessity on admission | |||
| Continued Stay | |||
| Delay in service | |||
| Late notification | |||
| Clinical info not provided | |||
| Appropriateness of setting | |||
DENIALS BY REASON IN DAYS OVERTURNED |
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BASELINE |
TARGET |
MONTH |
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CONCURRENT |
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Medical necessity on admission |
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Continued Stay |
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Delay in service |
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Late notification |
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Clinical info not provided |
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Appropriateness of setting |
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| RETROSPECTIVE | |||
| Medical necessity on admission | |||
| Continued Stay | |||
| Delay in service | |||
| Late notification | |||
| Clinical info not provided | |||
| Appropriateness of setting | |||
DENIALS BY REASON IN DAYS UPHELD |
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BASELINE |
TARGET |
MONTH |
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CONCURRENT |
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Medical necessity on admission |
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Continued Stay |
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Delay in service |
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Late notification |
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Clinical info not provided |
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Appropriateness of setting |
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| RETROSPECTIVE | |||
| Medical necessity on admission | |||
| Continued Stay | |||
| Delay in service | |||
| Late notification | |||
| Clinical info not provided | |||
| Appropriateness of setting | |||
INPATIENT THROUGHPUT |
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BASELINE |
TARGET |
MONTH |
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Avoidable days due to no sub-acute vent bed available |
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Avoidable days due to no sub-acute vent/dialysis bed available |
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| AVOIDABLE DAY REASONS — FACILITY/SERVICE LINE | (OCC/DAYS) |
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| MRI | |||
| EEG | |||
| ECHO | |||
| CT | |||
| Cath | |||
| Radiology/X-ray | |||
| Vascular lab | |||
| Vascular surgery | |||
| Stress test | |||
| Physical therapy and PT consult | |||
| GI procedure and/or colonoscopy | |||
| OR booking and/or cancel OR booking | |||
| AVOIDABLE DAY REASONS RESOURCE | (OCC/DAYS) |
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| Guardianship | |||
| No aide available for home health care | |||
| No nursing home bed available | |||
| Ed issue inappropriate admission | |||
| AVOIDABLE DAY REASONS PATIENT/FAMILY | (OCC/DAYS) |
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| Family refuses | |||
| Family unable to pick patient up at discharge | |||
| Patient non-compliant | |||
| Patient refuses test/procedure | |||
| Unable to reach family | |||
| Pending custodial care | |||
| Family delay in Medicaid application | |||
| Guardianship/conservatorship issues | |||
| Difficulty with decision making | |||
| AVOIDABLE DAY REASONS PAYER | (OCC/DAYS) |
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| Delay in approval | |||
| Delay in discharge | |||
| Delay in processing forms | |||
| Insurance issues | |||
| AVOIDABLE DAY REASONS PROVIDER | (OCC/DAYS) |
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| Patient not acute, MD refuses discharge | |||
| Inappropriate transfer from another hospital | |||
| Consult delay | |||
| Decision-making delay | |||
| Delay in medical clearance | |||
| No consent for treatment | |||
| Delay in surgery | |||
| Awaiting procdure/ none specified | |||
| Preadmission issue | |||
| Delay in GI procedures | |||
| Delay in coordination of services | |||
| AVOIDABLE DAYS TOTAL | |||
DISCHARGE PLANNING |
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| Completion of initial assessment/discharge plan within 24 hours |
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|
REFERRALS TO POST-ACUTE CARE |
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Home w/No Services (as % of discharges) |
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Home Care (as % of discharges) |
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Acute Rehab (as % of discharges) |
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Sub-acute rehab (as % of discharges) |
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Sub-acute medicine (as % of discharges) |
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| Sub-acute vent (as % of discharges) | |||
Long Term Care (as % of discharges) |
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The report card that begins below is an example of a method for aggregating and reporting all the measures that we have reviewed in the last two issues.
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