Making your case
Explain roles, measures that affect caseload
In addition to giving your administration a list of roles, provide specific and detailed definitions and outline the functions your department performs for those roles, says Toni Cesta, RN, PhD, FAAN, vice president, patient flow optimization for the North Shore-Long Island Jewish Health System and health care consultant and partner in Case Management Concepts LLC.
For instance, your department may be responsible for utilization management but senior management may not know what that job specifically entails, she points out.
"List the specific functions your department performs under the role of utilization management, such as insurance reviews, concurrent and retrospective appeals, determining levels of care, and so on," Cesta says.
Determine who performs each role, whether it's a nurse case manager, a social worker, an appeals manager, or the director of the department, she says.
Optimal caseloads will be affected by your model design and the various role functions of the case managers.
Case management caseloads may be affected by staffing patterns, patient complexity, intensity of service, payer mix, length of stay, and use of technology, Cesta says.
If you have a higher percentage of patients covered under managed care, you're likely to be doing more reviews. If Medicare makes up a higher percentage of your patients, they're likely to need more complex discharge planning. A high percentage of Medicaid patients means more psychosocial issues to handle.
Length of stay can be a double-edged sword, Cesta points out. A shorter length of stay means a faster turnover and a shorter time to take care of patients' discharge needs. A longer length of stay typically means patients need more complex discharge planning.
In addition to giving your administration a list of roles, provide specific and detailed definitions and outline the functions your department performs for those roles, says Toni Cesta, RN, PhD, FAAN, vice president, patient flow optimization for the North Shore-Long Island Jewish Health System and health care consultant and partner in Case Management Concepts LLC.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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