Physician-aligned case management improves efficiency and cuts LOS
Partnership ensures that patients get the right treatment at the right time
INTEGRIS Rural Health (IRH), based in Oklahoma City, has been able to cut its systemwide average length of stay by at least a day across its eight-hospital system by implementing a physician-aligned model of case management.
In a physician-aligned case management model, the case manager is assigned to work with patients of a specific group of physicians and partners with each physician to get the patient through the hospital stay as efficiently as possible, removing any barriers that may delay care and ensuring that the patient is at the appropriate level of care.
"In addition to providing the best level of care for our patients, the teamwork between our physicians and case managers generated a lot of savings by providing better utilization of our services," says Denise Caram, MS, CPUM, CPUR, director of support services for IRH.
The model, established about three years ago, is so popular with physicians that when the hospital surveyed them, 95% reported that the case managers help make their jobs easier, Caram says. Since the model was established, the case management departments at some of the hospitals actually have been able to add staff because management has seen an increase in reimbursement along with the decrease in length of stay, she adds.
In a physician-aligned model, the case manager is the physician’s "right-hand person," says Carol Reeder, RN, BSN, MSA, a consultant with McCaw Park, IL-based Cardinal Health Consulting & Services, who helped IRH establish its case management model. Ideally, a case manager works with a single group of physicians and has a clinical background that is pertinent to the physician’s practice, she adds. For instance, a nurse assigned to a group of cardiologists would have an understanding of the clinical perspective and overall expectations for patients receiving cardiac care.
Case managers follow the patients throughout the hospital stay no matter where they are placed.
"The case manager knows the patients and understands their needs because they work with the same physician groups," Reeder says. "The patients and their families get to know the case manager and utilize the case manager as a resource and coordinator of care." The case manager helps coordinate the care of the patient in the hospital by identifying when other disciplines, such as physical therapy, social work, or home health need to be consulted, when a less intense level of care may be appropriate, and by arranging for the discharge needs of the patient, she says.
The case manager makes sure that when the physician makes rounds, he or she has current and complete information about each patient, such as diagnostic studies and lab results, so he or she can make informed decisions.
"This allows patients to be moved to less intense levels of services as soon as it’s appropriate, thus opening beds for new, more clinically complex patients," Reeder says. In addition, having current, timely information available to the physician helps with clinical reviews for continued stays and may decrease reimbursement denials, she adds. "If we can reduce the barriers that are there, we can get efficiency of cost, and all those good things will follow, but that cannot be the initial focus."
A partnership between case managers and physicians can dramatically improve patient care as well as helping physicians, Reeder says. "Case managers are in so many areas of the hospital that they are able to identify potential barriers to the patient moving through the system."
For instance, when lab reports aren’t available on time, the physicians are frustrated because they don’t have the information they need to evaluate the next step for the patient.
Reeder also suggests weekly interdisciplinary meetings with all ancillary departments to discuss moving patients through the continuum. The cases discussed during these meetings would depend on what cutoff the hospital selects. It could be length of stay or patients whose care has reached a certain dollar amount. "The team should look at issues that are prolonging the stay to see if there is something as an organization that can be done to help move the patient along. Sometimes the patients are just extremely sick. In those cases, we look at whether specialists have been called in."
The medical director for case management typically runs the weekly meetings. Physicians are always welcome at the meeting. If a particular patient has been a long-term problem, Reeder recommends inviting the attending physician to be present. "Sometimes just hearing questions asked by various disciplines can help a doctor come up with a new strategy," she says.
Physicians at IRH hospitals have welcomed the new model, Caram adds. "The physician see the advantages of having someone help them make the referrals to long-term care if needed. They see the case managers working with the family members on social needs and making sure end-of-life issues are taken care of."
INTEGRIS Rural Health (IRH), based in Oklahoma City, has been able to cut its systemwide average length of stay by at least a day across its eight-hospital system by implementing a physician-aligned model of case management.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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