Ties that bind now even tighter
Creation of role combines best of many worlds
As your job as case manager continues to evolve into other areas, you could one day find yourself in a role where your employer is no longer the hospital.
Case managers at The Ohio State University Medical Center in Columbus are called patient care resource managers (PCRMs) and work for both the hospital and a physician specialty group. The PCRM role combines the best of many worlds -- case management, quality improvement, patient care, and utilization management.
The program was piloted in April 1994 with one PCRM for nephrology, and since that time has continued to grow, says Carol A. Phillips, RN, MHA, one of three directors for patient care resource management. The facility and physicians now employ 38 PCRMs.
It was out of a task force's recommendation that the medical center should hire professionals with multiple skills that the PCRM position evolved. With integration on the horizon in their market, the hospital and physicians decided to move forward and, through this role, make a commitment to each other, Phillips explains.
The PCRMs are hired jointly by the hospital and physicians. Based on the job description, one of the hospital's three PCRM directors and the physician director who will be working directly with the PCRM negotiate how much of the PCRM's salary each will pay. "We usually start with the hospital paying 75% and the physicians paying 25% of the PCRM's salary and benefits. It is usually very clear what the partnership will entail, as the job description is agreed upon by both parties," says Gail March, hospital administrator.
Staff answer directly to the physician director and report indirectly to one of the PCRM directors. "The PCRMs are responsible directly to the physicians, but they have a dotted line reporting to us. We are not their managers, and we do not set their hours. We do make sure the service is covered and that their jobs are getting done," Phillips explains.
When beginning the working arrangement, service area needs are assessed carefully by the PCRM directors and physician directors. "We first meet with a particular physician, who might be the department chair or the department director of each service," Phillips says.
For instance, Phillips and the PCRMs met with the medical center's cardiologists and presented ways both the specialists and PCRMs could provide more efficient use of resources, improved patient education, and quality care, she says.
"Then we negotiate the job description. We start out with the generic job description, which includes the four main areas. Then we ask them what they would like to have help with. We ask them questions like, 'What can we put in here to make this specific to infectious disease?' and 'What would make you happy and help your patients?'" Phillips explains.
The physician directors then explain what they want to particularly concentrate on in their area. For example, directors from hematology expressed concern that "there was a big hole between the time patients were diagnosed in the clinic and the time they were admitted to the hospital. Furthermore, there was not a system in place for continuity of care between those two time periods, and that needed to be addressed, as well," says Phillips.
PCRMs help build a trusting relationship by conducting rounds with the physicians and becoming a part of the care team. As a result, the PCRMs know everything that's going on with the case. "The doctors trust them, and when [the PCRMs] say there's an alternative site for this patient, the doctors believe it," Phillips says. *
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