Delegate clerical functions and free up professionals’ time
Case management extenders can maximize time of licensed staff
Delegating nonprofessional functions to a clerical staff can help improve your productivity as a case manager and give your licensed clinical staff more time to spend with patients, according to some case management experts.
Case managers are highly trained professionals, but in many cases, based on the requirements of their job, they are providing clerical activities such as faxing insurance reviews and other documents for discharge planning, copying charts for patient transports, logging in data at the end of the day, and spending time on the phone with insurance companies or ancillary departments.
"These are duties that could be more efficiently accomplished by a clerical assistant, allowing the case manager to have more time for face-to-face interactions with patients and physicians, intervening to prevent delays, planning and preparing patients for discharge, holding interdisciplinary conferences for complex discharge planning, and assuring appropriate documentation," points out Teresa Fugate, RN, BBA, CPHQ, CCM manager at Pershing, Yoakley & Associates, a Knoxville, TN-based health care consulting firm.
As she visits other hospitals as a consultant, Toni Cesta, PhD, RN, FAAN, vice president of patient flow optimization at North Shore-Long Island Jewish Health System in New York City, often encounters case managers who are frustrated that they have to spend their time faxing, copying, and ordering durable medical equipment.
"These are highly paid professionals who are doing functions that keep them away from the patients. It has never made any sense for them to spend their time that way," she says.
Cesta recommends a model in which one clerical person supports five to seven case managers and is cross-trained to do whatever needs to be done.
"It’s a matter of getting the right people in the job, setting up the structure properly, and training them," she explains.
At Cesta’s hospital, the clerical staff are entry-level people who are a notch below the secretarial staff.
"It’s helpful if you can hire people who have worked in utilization review or the social work department, but you may not be able to find them. They will need training if they haven’t worked in health care in the past," she says.
Most of the training for clerical staff can occur on the job if an experienced clerk is available.
Look for people with good organizational skills and good communication skills since they are the ones who will talk to people outside the hospital and represent your department.
"Clerical staff have a lot to do, but what they do is not complicated," Cesta says.
Utilizing LPNs as case management assistants can reduce the cost of staff since they are paid at a lower rate than RNs or social workers, Fugate says. These staff can perform utilization management reviews, call in clinicals to the insurance company, perform simple discharge planning activities, and assist the case manager in other daily activities, she says.
While adding nonclinical staff to the case management department will help maximize the value of the professional staff by freeing them up to do tasks that require the kind of training they have, there are some pitfalls to bringing new staff in new roles into a department, Cesta says.
It’s likely to take some time for the clerical staff to demonstrate their competency and develop a trusting relationship with the case management staff, she warns.
"Some case managers don’t want to give up control. It takes time for them to let go of things and to develop a level of confidence in the clerical staff," Cesta says.
Conversely, be careful that your case managers don’t develop so much confidence and trust in the clerical staff that they turn over work to them that should be left to the clinical staff.
Typically, case management departments are understaffed, and there is the possibility that professional staff are so overwhelmed that they are tempted to offload some of their work to the extenders, Cesta says.
"Once they develop a trusting relationship with their extenders, case managers may be tempted to ask the clerical staff to do jobs that they are supposed to do," she says.
If you do hire extenders in any capacity, make sure they don’t overstep their bounds and perform tasks that should be done by licensed professionals, Cesta suggests.
For instance, Medicare’s conditions of participation specify which tasks should be done by the professional staff.
If the extenders are involved in anything that requires a professional’s sign off, make sure they are closely supervised, Cesta advises.
There are a lot of variations in the kind of jobs that case management extenders do and what kind of people are hired to fill the slots, Cesta points out.
Whatever kind of staffing you decide on, develop clearly defined roles and clear expectations so that everyone knows what his or her responsibilities are, she advises.
"There should be a job description that clearly supports the role function. Make sure that the professional staff doesn’t blur the line," Cesta says.
Many hospitals are turning toward case management extenders to improve efficiency and effectiveness. Hospital Case Managementtalked to case management directors at four hospitals. In the following case studies, we’ll discuss what they do.
Delegating nonprofessional functions to a clerical staff can help improve your productivity as a case manager and give your licensed clinical staff more time to spend with patients, according to some case management experts.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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