Case Management is one of the most effective means by which a continuum of care functions effectively and efficiently. Murer Consultants has been an advocate of centralized case management for over 15 years. A number of important regulatory changes have occurred in the past 13 years, and there is now a new landscape of healthcare reform.
The case management team includes many more individuals than simply those with the title of “Case Manager”. The team must consist of any key clinical personnel including the nurse, the physician and the case management team, each of whom have specific roles. Administration also plays a role in assuring each member of the team is on board with the hospital’s or health system’s goal to assure that the patient is at the right place at the right time in their episode of care.
The key elements of our case management projects include:
- situational audit(s) to identify current status of existing post-acute venue options;
- identification of opportunities to enhance the infrastructure of the continuum of care;
- evaluation of discharge data, as well as those patients in house, to identify areas which can be addressed through education and process revision;
- implementation and/or revision of existing processes for more efficient and meaningful collection and use of information;
- development of a hospital profile to identify financial vulnerabilities resulting in lack of availability, or optimal utilization of post-acute venues to minimize the financial burden on the hospital for patients remaining in the acute bed beyond the DRG mean length of stay;
- consensus determination as to the scope of case management based on identification of diseases/venue management and payor mix structuring for management of capitated/risk patients;
- education and training of identified case management staff to assure uniformity of knowledge and expertise; and
- interviews and interaction with medical staff through multiple informal orientation sessions to identify and address physician concerns and suggestions as well as to assure accurate and consistent information as to the implementation of a case management system.
Case Management has become more important than ever with the imposition of reimbursement ramifications for re-admissions. Case management projects also include the evaluation and education on those re-admissions which will impact the hospital, as well as preparation for future additions to the current diagnoses at issue.
Murer Consultants has been effective in the training of every part of the case management team and has developed a 6-month ongoing education curriculum specifically developed for an institution or a system.
The principals of Murer Consultants (Cherilyn Murer, Michael Murer and Lyndean Brick) have also written two books regarding Case Management. The first, The Case Management Sourcebook (McGraw Hill, 1997), dealt with auditing existing models by implementing a centralized case management system, whether for a single hospital or an entire health system. The second book, The Case Management Workbook: Defining the Role of Physicians, Nurses, and Case Managers (Productivity Press, 2011), is a complete examination of the application of the continuum of care. This book defines the roles of the case management team and provides an overview of key post-acute venues of care.