All Entries Tagged With: "director of case management"
The four R’s build a strong case management team
The following post was written by Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, MBA, senior director of case management services for the Kindred Healthcare Hospital Division in Westminster, CA. It first appeared in the April issue of Case Management Monthly.
The case management workforce is aging, and the next generation of RNs essentially has its choice of professional paths and work sites in which to pursue them. However, the number of case management candidates is dwindling, and recruitment and training costs are rising.
Kindred Healthcare’s long-term acute care (LTAC) hospitals use the four “R’s”—recruit, retain, renew, recognize—to recruit and retain quality case management candidates while renewing each case manager’s commitment to the field by offering education opportunities and recognizing achievements.
Recruit
The August 2010 Case Management Monthly described the partnership between Kindred Healthcare and the Samuel Merritt University’s masters program in nursing case Management (MSN/CM). Since then, three graduates have completed Kindred’s six-month case management mentorship program.
The relationship between the hospital and the university in Oakland, CA, has created a pipeline of highly trained case managers who begin their careers with an organization that supports higher competencies. This year, Kindred will hire additional MSN/CM graduates to participate in the mentorship program.
Retain
Kindred is developing an alliance with American Sentinel University’s MSN/CM online training program to offer a career ladder program to existing Kindred case managers. Career ladders and succession planning strengthen the competencies of current case management employees through enhanced training and opportunities for professional growth.
Facilities can take the pulse of their staff through an annual case manager opinion poll, and monitor external market movement and salary competitiveness through surveys. These surveys promote retention through responsiveness to program design and help the facility stay competitive.
Renew
Kindred also joined the Case Management Society of America’s (CMSA) Career Consortium think tank to develop ideas for earlier access to careers, education, and training. CMSA plans to partner with Kindred West Region in development of a pilot case manager career ladder project using CMSA’s online courses. The courses help improve leadership skills and count toward certification.
By contributing to CMSA and other professional affiliations, Kindred shows potential hires its commitment to their professional growth.
Recognize
Internal and external awareness of each case manager’s success stories and outcomes contributes to the growth of the profession and the public’s awareness of the value of case management. Leaders should seek opportunities to address local organizations and publish success stories in industry journals. Encouraging such publication illustrates management’s recognition of the individual’s efforts and helps case managers recognize their effect on patient care as well.
Salary survey results suggest that the economy is on the rebound
The results of the 2011 Case Management Monthly salary survey are in and I am in the process of analyzing the results. We received more than 700 responses from RN case managers (51%), social work (SW) case managers (10%), case management directors (23%), and case management managers/supervisors (16%) from all over the country.
One of the first things I noticed when looking at the figures is that more than half of the respondents (70%) indicated that they received a raise in the last 12 months. That number is up 8% from last year’s results, which could suggest that the struggling economy is on the mend. Of those who received a raise, 42% received a 2% pay increase, 33% received a 3% increase, and 12% received an increase of 1% or less.
A majority of the respondents (70%) also work more than 40 hours a week (see graph below). The most common work week for all case management department employees appears to be between 41 and 50 hours a week. The majority of case management directors (65%), case management supervisors/managers (61%), SW case managers (58%), and RN case managers (51%) responded that they typically work those hours. Interestingly, of the respondents who received raises, 72% work more than 40 hours in a typical week.
Although most case management department employees work more than the typical 40 hour work week, 71% of respondents indicated that they do not receive overtime pay. One of the respondents wrote, “If we work extra they have a set rate, which is unfortunately the same hourly rate I currently make due to my longevity.”
Keep an eye out for part one of the salary survey results in the May issue of Case Management Monthly. Not a subscriber? Head over to the HCMarketplace and sign up today!
Last chance to participate in the 2011 Case Management Monthly salary survey
We need your help. Please help us better understand your position by completing the 2011 Case Management Monthly Salary Survey. The survey results will be included in an upcoming issue of Case Management Monthly.
The link below will take you to the survey’s Web site; simply click on the link to answer the survey questions online. If the click-through does not work, please cut and paste the URL into the address bar of your browser.
This survey will close on Friday March 4.
Here’s the link to the survey:
http://www.zoomerang.com/Survey/WEB22BSWADRZ5S/
Thank you for your time and assistance.
Associate editor
bamirault@hcpro.com
Case management salary survey
We need your help. Please help us better understand your position by completing the 2011 Case Management Monthly Salary Survey. The survey results will be included in an upcoming issue of Case Management Monthly.
The link below will take you to the survey’s Web site; simply click on the link to answer the survey questions online. If the click-through does not work, please cut and paste the URL into the address bar of your browser.
Here’s the link to the survey:
http://www.zoomerang.com/Survey/WEB22BSWADRZ5S/
Download the Patient Discharge Plan form
Diana Cripe, MSW, director of case management at Morton Plant Hospital in Clearwater FL was kind enough to share her facility’s Patient Discharge Plan form in the November issue of Case Management Monthly.
Each inpatient has a Patient Discharge Plan form that the multidisciplinary team marks throughout his or her stay. Looking at the form, patients can easily see the problem they presented with, the care they received while in the hospital, and the specific healthcare goals they need to monitor after they leave.
Patients can present the form to care providers at follow-up appointments to give the provider an idea of what went on during the patient’s hospital stay.
The Lean Six Sigma process applied to case management
I recently spoke with a hospital customer who was trying to improve processes in the case management and utilization review (UR) departments at a large teaching hospital. The facility recently instituted 24/7 case management in the ED and was looking to create process improvement in a culture reluctant to change.
One of my favorite quotes is attributed to Albert Einstein who said, “Insanity is doing the same thing over and over again and expecting different results.” I fear hospitals, providers, and payers are applying business-as-usual methods to a vastly changing industry. Hospitals and physicians who are willing to explore process change and embrace what other industries have used successfully will prosper.
The Lean process
According to the Lean Enterprise Institute, “The core idea in Lean Six Sigma is to maximize customer value while minimizing waste.”
Sigma is a term used to represent levels of excellence or quality. Six Sigma seeks to achieve a ratio of 3.4 defects per one million opportunities. The process began in manufacturing as a defect-reduction effort and has spread to other industries, most notably air transportation. Airlines strive to achieve perfection because lives are at stake when an error is made.
The six process elements also known as DMAIC(T) include:
- D-define opportunity
- M-measure performance
- A-analyze opportunity
- I-improve performance
- C-control performance and optionally
- T-transfer best practice (to spread learning to other areas of an organization
A company or facility that follows the Lean principles focuses its core processes on continuously increasing customer value while producing no waste. These efforts result in processes that require less input (e.g., human, space, time, or financial) which equates to fewer defects and reduced cost.
Lean makes an organization more nimble, which allows it to react to changes in the market and customer preference. A Lean organization can create products and services with more variety, higher quality, and lower cost. It can also manage information and data used to generate services more efficiently because the information is simpler and more accurate.
Key concepts
Two key concepts in the Lean method are customers and waste. To make process change you must be able to identify and quantify these concepts. I can immediately think of examples of waste in hospital processes.
Hospital errors typically occur due to the vast number of processes required to complete a task. Simple things like when a patient uses an expired insurance ID can result in case managers sending clinical information to a payer who no longer covers the individual. The time lost while sorting out the mistake can cost the hospital a day’s reimbursement.
Then I thought about the medical record. The process of several different individuals and departments documenting in the patient record is open to significant error. I can recall the frustration experienced when the chart itself disappeared.
The customer
It was a challenge to identify and quantify the case management customer.
My initial thought was clear–the patient is the customer. Then I spoke with colleagues who said the physician is a potential customer. Without physicians and other providers who admit patients and refer them to outpatient services, there would be no patient to serve. Then it occurred to me that perhaps the customer is the insurance company or third-party payer because they pay for the services consumed.
It is easy to see how many customers case managers serve. A case manager who makes arrangements for post discharge care at a SNF may say the rehabilitation facility with an available bed is the customer. The ambulance available to transport the patient to the post discharge facility is also a potential customer.
Clearly, case managers serve multiple entities. To begin successful process improvement in case management, how do we identify the customer? What are your thoughts?
Assess case management department FTEs: Demonstrate your impact on the revenue cycle
Case management departments need appropriate staff in order to meet goals and improve outcomes. Money talks. Departments that can demonstrate their influence on the hospital’s revenue cycle will be able to make a strong case for staffing needs.
Now is the time to assess how your case management department interfaces with the organization’s revenue cycle. Are your department’s goals clear, measurable and aligned with your organization’s goals? Do your case managers have more cases than they can handle? Are their caseloads preventing positive outcomes?
HCPro’s audio conference Assess Case Management Department FTEs: Demonstrate Your Impact on the Revenue Cycle will help case managers demonstrate their worth and justify staff.
Listen to the audio clip below to hear more about the program’s benefits from one of the speakers, Tina Davis, RN, MS, CMAC a consulting associate for The Center for Case Management in Wellesley, MA.
Sample transfer agreement
The January issue of Case Management Monthly includes an article about the importance of reciprocal transfer agreements.
Sherri Sochaski RN, BAS, director of case management at JFK Medical Center (JFKMC) in Edison, NJ was kind enough to provide a sample transfer agreement form from her facility. It is good parctice for facilities like (JFKMC), who accept patients for a more advanced level of care, to have a reciprocal transfer agreement policy. Reciprocal transfer agreements ensure the accepting facility can return a patient after specialized care is no longer necessary.
2009 Case Management Monthly salary survey
We need your help.
We at HCPro want to provide you with the salary information for case managers that you need in the most useful format.
Please help us better understand your position by completing the 2009 Case Management Monthly Salary Survey. The survey results will be included in an upcoming issue of Case Management Monthly.
The link below will take you to the survey’s Web site; simply click on the link to answer the survey questions online. If the click-through does not work, please cut and paste the URL into the address bar of your browser. Here’s the link to the survey:
http://www.zoomerang.com/Survey/?p=WEB229QJRN9FKN
Thank you for your time and assistance.
The ZPICs have begun in zone 4
Health Integrity LLC, the zone four (Colorado, New Mexico, Oklahoma, and Texas) Zone Program Integrity Contractor (ZPIC), has begun requesting medical records for review.
The ZPICs are Medicare audit contractors that specifically identify cases of fraud and abuse. According to the CMS Program Integrity Manual, ZPICs may “take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid out and that any mistaken payments are recouped.”
During HCPro’s November 3 audio conference, “Zone Program Integrity Contractors Learn Who They Are, What They Want, and How to Respond to a Review”, a caller from Oklahoma shared that a Health Integrity representative visited the facility recently and stayed for a two-day, on-site audit. During the visit, the auditor reviewed more than 40 medical records related to one-day stays dating back as far as 2007.
This information came as a mild surprise to Robert Wade, partner at Baker and Daniels, LLP, in South Bend, IN. Wade said ZPICs have the authority to start reviews as soon as they are awarded the contract, and Health Integrity was awarded the zone four contract in February.
Facilities should be aware that ZPICs could notify the facility via fax a mere hour before the visit. This can leave little time for the facility to prepare. Wade said in situations where ZPICs give short notice, facilities are within their rights to supplement any requested records with supporting documentation even after the visit is complete.
So far CMS has awarded only three of the seven ZPIC contracts:
- Zone 4: Colorado, New Mexico, Oklahoma, and Texas—Health Integrity LLC
- Zone 5: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia—Advance Med
- Zone 7: Florida, Puerto Rico, and Virgin Islands—SafeGuard Services LLC
So what does this information mean for providers that are within one of these zones?
“They can come knocking at any time,” Wade said.
Consequences of a ZPIC review include payment denials, recoupment of overpayments, and referral to other law enforcement agencies. Because ZPICs can refer cases to the Department of Justice, Office of Inspector General, or other law enforcement agencies, a ZPIC review may only be the first step in a long legal battle.
Have you heard about the ZPICs starting in any other zones?
