All Entries Tagged With: "patient funding"

ER case managers must have special skills

A nurse case manager is a definite asset in the emergency room (ER).  An ER case manager benefits the patients, the staff, and the hospital.  The role is multi-faceted and requires superior skills in:

• Quality
• Education
• Communication
• Customer service
• Negotiation
• Creativity
• Risk management
• Knowledge and understanding of insurance requirements and regulatory mandates

It also requires an ability to interact with patients, families, insurance representatives, and caregivers both in the ER and those who are treating the patients in the out-patient arena.

Visits to the ER may have one of several outcomes. Usually, the patient is treated and discharged home with a plan or the patient is admitted to the hospital. It is here that the ER case manager can be most effective to improve the quality of care and prevent readmissions to the ER.

An ER case manager can ensure that each patient who is discharged from the ER has an appropriate discharge plan that is viable and appropriate to assist the patient in recovering and maintaining their health.  A case manager is an expert in confirming the patient can afford any prescriptions provided , is able to be compliant with recommended follow-up visits with  specialists and can assist the patient in connecting with a primary care physician. The nurse case manager can be instrumental in  working with the patient  and their support system to make sure that they understand and have the interest and ability to be compliant with the discharge instructions.

The case manager can enhance the care provided by a busy ER nurse and physician  by assessing situations and family dynamics, listening to the patient and helping them understand the rationale for various tests and the time needed to interpret results. The case manager can assist the ER nurse with patient education and  providing information necessary to maximize  the patient’s health status.

The case manager can also benefit the hospital by working with both ER physicians and admitting physicians to ensure that all acute care admissions meet medical necessity and are admitted to the appropriate level of care.  The case manager can assist with transfers to alternative levels of care such as skilled nursing or rehab when patients do not meet criteria for acute care but are unsafe to return home.  The case manager can arrange home healthcare, physical  and occupational therapy or other appropriate services to help a patient maintain their independence in the home.

Case managers are an integral part of the ER team to improve the quality of care and help maintain fiscal responsibility for resources both in the ER and on the hospital admitting units. Case managers coordinate care and provide patients will all the tools necessary to improve their quality of life and feel their best within any limits of their illness or disability.

What do hospital case managers do, anyway?

This is a question frequently asked by patients, family members, physicians, and other members of the medical staff.

Many people think that case managers are discharge planners, and that the only time a patient needs a case manager is when he or she has discharge needs. Case management is much more than that. It is important that we make sure that, not only do patients and families know what case management is, but that the nursing staff members know also.

Case managers work in forces behind the scenes, much like the crowd of people in the Verizon commercials. Case management is a hidden resource for patients. Often, the case managers work in the trenches, with their heads in charts, communicating with an interdisciplinary team of healthcare professionals to make sure that the patient is moving smoothly through the continuum of care, and there are no delays or detours in their care. This is usually an unknown aspect of case management.

Hospital personnel and the public need to be aware that case managers are advocates for all patients; they ensure that their healthcare facility and professionals are doing what is truly right for the patient, in the right setting, receiving the most appropriate care, and in the most cost-effective manner. Case management follows the patient’s plan of care to make sure that it is appropriate and timely, that their hospital admission status is appropriate, that their discharge planning is initiated, and that goals are set to meet the discharge plan. It is imperative that the case manager build a relationship with the patient and their families in order to reach a mutual goal of discharge.

It is also important for the bedside nurses to know that case managers are an excellent resource for them in planning the patients’ care and goals. One thing I did at our institution while we were redesigning our case management model was to do a mandatory in-service to nursing staff on how case management affects not only patient outcomes, but the financial outcomes for hospitals.

At our institution this year, we included a station on case management and interdisciplinary rounds at the nursing annual competency testing. Case management had a display booth with information about what case management is and the importance of interdisciplinary rounds. We also had a test for the nurses to complete. The comments we received from staff were very interesting.

Does your institution do anything like this? Are you confident that nursing staff members truly understand what case management is?

And one more important question: Do your physicians really know what case management is?

CMW Tip of the Week: Investigate transportation options for patients from the ED

This week’s tip comes from Kathleen Walsh, RN, MS.

Many patients are brought to the ED by ambulance or dropped off by a friend or family member and do not have transportation home once medically cleared. For these patients, the case manager could try, with the patient’s help, to call family, friends, or neighbors for assistance. Some EDs offer bus or subway tokens, or prearranged taxicab company vouchers. For others, developing contracts with local ambulance companies for chair-van services at a reduced rate is helpful.

Investigate whether a hospital ATM machine could be used by the patient to secure cash for a cab or whether the patient/family will be able to pay a cab with cash at home.

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!

CMW News: Demand for Medicaid increases while funding decreases

Since the economic recession began in December 2007, the unemployment rate has risen from 4.7 to 6.7%. Economists estimate that each 0.1% rise in the unemployment rate translates into an additional one million enrollees in Medicaid and the State Children’s Health Insurance Program (SCHIP), according to a Kaiser Family Foundation report.

This increase in enrollment comes at a time when tax revenues are falling short of predictions, leaving a large gap in funding for the programs. State governors are asking President-elect Barack Obama and Congress to increase the federal government’s share of spending by $40 billion. The governors say this would help states reduce service cuts or tax increases needed to balance state budgets.

So far, 19 states have proposed or enacted cuts to Medicaid and SCHIP for the current year or fiscal year 2010. For example, Governor Arnold Schwarzenegger (R) of California has proposed changing income eligibility for parents of SCHIP enrollees to 72% of the poverty level from the current level of 100%.

Source: San Francisco Chronicle

CMW News: Massachusetts seniors waitlisted for homecare

Because of state budget cuts in Massachusetts, many seniors find themselves on a waiting list of more than 300 names to receive the help of a homecare aid—a waiting list that didn’t exist two months ago.

Homecare aids help seniors avoid costly nursing homes by giving them assistance in their homes with basic tasks such as bathing and grocery shopping. However, state budget cuts took away about $4 million—or 3.6%—of the funding for the program.

Homecare representatives say the cuts are ironic because keeping seniors out of nursing homes saves the state money. Since the homecare program began in 2001, the number of patient days in nursing homes has decreased approximately 21%, according to The Boston Globe. The state pays about $158 per patient per day in a nursing home and only about $8.76 per day for each resident enrolled in the homecare program.

Sources: HealthLeaders Media, The Boston Globe