Hospital Case Management Beyond Your Numbers Improve continuum of care management Promote quality, cost- effective outcomes Monitor & manage transfer cases Improve physician documentation & coding Improve emergency department bed management Improve case-mix index Help from BKD The case manager coordinates the clinical team goals with the patient goals, and manages the financial and quality outcomes of the care pro- vid ed. Wit h a ppr opr iat e t ra ini ng, edu cation a nd direction, case managers are able to leverage their skills to effect a balanced clinical and financial out- come. BKD Health Care Group can provide an inde- pendent assessment of your case management roles, functions and effe ctiveness. Our focus is to unveil potential business implications and oppor- tunities. You will rece ive a report with our find- ings and recommenda tions. Based on the proces s changes you wish to adopt, you may choose ongo- ing support from BKD to facilitate the change process. Focus Areas Appropriate Use of the Continuum of Care - Planning for discharge begins the moment a patient steps foot in your hospital. A case manag- er’s understa nding of the appropriate level of care and factors affecting a patient’s movement between levels of care can have a significant impact on the hospital’s bottom line. Wit h a goa l of hel pin g t he pat ien t mo ve se am- lessly through the continuum of care, case man- agers are in a unique position to share their knowledge with other members of the health care team. BKD can provide tools, guidan ce and educa- tion to promote appropriate use of the continuum of care and allocation of resources. Promote Quality, Cost-effective Outcomes - Promoting quality and achieving cost-effectiv e out- comes involves everyone. Each department, from nursing to lab to housekeeping to physicians to billing, plays an impor tant role. Communication between departments is the key to providing quali- ty, cost-effect ive care. BKD can help train staff to understand their role in the fiscal health of the hos- pital and can provide tools and guidance to open the lines of interdepartme ntal communication related to quality care and fiscal responsibility. Transfer Cases - Historically, case managers have been encouraged to focus on decreasing patient length of stay. This practice may actually result in reduced hospital revenue from certain patient pop- ulations, such as those being transferred to another care provider. These transfer cases present a unique opportunity for health care organizations to poten- tially improve both the quality of care to the patient and the financial outcome for the organization. BKD helps case managers with processes and sys- tems to identify , monitor and manage transfer cases. Physician Documentation - The quality of a physician’ s documentation has significant financial implications for a hos pital. The Centers for Medi- care and Medicaid Services and other regulatory agencies have specific coding guidelines that do not allow coders to make assumptions on the physi- cian’s behalf. A c ode r may kno w th e c ond iti on bei ng tre ate d but cannot code it unless the physician has docu- mented the condition using wording acceptable to these regulatory agencies. For example, a lab report may show a declining hemoglobin and Case management plays a key role in a hospital’s financial success. It should be a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes. An effective case management system actively manages patient care from admission through the entire continuum of care. Solutions from BKD Health Care Group
