Case Management

Measure department effectiveness beyond LOS

Case Management Monthly, September 1, 2010

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by Rochelle Schiller, RN, MBA

Hospital executives frequently use LOS to measure how well a case management staff performs, but there are other indicators, such as patient satisfaction and observation use, that prove department effectiveness.

Case management is the art of managing clinical and financial risk across hospital departments and patient populations. To do this, case managers need a depth of clinical knowledge and a keen awareness of how organizations receive reimbursement. 

We determine patients’ clinical risk through an assessment of their overall DRG trajectory, comorbidities, and an evaluation of important independent ADL. We do this to establish a safe and adequate method for patients to manage their postacute care. We also track the hospital’s readmission rate.  

Additionally, we review each patient’s financial situation to determine whether the third-party payer should bundle hospital payment. The dollars associated with bundled cases indicates whether adequate resources were established for care after discharge.   

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