Case Management

Celebrate the New Year with some professional resolutions

Case Management Insider, January 6, 2015

Happy 2015! By this time you’ve probably made your personal New Year’s Resolutions, whether it’s to work out more or to finally clean out that junk drawer. But now is also the time to create some professional resolutions for the New Year. We asked some of our experts what professional case managers should resolve to do in 2015 and they came up with some items you might want to consider putting on your list:

  • Focus on the 2-midnight rule. We know, we’re sick of hearing about it too, but Beverly Cunningham, MS, RN, vice president of resource management at Medical City Dallas Hospital says the challenge of meeting this regulation isn’t over for case managers. “The probe and educate process doesn't seem to have been as invasive as we all expected,” says Cunningham. “If we aren't really looking at our one- and two-day stays and doing the expected self-denials—and I'm not seeing hospitals being as diligent as they should—we will get hit hot and heavy with the Medicare Audit Contractors' focus being released quarter two of 2015.”   
  • Prove your worth. “Resolve to create scorecards to objectively demonstrate the value of the case management/utilization review team,” says Stefani Daniels, RN, MSNA, CMAC, ACM, managing partner at Phoenix Medical Management, Inc., in Pompano Beach, Florida. “A scorecard is not a productivity record. Therefore, it must not include volumes of cases. Instead, it must cite improvements over time in the desired outcomes.” Don’t forget to include the financial component, which will allow the c-suite to appreciate the improvements from a dollars and cents standpoint.
  • Remember where your focus belongs. While these days case managers are torn between meeting financial and regulatory demands, it’s always good to remember where your attention belongs—on your patients. "In your role, you can help patients improve their own compliance to health care practices,” says Jackie Birmingham, RN, MS, VP, Emerita, Clinical Leadership for Curaspan in Newton, Massachusetts. “Case managers are ‘support’ people – not a substitute for patients taking responsibility for outcomes.”
  • Improve care coordination. “With the value based purchasing metric of Medicare spending per beneficiary we must do better care coordination,” Cunningham says. “That means case management directors must have that as a focus.” This means making sure you’re adequately staffed and that staff members have the mentorship they need to be successful. “The last part of care coordination is ensuring that we are referring to optimal post-acute vendors who take the right patient at the right time and that they help us keep the patient out of the hospital,” Cunningham says. “This is a complex critical focus. Additionally it will decrease readmissions.” 
  • Focus on the numbers. “In trying to meet the value-based purchasing metric up Medicare spending per beneficiary, if you're not a part of an [accountable care organization] you need to at least act like an [accountable care organization],” Cunningham says. 
Whatever your professional resolutions this year, we wish you a Happy New Year and the best of luck sticking to your plan in 2015.



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