Case Management

Take the pulse of your department's efforts by monitoring taxonomy

Case Management Insider, March 10, 2015

Keeping tabs on your department’s performance should be a high priority for case managers. Doing so can help demonstrate your value to higher ups within the hospital.

But you may wonder, what exactly should you be measuring?
Stefani Daniels, RN, MSNA, CMAC, ACM, president and managing partner of Phoenix Medical Management, Inc., in Pompano Beach, Florida, says there’s a new strategy you can use to identify outcome metrics, taxonomy of progression-of-care inefficiencies—taxonomy for short.
Call it a new spin on the old practice of measuring avoidable days.
Taxonomy can help identify and categorize all the waste that slows down patient progress through the system. “It can be used to identify and prioritize activities that should be monitored by the case manager, utilization review (UR), and clinical documentation improvement (CDI),” Daniels says.
If an organization is truly committed to reducing inefficiencies in the new environment of bundled payments, risk-sharing arrangement, and population health management, then everyone should recognize where the waste occurs and whether something can be done to avoid or minimize its effects, Daniels says. “Since case managers and their UR/CDI colleagues are often the only ones who have the 500-foot overview of the patient's progression of care, they are in the best position to track occurrences that delay the patient's journey through the hospital and beyond,” she says.
Start by examining patients’ progression through the facility and all the touch points. Convene a meeting of the key process-owners, including nursing, radiology, pharmacy, central supply, and lab. Hold an informal, hour-long discussion to list all the waste that patients' may have to experience in their journey through the organization. What factors are slowing them down or impeding their progress?
Ideally, case managers should help members of the group understand why some of their internal processes may cause delays or avoidable days. “By looking to identify these factors and turning these areas of waste into measurable indicators for performance improvement, the case managers can influence efficiency and improve quality and therefore demonstrate their value to the organization,” Daniels says.  “The administrative team should be urged to designate someone in data informatics to work with the case management team leadership to come up with a way of tracking, trending, and reporting.”
Taking the time to develop the taxonomy may help you improve patient care and efficiency overall. But remember, this is not a one-time process; it’s got to be an ongoing exercise in order to be effective.
The taxonomy may include categories such as “overtreatment,” meaning all the occasions when more is being done than the patient actually needs or “defects,” which refers to doing something incorrectly such as admitting as inpatient when documentation only supports outpatient/observation services.


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