Empowering Case Managers In The Emergency Department A STRATEGIC ROLE BENEFITS PATIENTS, CARE TEAMS, AND PROVIDERS

Transcription

1 Empowering Case Managers In The Emergency Department A STRATEGIC ROLE BENEFITS PATIENTS, CARE TEAMS, AND PROVIDERS

2 Empowering Case Managers In The Emergency Department A STRATEGIC ROLE BENEFITS PATIENTS, CARE TEAMS, AND PROVIDERS By Ryan Bengtson, managing director, and Becca LaFond, senior director, Huron Healthcare Healthcare reform and growing economic pressures have made high-performance in the Emergency Department (ED) more important than ever. OVERVIEW Changes in healthcare have increased the stakes for Emergency Department (ED) performance. Readmission penalties, new links between patient satisfaction and reimbursement, competitive threats from other providers, and the impact of the ED on hospitals, health systems, and academic medical centers overall market reputations all have focused heightened attention on case management at all points of entry. This pressure for high performance comes at a time when healthcare reform has the potential to shift the volume and acuity of ED patients. Achieving high performance means delivering the right care efficiently and effectively, smoothly handling transitions, and fully engaging patients and family members as part of the care team. When empowered and effectively utilized, case managers play a vital role in meeting these challenges. A proactive approach to case management in the ED can result in more effective, efficient, coordinated, affordable care. It can also play a key role in reducing length of stay, facilitating early interventions in the emergency room, assessing patient status appropriately, improving care across the continuum, and minimizing non-medically necessary time spent in the hospital. Finally, it can also help mitigate risk of reimbursement losses from readmissions, improve patient satisfaction scores, and strengthen the reputation of an organization s ED. The Clinical and Financial Value of Case Management in the Emergency Department Often, case managers in the ED are charged primarily with utilization management and simple discharge planning. While these are important functions, they fall short of delivering the full value of a more proactive approach. However, when case managers are empowered to become true care coordinators, their value to the organization, and to their patients, increases exponentially. This is true in any care setting, but is especially true in the ED, where the pressures for high performance and the penalties for inefficient or ineffective performance are great. To maximize ED performance and the value of case managers, organizations should pay particular attention to three areas: 1) Improving Effectiveness And Efficiency By Coordinating Care Across The Care Team In a busy ED, communication can become fragmented. In this fast-paced environment, doctors, nurses, and other members of the care team may repeat steps, ask patients and each other redundant questions, or order duplicative tests. Empowering case managers to work closely with the care team provides more efficient communications between team members, which in turn improves care delivery across the continuum. Case managers and care teams can facilitate a more synchronized plan of care through interdisciplinary care coordination meetings that are adapted to the ED environment. By instituting ED flow rounds at least twice per day and empowering case managers, organizations can significantly improve ED performance, says Ryan huronconsultinggroup.com/healthcare 2

3 Empowering Case Managers In The Emergency Department Bengtson, managing director. During these rounds, the entire care team spends one to two minutes per patient, talking about the plan of care, the patient s current status, any barriers to discharge, and what needs to happen to move that patient forward efficiently through the care continuum. As an active participant in these meetings, the case manager provides information to the care team about potential barriers to discharge or assignment of patient status (i.e. outpatient observation, or inpatient, etc.) and gathers information about the plan of care to be communicated back to the patient and family. Case managers also identify risks and communicate them to the care team and, when appropriate, raise alternate plans of care that might better serve the patient. The University of Virginia Medical Center worked with Huron Healthcare to implement this approach in their ED. Case managers were trained to collaborate more closely with the care team. Twice-daily ED flow rounds were conducted at 9 a.m. and 9 p.m., or as needed by the attending or nurse in charge. We empowered case managers to work with physicians on the level of care assessments, so that patients are placed in inpatient or outpatient observation appropriately, says Dr. Chris Ghaemmaghami, Medical Director, Department of Emergency Medicine at the University of Virginia Medical Center (UVMC). That approach has improved the accuracy of care assessments, which translates into better care, better reimbursement patterns, and fewer penalties, now that we re in the age of penalties for readmissions. At UVMC, ED case managers helped lower medically unnecessary length of stay by 34 minutes. This reduction created the capacity for UVMC to see up to 4,000 additional patients per year. 2) Ensuring Successful Transitions From The ED Transitioning patients from the ED to their next care setting is a crucial process with implications for readmissions and reimbursement. Whether a patient is being moved to inpatient or outpatient observation, or discharged with home health follow up, the transition requires strong planning, accurate information, and clear communication. Case managers can play a crucial role in this area by advocating for a proactive, accountable approach to creating and executing a patient s appropriate transition plan. In the absence of ED flow rounds, care team members often find it difficult to ensure that the entire care team is on the same page regarding when and how a patient will transition out of the ED, says Becca LaFond, senior director, Huron Healthcare. Without a proactive approach, it s difficult to ensure that all the necessary steps have been taken to optimize next steps whether that s scheduling patient follow-up appointments after discharge, or requesting an inpatient bed. At UVMC, case managers play a substantial role in the transition planning processes, while ED flow rounds have improved the coordination around patient transitions. In cases where transitioning to inpatient status is recommended, case managers ensure that the ED physician and admitting physician understand whether the patient meets the prescribed care guidelines to be admitted. Physicians aren t always aware or focused on assigning important status criteria or of documentation, says LaFond. Particularly in academic environments, there are often care team members, such as residents, who do not yet have full understanding of the importance of accurate patient status. Case managers help educate residents on these issues as they rotate through. Case managers at UVMC also provide an update on transition planning during ED flow rounds, identifying next steps. In discharge situations, maybe someone needs to have oxygen delivered to their house, or we re waiting to hear back from Home Health, or something of that nature, says Dr. Ghaemmaghami. Having that update helps with the flow. The flow round also provides a great opportunity to bring up any roadblocks we need to address. Case managers participation is very helpful and very reliable in that way. 3

4 UVMC case managers are also a source of information about alternative options for care in the community. You often encounter situations where physicians don t feel comfortable sending a patient home, and yet the patient doesn t meet criteria to be either admitted or placed in outpatient observation, so there doesn t appear to be a safe option for the patient, says LaFond. Often, this is because physicians aren t fully versed in the alternatives available in the community. Case managers can help hospitals take a broad look at options in the community and connect the patient with the right resources to get the follow up care and support they need. This helps to ensure that the patient is receiving the right care in the right place at the right time to make care both affordable and effective. 3) Engaging Patients As Active Participants In Their Care The fast pace of the ED can make true patient engagement a challenge. But when patients are not active participants in their care, they are less able to advocate for themselves and are often less satisfied with the overall experience. Case managers are often in the best position to take a focused, systematic approach to patient engagement, compared to other care team members. Making ED case managers accountable for engaging patients in their plan of care can be a win for patients, physicians, family, and the hospital. This approach also has a significant impact in reducing readmissions. Making case managers accountable for patient engagement, and providing processes that support their efforts, pays benefits in a number of ways, says LaFond. It helps patients understand the clinical and financial implications of options that the care team develops. And it leads to increased satisfaction among patients and families when they feel a part of the decision making. At UVMC, ED case managers acted mainly as utilization management nurses and were rarely out in the department, prior to the Huron Healthcare engagement. Under the new, more empowered approach, case managers are expected to engage with both patients and physicians. By acting as a communication link, the case manager can also ensure that the ED physician and the admitting physician understand the patient s concerns. Our case managers are registered nurses, says Dr. Ghaemmaghami. They re very compassionate and they are able to understand the patient s and family s point of view, which is extremely important. They talk with patients about a wide range of issues. If patients are being discharged, they ll talk about the type of transportation that s available and discuss whether the patients are eligible for home health benefits, physical therapy, or outpatient treatments. They also make sure patients are aware of financial assistance programs and community resources, and help get them registered if they re eligible. BOTTOM LINE Hospitals, health systems, and academic medical centers are under increased pressure to deliver effective, efficient, affordable care in their EDs and beyond. These pressures stem from many forces including changing reimbursement models, penalties tied to readmission, the increased importance of patient satisfaction, capacity management challenges, and competition pressures. Case managers can play a vital role in meeting these challenges if they are empowered to be coordinators of care across the continuum. Empowered case managers can help improve communication among all ED care team members, ensure more successful patient transitions between care settings, and help fully engage patients and families in care decisions. Having strong case managers at all points of entry including the ED results in accurate patient status, improves patient satisfaction, facilitates early identification of potential discharge, and helps reduce length of stay. It improves care delivery for patients while allowing organizations to decrease reimbursement losses due to readmission and strengthen the organization s reputation in the community huronconsultinggroup.com/healthcare 4

5 CONTACT To talk further about any of the issues discussed here, please contact: Ryan Bengtson, MHSA Managing Director Becca LaFond, MHA Senior Director ABOUT HURON HEALTHCARE Huron Healthcare is the premier provider of performance improvement and clinical transformation solutions for hospitals and health systems. By partnering with clients, Huron delivers strategy and solutions that improve quality, increase revenue, reduce expenses, and enhance physician, patient, and employee satisfaction across the healthcare enterprise. Clients include leading national and regional integrated healthcare systems, academic medical centers, community hospitals and physician practices. To see how Huron Healthcare solutions can empower your mission, contact us at or visit huronconsultinggroup.com/healthcare. YOUR MISSION OUR SOLUTIONS YOUR MISSION OUR SOLUTIONS v 9 Jan Huron Consulting Group helps clients in diverse industries improve performance, comply with complex regulations, reduce costs, recover from distress, leverage technology, and stimulate growth. The Company teams with its clients to deliver sustainable and Huron Consulting Group helps clients in diverse industries improve performance, comply with complex regulations, reduce costs, recover from distress, measurable leverage results. technology, Huron and provides stimulate services growth. to The a wide Company variety teams of both with financially its clients to sound deliver and sustainable distressed and organizations, measurable results. including Huron provides healthcare services organizations, to a wide variety Fortune of both 500 financially companies, sound leading and distressed academic organizations, institutions, including medium-sized healthcare businesses, organizations, and the Fortune law 500 firms that Huron Consulting Group helps clients diverse industries improve performance, comply with complex regulations, reduce costs, companies, represent leading these various academic organizations. institutions, medium-sized Learn more businesses, at recover from distress, leverage technology, and stimulate growth. and The the law Company firms that teams represent with these its clients various to organizations. deliver sustainable Learn more and at measurable results. Huron provides services to a wide variety of both financially sound and distressed organizations, including healthcare 2012 Huron organizations, Consulting Fortune Group 500 Inc. All companies, Rights Reserved. leading academic Huron is a institutions, management medium-sized consulting firm businesses, and not and a CPA the firm, law firms and does that 2013 Huron Consulting Group Inc. All Rights Reserved. Huron is a management consulting firm and not a CPA firm, and does not provide represent not provide these attest various services, organizations. audits, other Learn engagements more at accordance with standards established by the AICPA or auditing attest services, audits, or other engagements in accordance with standards established by the AICPA or auditing standards promulgated by the Public standards Company promulgated Accounting by Oversight the Public Board Company ( PCAOB ). Accounting Huron is not Oversight a law firm; Board it does ( PCAOB ). not offer, Huron and is not is not authorized a law firm; to provide, it does legal not advice offer, or and counseling is not authorized 2012 Huron in any Consulting jurisdiction. to provide, legal advice or counseling in any jurisdiction. Group Inc. All Rights Reserved. Huron is a management consulting firm and not a CPA firm, and does not provide attest services, audits, or other engagements in accordance with standards established by the AICPA or auditing standards promulgated by the Public Company Accounting Oversight Board ( PCAOB ). Huron is not a law firm; it does not offer, and is not authorized to provide, legal advice or counseling in any jurisdiction.