Technology helps CMs manage care in real time
Home grown program integrates tasks
When case managers for Medical Management International visit clients and providers, they use the latest information technology equipment to enter documentation, create and transmit reports, forward orders for durable medical equipment, tests or procedures, and send letters to patients, physicians, attorneys, or other interested parties, all in real time while they are still with the patients.
"Case management is coordination. We're not about hands-on patient care. We are about communication, education, and coordination. When we do everything in a timely manner, we save time, improve patient care, and reduce costs," says Suzanne Tambasco, RN, BSN, Med, CCM, CBMS, CRRN, COHNS/CM, LNCC, NCLCP, chief executive officer of Atlanta-based Medical Management International, who is also a practicing case manager.
Medical Management International contracts with insurance companies to manage workers compensation claims, legal liability, short-term and long-term disability, and legal nurse consulting.
The company has created its own case management software system that integrates case management documentation with billing and reporting. The software is on an Internet-based platform on the company's server. It uses an off-the-shelf product that has been customized to meet the company's needs and integrates well with all business software.
"This system allows us to input all our patient records, do a data search and get what we need. We have spent the last 10 years collecting data on what specific activities we do over and over regardless of the diagnosis and what specific activities impact patient satisfaction, claim outcomes or medical outcomes in significant ways," she says.
The system uses case management work flow that reminds the case manager of specific activities that have not been done or should be done.
It's all on a secure server that meets Health Insurance Portability and Accountability Act (HIPAA) medical record-keeping standards. For the field or telephonic case manager, the system helps them multi-task in a more organized fashion. "The field case manager can take care of sending letters and reports while we are waiting for the next appointment," Tambasco says.
The case managers in the field take notebook computers or tablet computers and small scanners with them as they visit clients and providers. The technology enables them to scan any orders the physicians issue and use e-mail to instantly transmit the orders to the vendor, physical therapy, and the laboratory and copy the insurance adjuster, the patient, and attorneys, if they are involved, all at one time. "This eliminates redundant communication, and whoever needs the information gets it immediately and simultaneously," Tambasco says.
The system allows the case managers to have the patient's entire medical record with them when they accompany the patient to appointments. If the physician hasn't gotten an X-ray or laboratory report, the case manager can access it, show the physician on the computer, and print a copy for the patient files. If the company gets a last-minute referral, the case manager can get the adjuster to e-mail the patient records to her in the doctor's office and can print a copy for the doctor.
"In the past, we'd have to make a phone call and wait for someone to fax the information we needed. Now it's all on the computer at our fingertips. There's no down time with this system," Tambasco says.
The system includes an interactive medical database that case managers can use to show the patients the extent of their injuries and what surgery or other interventions will provide.
"If the patient has a spinal injury, we can show him pictures of the spinal nerves and where the injury occurs and demonstrate what the surgeon is going to do. Patients feel like they totally understand what's going on, and they are grateful for having a case manager. This system has increased patient and physician satisfaction and has helped cement the relationship between the case manager and the physician office," she says.
In the past, case managers made hand-written notes and completed their reports at the end of the day or the end of the week. Now, they enter information into the computer as they talk to doctors and patients and automatically create their report. "Using notes is never as good as entering real time data. The information they document on the computer is more thorough and complete. Case managers can handle more cases and handle them more efficiently. The documentation they enter in the computer tells the story," Tambasco says.
The software includes standardized letters that are automatically customized and generated to update patients, therapists, employers, attorneys, or insurance companies, including the data necessary for each recipient. The case manager can choose the type of letter, and the system will automatically extract the data and include it in the letter. "It eliminates unessential typing, and the recipient can get the document immediately," she says.
Each field case manager works as a team with a telephonic case manager, who acts as a back-up person and a supervisor. For instance, when the field case managers are with a patient, they forward their calls to the telephonic case manager who can answer patients' questions about appointments, equipment, or other concerns. "This allows us to be more patient-centered. The patients are happier because they don't have to wait for a return phone call, and the field case manager can totally focus on what he or she is doing," she says.
Tambasco continuously adds functionality to the software program to enhance patient and client outcomes. "I like to use software as a training tool and educational tool, even for experienced case managers. We get so caught up in tasks that we often forget that we have not stopped to get the patient's subjective assessment of their status. We've recently added an automatic diary that is based on patient acuity and allows the case manager to change acuity levels based on the patient's medical status," she says.
The system prompts the case manager with an e-mail on a specific schedule to check on the patient and includes a list of patient-centered questions that are designed to quantify and quality function, pain, and response to treatment.
"This gives us a good idea what is going on with the patient, whether it's a medical or mental health issue. The documentation can also clearly document our actions and responses in case we are a party to a lawsuit," she says.
"The program makes it easy to analyze data in multiple areas," Tambasco says. For instance, the company looks at compliance rate and return-to-work for individual case managers and can determine average office times for individual physicians so the case managers aren't overbooked.
"We can compare cases with similar demographics but different outcomes to identify why one CM has better medical, vocational, or satisfaction outcomes and use that data to train," she says.