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Examples of financial outcomes measures include length of stay (LOS), cost per day, cost per case, and third party payer denials.
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[Editor's note: This month we include the first part of a two-part series on demonstrating the value of case management to your organization. We cover metrics to measure and goals for your department. In next month's issue, we'll continue with examples of benchmarking and case management report cards.]
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As part of its efforts to increase patient satisfaction and reduce length of stay, City of Hope reorganized its case management department, assigning case managers by unit and assigning all utilization review activities to a dedicated staff of registered nurses.
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At New England Baptist Hospital, in Boston, social workers meet most patients at the pre-admission screening appointment. A case manager follows up with at risk patients after discharge to make sure they have a smooth transition home.
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It happens again and again at hospitals across America. A new case manager joins a department and receives minimal on-the-job training from another case manager who is trying to do his or her own job at the same time.
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Quality outcome metrics, compiled for the entire organization, include readmissions, discharge/disposition delays, delays in service/turnaround time, patient satisfaction, and inappropriate admissions.
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The first year after Piedmont Hospital in Atlanta implemented a Heart Failure Resource Center that provides care coordination for patients discharged with heart failure, the 30-day rehospitalization rate for heart failure patients in the program decreased from 4.6% to 1.6% when compared to heart failure patients treated at Piedmont and not in the program.
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WellPoint's initiatives to reduce hospital readmissions by following up with Medicare Advantage members after discharge has decreased the readmission rate and reduced skilled nursing days, according to Karen Amstutz, MD, vice president and medical director of care management for seniors and state sponsored business for the Indianapolis-headquartered health benefits company.