Enhance job security by proving your worth to your organization

Track your interventions and productivity

In these days of increasing health care costs and decreasing resources, it’s essential that case managers get more savvy about documenting and putting a dollar value to what they’ve accomplished if they’re going to survive the inevitable budget cuts.

"Case managers need to take steps so the administration will look at case management as a revenue center as opposed to a cost center. Revenue centers don’t get cut when the budget is revised. They get money to move their operations forward," says Peter Moran, RN, CM, BSN, MS, CCM, a nurse case manager in the emergency department at Massachusetts General Hospital in Boston.

Nurses are considered one of the highest cost centers in health care, Moran points out. "But in case management, we do have the potential to save money for our institutions. We need to recognize and document what we are doing and how it is positively impacting the health of people and the financial health of the organization," he says.

If you think you already are so busy doing paperwork that you can’t possibly take on another task, think again, Moran says. "If you can put a dollar value on your work or show a return on investment, I would sell that as job security," he suggests.

Paperwork and documentation can be frustrating to case managers, many of whom got into health care because they wanted to help people, adds Joann C. Milne, RN, BSN, CRRN, PHN, assistant vice president of medical management programs with IOA Re, a professional underwriting manager with headquarters in Plymouth Meeting, PA.

"Nursing has lost so much of its nurturing ability because we have to cut to the bottom line. The problem is, we’re not going to be around in 10 years to provide the nurturing if we can’t communicate our worth. If we can prove our worth, we can go back to the things we want to do," Milne adds.

There are three ways that case managers can demonstrate their value to their organization, Milne says:

1. By assisting in financial planning.

When you have cases that you know are going to cost a lot, notify your chief financial officer and the administration so they can make plans to cover the costs. (For more details, see Case Management Advisor, June 2002, pp. 64-68.)

2. By saving money through basic interventions.

This involves tracking both soft and hard savings. 

3. By calculating the productivity level of the case management department. 

"When case management does get involved, redirects care, and does negotiations, it can impact financial cost and improve clinical outcomes," Milne says.

Don’t be afraid to take credit where credit is due, Milne and Moran suggest.

"Most of us are not trained for the business end of health care, but in these times of decreasing economic resources and increasing costs, the administration is looking at where they get a return on their investment. Yes, you know you can make the patient feel better, but you need to document cost savings," says Moran.

Case managers should get tied in to their organization’s information system so that they can produce reports that show their value in a format that can be distributed and shared, Milne says.

"As clinicians, no matter where we work, we need to align ourselves with the financial people in the organization in which we work. We need to pick their brains and understand the role they play," Milne says.

Here is one scenario where a case manager’s honest appraisal was invaluable:

The case involved a baby with multiple congenital problems. Milne asked the case manager to estimate the cost of caring for the baby over the next year.

The reply: $250,000-$750,000, because it was too soon to know exactly what the baby’s care might entail.

"The fact that this case manager is not afraid to step up and put a number behind what she is seeing clinically means a lot to a lot of people," Milne says.

For instance, the chief financial officer of the baby’s HMO was negotiating to purchase reinsurance for the following year. Knowing there was the potential for a $750,000 claim made a difference in the reinsurance policy amount.

"Putting the dollars behind what we see clinically can help the institution remain in a positive financial position," Milne says

Case managers must get involved in the financial aspects of their organizations, Milne says. It’s not enough just to manage cases.

Case managers in private practice especially should beware of turning a blind eye toward the financial component of case management, she adds.

"It’s very difficult to succeed until you put the clinical and the financial piece of any case management business together," she says.

Take credit where credit is due, Milne advises.

When you handle a problem, document it. Create an invoice and bill for it.

"That’s what you do. Without those steps, your program cannot succeed, at least financially," she adds.