Document the savings of your interventions

Learn to put a dollar value on your services

When Peter Moran, RN, CM, BSN, MS, CCM, was a case manager for a payer organization that was considering cutting personnel, he was able to document that case management interventions netted his organization $190,000 in hard cash savings over the course of three quarters.

Moran’s cost savings were not intangible costs.

"They involved moving patients from a non-contracted vendor to a contracted vendor, getting a patient home sooner, getting a patient discharged to home instead of subacute care, or getting a family member to drive someone home and saving a $300 ambulance ride," says Moran, now a nurse case manager in the emergency department of Massachusetts General Hospital in Boston.

Proving the worth of case management is a challenge everyone in the field must face, Moran says.

"The question is, how do we put a dollar value on our services, whether it’s patient satisfaction, length of stay, better outcomes, [or] fewer lost days before the patient returns to work. Those are the type of things we need to document with hard facts," he says.

Example of hard savings

Before you start to tally your savings, make sure your organization has in place a policy that documents how case managers can account for soft savings and how they can account for hard savings, advises Joann C. Milne, RN, BSN, CRRN, PHN, assistant vice president of medical management programs with IOA Re, with headquarters in Plymouth Meeting, PA.

"Those policies have to be agreed upon by the administration. There can be no questions and no gray areas," she says.

The policies should not be open for interpretation. For instance, if a patient is in the intensive care unit and the case manager gets the patient moved to a regular bed two days before the date the physician wrote in the original order, some people would say it’s a hard savings and others might argue that it’s a soft savings because you can’t document whether the patient was moved because of the case manager’s intervention or because the physician changed his or her mind.

Here is an example of hard savings: A patient needs to go to a transitional care center but lives in a remote area where there isn’t a center in the PPO network. The case manager negotiates a $300-a-day rate with an out-of-network center. Then, she calls the business office and asks what the average billed charges are per day. If the average charges were $650 a day, the case manager saved $350 a day.

"If there was a skilled facility in network and the case manager made sure the patient went to that one, that might be a soft savings. It depends on how your policies are written," Milne says.

It doesn’t really matter what you consider soft savings or hard savings as long as the administration of your organization agrees to the standard, she says.

"The last thing you want to do is to submit a report to the administration and have them pick it apart, which diminishes the overall value of the report," she adds.

Even if you don’t have the technology to track data, you can start by doing a bit of simple tracking on paper, Moran suggests.

Sometimes it’s best to just figure out where your biggest costs are and then identify where the cost savings occur, Moran adds.

For instance, look at your organization’s largest diagnosis-related group and focus your resources on that. Track your interventions and your savings.

"If case managers can take a look at what they are doing in day-to-day practice and where they are making a difference, whether it’s returning the patient to work or getting him home with a family member rather than an ambulance, they can show that they are making a difference," Moran says.

Consider sending surveys to patients and physicians, asking them to evaluate the services of case managers, Moran suggests.

Point out to management that patient satisfaction can make a difference when the employee group chooses a policy. If your patient satisfaction scores are high, they’re likely to choose your company instead of your competitor.