Case Management Insider

Case Management Report Cards — Keep it Simple, Keep it Clear

By Toni Cesta, PhD, RN, FAAN
Senior Vice President
Lutheran Medical Center
Brooklyn, NY

The report card that begins below is an example of a method for aggregating and reporting all the measures that we have reviewed in the last two issues.

The sections included in this exemplar are length of stay, denials, avoidable delays, and discharge planning. The first column includes the categories with detail below each label. The next column includes the baseline, target, and month's data. The baseline should be the prior year's performance in that metric. The target should be this year's goal, and the month's data is the actual metric achieved for the month being reported.

This report card serves as an example only. You should consider adding or deleting from this as needed based on the data you are collecting.

You might also want to consider an executive summary of the data that explains those outcome metrics that performed poorly for the reporting month with an explanation as to why.

Regardless of which measures you use, be sure they are clear, measurable, and accurate.

HOSPITAL NAME

BASELINE

TARGET

MONTH

LENGTH OF STAY

ALOS

Medicine

Surgery

# of Patients with LOS 7-10 days

% of Total Discharges

# of Patients with LOS > 10 days

% of Total Discharges


DENIALS BY REASON IN DAYS — PENDING

BASELINE

TARGET

MONTH

CONCURRENT

Medical necessity on admission

Continued Stay

Delay in service

Late notification

Clinical info not provided

Appropriateness of setting

RETROSPECTIVE
Medical necessity on admission
Continued Stay
Delay in service
Late notification
Clinical info not provided
Appropriateness of setting

DENIALS BY REASON IN DAYS —OVERTURNED

BASELINE

TARGET

MONTH

CONCURRENT

Medical necessity on admission

Continued Stay

Delay in service

Late notification

Clinical info not provided

Appropriateness of setting

RETROSPECTIVE
Medical necessity on admission
Continued Stay
Delay in service
Late notification
Clinical info not provided
Appropriateness of setting

DENIALS BY REASON IN DAYS —UPHELD

BASELINE

TARGET

MONTH

CONCURRENT

Medical necessity on admission

Continued Stay

Delay in service

Late notification

Clinical info not provided

Appropriateness of setting

RETROSPECTIVE
Medical necessity on admission
Continued Stay
Delay in service
Late notification
Clinical info not provided
Appropriateness of setting

INPATIENT THROUGHPUT

BASELINE

TARGET

MONTH

Avoidable days due to no sub-acute vent bed available

Avoidable days due to no sub-acute vent/dialysis bed available

AVOIDABLE DAY REASONS — FACILITY/SERVICE LINE

(OCC/DAYS)

MRI
EEG
ECHO
CT
Cath
Radiology/X-ray
Vascular lab
Vascular surgery
Stress test
Physical therapy and PT consult
GI procedure and/or colonoscopy
OR booking and/or cancel OR booking
AVOIDABLE DAY REASONS — RESOURCE

(OCC/DAYS)

Guardianship
No aide available for home health care
No nursing home bed available
Ed issue — inappropriate admission
AVOIDABLE DAY REASONS — PATIENT/FAMILY

(OCC/DAYS)

Family refuses
Family unable to pick patient up at discharge
Patient non-compliant
Patient refuses test/procedure
Unable to reach family
Pending custodial care
Family delay in Medicaid application
Guardianship/conservatorship issues
Difficulty with decision making
AVOIDABLE DAY REASONS — PAYER

(OCC/DAYS)

Delay in approval  
Delay in discharge  
Delay in processing forms  
Insurance issues  
AVOIDABLE DAY REASONS — PROVIDER

(OCC/DAYS)

Patient not acute, MD refuses discharge  
Inappropriate transfer from another hospital  
Consult delay  
Decision-making delay  
Delay in medical clearance  
No consent for treatment  
Delay in surgery  
Awaiting procdure/ none specified  
Preadmission issue  
Delay in GI procedures  
Delay in coordination of services  
AVOIDABLE DAYS TOTAL  

DISCHARGE PLANNING

Completion of initial assessment/discharge plan within 24 hours

     

     

     

REFERRALS TO POST-ACUTE CARE

Home w/No Services (as % of discharges)

Home Care (as % of discharges)

Acute Rehab (as % of discharges)

Sub-acute rehab (as % of discharges)

Sub-acute medicine (as % of discharges)

Sub-acute vent (as % of discharges)

Long Term Care (as % of discharges)