Resource center frees up CMs for clinical tasks

Clerical staff handling faxing, copying

A resource center at Baptist Memorial Hospital-Memphis — staffed by clerical assistants who handle routine faxing, copying, and telephone calls — has helped free case managers to concentrate on the clinical aspects of their job.

"The clerical assistants do nothing independently. Their job is to take care of paperwork and other details so the case managers and social workers can concentrate on ensuring that their patients get what they need," says Randy Brightwell, RN, BSE, MA, case manager and contact person for the resource center staff.

The resource center recently began handling the hospital's bed express staffed by RNs 24 hours a day, seven days a week. The bed express tracks and places all patients admitted to the hospital, he says.

"Previously, the facility has spent many days in what we call 'red status,' which means we are holding patients in the emergency department or post-anesthesia care unit. The resource center's primary function is to smooth flow by evaluating all patients in the admission queue and providing for an orderly transition between levels of care," says Darla Belt, director of performance review and accreditation.

The resource center opened in October 2007, at the time the case management department was reorganized.

Since the reorganization, the average length of stay has dropped by one day.

"The resource center has been a factor in the decrease in length of stay because the case managers can attend to the kind of clinical issues for which they are trained, instead of spending time on the telephone or faxing. However, we can't take sole credit for the drop in length of stay but we feel that the resource center has been a contributing factor," Brightwell reports.

Baptist Memorial Hospital-Memphis has more than 30,000 discharges a year and more than 50,000 ED visits.

The 706-bed tertiary care hospital has 36 case managers and 15 social workers. Some are unit-specific and others are assigned to major hospitalist groups. Others cover access case management in the ED.

The resource center was developed in response to the hospital's senior leadership strategic initiatives that include improving patient flow and increasing productivity and revenue and reimbursement issues, Belt says.

Belt asked the case managers and social workers to evaluate the clerical duties they were responsible for to determine what could be done by the clerical staff and what had to be done by clinicians, Brightwell says.

"We brainstormed about the development of the resource room and the tasks the staff could do to increase the efficiency of the case managers and social workers," Brightwell says.

For instance, Medicare's patient self-determination regulations require that hospitals give patients a choice of post-acute facilities that will meet their needs.

"This means a lot of copying and faxing to provide patient information to those facilities. We determined that the case manager should direct what information should be provided to which facilities but the clerical staff could do the copying and faxing, freeing up the case managers to spend more time with the patients and families," he says.

The team looked at insurance company precertification requirements and determined which tasks could be handled by a clerical person.

For instance, some insurance companies require that an intake person assign a case number and then refer the precertification request to a case manager for review. With other companies, a precertification call goes directly to a case manager.

"When we analyzed this, we determined that it was a waste of time for case managers to talk to the intake person to establish the case. We moved that task over to an assistant. They contact the insurance company by telephone, fax, or e-mail, depending on the insurer's preferences, to establish the initial notification for referral to an insurance case manager," Brightwell says.

The resource assistants notify insurance companies about the admission of patients who have secondary Medicare coverage, such as private HMOs that provide Medicare Advantage coverage.

"If it's a plan that requires clinical information, the assistants don't get involved except for faxing the information," he says.

Information on the patient is entered into the hospital's electronic case management system by the case manager, who is an RN. The assistants in the resource room forward the information to the insurance company.

"Assistants in the resource room are not allowed to enter clinical information into the computer system. Their job is to take the information entered by the case manager and disseminate it," he says.

Assistants handle IM delivery

The assistants facilitate delivery of the Important Message from Medicare (IM) required by the Centers for Medicare & Medicaid Services (CMS) to notify patients of their rights to appeal their discharges.

The initial IM is given to patients in the admitting department.

As case managers on the floor review their patient admissions, they enter a projected discharge date into the electronic case management system. The system automatically generates a list of anticipated discharges each morning.

A resource assistant compiles the list, informs the case managers of their patients on the list, and assists in serving the letters to the appropriate patients.

When case managers or social workers have clerical needs, they assign the task to the resource center staff through the hospital's electronic case management system.

Since the hospital's patient population comes from a three-state area, the resource center staff provide invaluable assistance in researching post-acute services for these patients, Brightwell says.

"The assistants in the resource room keep up with the post-acute services that are available throughout the area. We are compiling a book of resources, and the assistants are good on the computer, searching for new facilities that may be able to meet our patients' needs," he says.

The resource room staff include four assistants and a secretary who also assists the director. The resource assistants share space with Brightwell, the bed express operation, the director, and the physician advisor.

"I'm the 'go-to' person, and they have other people nearby to turn to if they need help or have questions," Brightwell says.

Assistants must have diverse skills

The assistants come from a variety of backgrounds and have diverse skills, giving them the ability to work as a team and fill all the needs of the case managers and social workers.

For instance, one staff member had worked as an intake specialist in an insurance company and understands how payers operate. Another has a lot of computer experience and skills. The other two already were employed at the hospital as unit secretaries and were familiar with the programs that the hospital uses.

"As we interviewed people, we looked at the skills they had to offer and hired staff with a good balance of skills. Each has their own strengths and can help their peers if needed. We were fortunate that we got a group of well-rounded people who could be cross-trained so they develop new skills," he says.

Each of the assistants has a special assignment in addition to other duties. For instance, one assistant comes in at 6:30 a.m. to compile the IM list and have the documents ready when the case managers arrive. Another works to ensure that all privately insured patients in the hospital have a precertification number to facilitate the billing process.

Others assist case managers with durable medical equipment orders and home health placements; compile the patient log for the in-house skilled nursing facility; work with the bed express to help place patients; and compile data to create reports for hospital revenue and reimbursement meetings and quality reporting.

(For more information, contact Randy Brightwell, case manager, Baptist Memorial Hospital-Memphis. E-mail: randy.brightwell@bmhcc.org.)