What good are data if they are not used? Many case management departments collect data and report trends, but the information is only as good as how the hospital uses it. The extra effort is worth it. Case managers and their departments who use data in meaningful ways experience better outcomes — but the decision to be resourceful often starts higher up.
“Case managers must depend on their leadership to share data and information related to their roles, particularly around denials and appeals, discharge planning, length of stay, readmission rates, and value-based purchasing,” explains Toni Cesta, PhD, RN, FAAN, owner and consultant with Case Management Concepts in North Bellmore, NY.
For many hospitals, data consumption is not just helpful — it is required.
“Hospital case managers and case management leaders have an obligation to consume data,” said Jeffrey Echternach, MBA, AS, NRP, DSC, technology officer at the Center for Case Management. “The data imperative is equally important for all leadership levels within case management, as this department is frequently viewed as the clinical arm of the revenue cycle and influences a number of essential metrics for hospital operations.”
A Data Treasure Trove
Echternach notes each level of staffing can glean different, helpful information from the collection. Frontline staff can learn about key trends affecting their patients and the hospital. Leaders can share top impact metrics and their relative influence with staff, in addition to key actions that will shift these metrics in a positive way. Both can leverage data and business intelligence tools to drive positive changes through performance improvement initiatives that drive efficiency and better patient care.
What kind of information is out there?
“[The kinds of data available] vary widely depending on the case manager job role — frontline staff vs. leadership — and the maturity of the business intelligence tools and curated metrics that are made available by the organization,” Echternach says.
Generally, case managers respond to data per encounter while leadership is more concerned with analyzing trends for a particular unit or division of the hospital, or the entire hospital. With that in mind, case managers might be accessing data more frequently, perhaps daily or even hourly. Echternach explains their data considerations usually include:
- length of stay (LOS);
- LOS variance from expected LOS;
- status (such as inpatient vs. observation);
- insurance information;
- approvals and authorizations;
- use of healthcare services (including past hospitalizations or emergency department visits);
- problem list and current or active diagnosis;
- social determinants of health (SDOH) and support systems;
- assessments, missing assessments, or gaps;
- medications, coverage (insurance), accessibility;
- hospital bed availability, hospital bed demand;
- readmission risk (calculations and artificial intelligence tool predictions);
- post-acute destination availability;
- denials of continued stay or admission coverage from insurance;
- medical necessity;
“The case manager is an advocate for the patient, balancing benefits, patient interests, and hospital utilization,” Echternach says. “As such, they are evaluating length of stay, appropriate testing and test setting, [and more]. Embracing and maximizing the use of data and/or technical tools to augment the practice serves the best interests of the patient and hospital.”
For those in leadership roles, the most useful data when analyzed for trends, leading to opportunities for improvement, include:
- LOS (observed to expected);
- case mix index;
- status changes and patient mix;
- observation with excess LOS;
- use of target or appropriate bed space;
- approved days vs. total, denied days vs. total, percentage of denied days overturned;
- avoidable days, stratified by reason;
- readmission rate, readmission interventions, post-discharge compliance for high-risk cases;
- population portion with a positive SDOH finding;
- SDOH population with one or more referral or active/documented community support;
- time to first assessment;
- time to first medical necessity appraisal;
- discharges by post-acute destination;
- patient choice turnaround time;
- referral to post-acute turnaround time;
- discharge processing turnaround time;
- long stay cases;
- high-dollar cases;
- clinical denials, concurrent denied trends by reason;
- high utilizer rates, high utilizer interventions, and response rates.
From Treasures to Tangibles
Taking the data to the next level and turning it into tangible opportunities for change is the most valuable part of the process.
“Case managers can see how their interventions are having an effect on the department, the organization, and their patients,” Cesta notes. “These data allow for continuous quality improvement. Without feedback, staff do not know where they are doing well or where they may need improvement.”
According to Cesta, improvements made because of data can have a positive effect on quality of patient care as well as hospital finances.
“Constant improvement can result in both financial as well as quality gains,” she explains. “On the financial side, denials can be reduced, and length of stay can be shortened. Value-based purchasing scores can alert the staff to areas needing improvement around cost and length of stay as well as readmission rates. Most of the case management outcomes can be calculated in terms of dollars.”
Case managers also should be sure to track their “saved days,” which are those days taken off the LOS following a case management intervention that resulted in an earlier discharge for the patient, Cesta says. When case management prevents an unnecessary admission or readmission, these interventions are tied to cost savings, and should be quantified as such.
In situations like those seen during the height of COVID-19, when some hospitals were beyond full, case managers who use data well can help make a deep impact in helping the hospital function under stress.
“In some cases, when hospital capacity is stretched to its limits, the case manager’s keen focus on utilization and level of care supports the greater good by helping clinicians with earlier identification of discharge options, downgrade options, and the creation of bed capacity to make room for additional demand,” Echternach adds.
Knowing how to translate the data and trends into deliverables can involve a steep learning curve. According to Echternach, many hospitals that are actively engaged with their data and make subsequent efforts to improve performance have:
- Cost savings per case.
- Wider access. By shortening LOS, hospitals can expand bed access, leading to more admissions, shorter wait times for existing admissions, and lower variable costs when admission demands are low or fulfilled.
- Cut readmissions with like causes. Preventing these situations can improve hospital margins and lead to improvements in disease management and compliance. Overall, reducing readmissions will contribute to favorable evaluation on value-based purchasing scores.
- Improved efficiency. Evaluating trends in reaction time or processing time and prioritizing improvements leads to time savings.
But to achieve these goals, case managers and leaders need to commit to engage with their data regularly, with an eye toward using it for performance improvement and cost savings.
“For case managers and social workers to see how they are doing, both good and bad, they need to see these data on a regular basis,” Cesta shares. “Data sets can be aggregated in a case management dashboard that is populated on a monthly basis and shared at a staff meeting. In this way, trends can be analyzed, and areas for improvement can be identified. This data collection falls under the responsibility of the director or manager of the department.”
Echternach shares the example of a hospital in Massachusetts that evaluated historical discharge data compared to bed capacity and identified a target and minimum number of discharges per day.
“This ‘magic number’ became a cornerstone of daily operations, stimulating action-oriented conversations when the morning bed huddle review demonstrated that predicted plus confirmed discharges for the day did not meet demand,” he explains. “Discussion moved from hypothetical and weak to action-oriented and objective. ‘If we need 83 discharges today, and have a combined total of 67, then ….’”
About That Learning Curve
Since it takes time, trial, and error to turn data analysis into meaningful action, it is wise for case managers and leadership to employ the help of professionals, including an in-house analyst, and seek resources to guide discovery.
“Some departments have a data analyst embedded in the department, but many do not,” Cesta notes. “Some hospitals have support staff who will run the data for the departmental leadership in a decision support department, or the like. In other instances, specialized case management software will populate a dashboard for the users. The director of the department should be sure to report the data in a format that is understandable to all, both within the department itself, but also for others in the organization.”
Echternach advises case managers to “learn from each other,” including tips and tricks they have learned in small group forum. Similarly, he says, “leaders can inform the staff on interpretation of data. Further engaging with subject matter experts from other departments in different types of learning events can enrich the learning experience.”
Other learning opportunities in data literacy are available through organizations and consultants, like the Center for Case Management, who can help leaders explore case management metrics, productivity, payer trends, denials, hospital capacity, and support case management department leaders in connecting case management practice to the influence of outcomes. Groups like these also publish articles, blog posts, video-based education, and direct training.
Case management departments are a powerful force for the hospital’s performance, both in quality of patient care and finances. Bringing in powerful data tools and knowing how to use them can set the case manager and leadership up for success — and the results often are priceless.