2008 Salary Survey Results

Salaries are up, but case managers have more responsibilities

Creative strategies help with staff retention

Case management salaries are on the rise, but the vast majority of case managers are working far more than the typical 40-hour week, according to the 2008 Hospital Case Management salary survey.

The 2008 salary survey was mailed to readers of Hospital Case Management in the June issue. More than half of the respondents (65%) were case management directors. The rest were case managers, utilization managers, social workers, or had other titles.

The majority of respondents (87%) to the Hospital Case Management 2008 salary survey report that they received a pay increase last year. The majority of raises (46%) were in the 1% to 3% range, with 34% reporting raises of 4% or more.

About 81% of respondents report receiving salaries of $60,000 a year or more, with the majority of respondents (55%) reporting an income in the $80,000-$90,000 range and 21% reporting salaries of $100,000 or more.

At the same time, case managers report putting in long hours. Nearly 87% of respondents report working more than 40 hours a week, with 36% putting in more than 50 hours.

CMs' duties expand

It's a general practice in many hospitals today to give tasks such as tracking core measures and clinical documentation improvement to the case managers "since they're already in the charts," says Toni Cesta, RN, PhD, FAAN, vice president, patient flow optimization for the North Shore-Long Island Jewish Health System and health care consultant and partner in Case Management Concepts LLC.

However, in many cases, the case managers already have more than they can handle and, since they are pressed for utilization review and discharge planning duties, other tasks may fall by the wayside.

In many hospitals, case manager staffing is not appropriate for the volume of work, Cesta points out.

Less direct patient care

The additional work that case managers must tackle decreases the time they spend with patients, creating an atmosphere of discontent that is causing some hospital-based case managers to look elsewhere for work, adds Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy & Associates, a case management training and consulting company.

"Nurses go into nursing because they want to help people, not because they want to spend time doing paperwork. When hospital-based case managers have limited patient contact, they don't get that feel-good feeling and often get burned out and look for other opportunities," she says.

The nursing shortage and increasing demands placed on case managers have prompted case management directors to work with their hospital administration to find creative strategies to keep experienced staff on board.

While their hospitals struggle with the nursing shortage, case management directors have developed creative strategies to keep experienced staff on board.

For instance, Baptist Memorial Hospital-Memphis opened a resource center with nonlicensed staff who support the case managers, handling faxing, copying, and nonclinical calls to insurance companies and referral sources. Resource center staff also are responsible for tracking and delivering the Important Message from Medicare, notifying patients of their right to appeal their discharge.

Benefits for CMs

Since the center opened 18 months ago, following a restructuring of the case management department, turnover has been minimal, says Darla Belt, RN, director of performance review and accreditation.

The hospital also has limited the caseload of case managers to 20 patients, she says.

"During the reorganization, we combined the utilization review and case management functions. We expect a lot of the case managers so we try to take away things that don't require their expertise and give them a manageable load," Belt explains.

Baptist Memorial Hospital-Memphis pays for case managers to become certified and gives them a $500 bonus once they are certified. So far, 60% of the case managers have met the goal of having all case managers in the department certified by 2010.

Harris Methodist Hospital in Fort Worth, TX, offers case managers flexibility in their starting and end times, allowing those with children to get them off to school and those who need to be home earlier in the day to come in earlier, says Mari J. Finley, RN, MBA, director of medical management.

The hospital administration is supportive of case management and has provided the department with a high-tech case management software system and laptop computers so the case managers can document while they are in the patient rooms, Finley says.

The department is undergoing a reorganization this year, with one of the goals being reducing the 30-patient caseload the unit-based case managers carry.

"We have been successful over the last few years in retaining our case management staff. It's always a challenge to find qualified case managers. Often, we have to take nurses who are new to case management and train them to perform the role," Finley says.

Recruiting qualified case managers is one of the biggest challenges that case management directors face today, and it's likely to get worse as today's case managers reach retirement age, Cesta adds.

The aging of case managers poses a challenge for the industry, Cesta points out.

With hospitals offering higher salaries, shift differentials, and overtime pay to attract nurses during the nursing shortage, many younger nurses are opting to stay on the floor rather than go into case management because they can make more money, she says.

"The pool of cases managers is getting older without younger, experienced nurses coming along to take their place. This is going to be a bigger challenge than the nursing shortage in future years," she adds.

In fact, most respondents to the salary survey are older and experienced case managers. More than half (55%) have worked in case management for 10 years or longer.

About 57% of respondents are over age 50, while 14% report being 61 years or older. Only 9% report being age 40 or younger.

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