List case management-related tasks before time studies

Activities depend on hospital’s model

A hospital case management model may include utilization management, discharge planning, quality improvement, risk management, or clinical care management, all under one umbrella.

"Case managers don’t do all these functions in all hospitals. There may be a social worker who handles discharge planning and a case manager looking at the clinical aspects, or they may be integrated so case managers do all of that work," says Teresa C. Fugate, RN, BBA, CPHQ, CCM, manager, Pershing, Yoakley & Associates, a Knoxville, TN-based health care consulting firm.

Before you do the time studies involved in setting up an acuity-based case management assignment system, you should define the activities involved in case management at your specific organization.

Include a column for clerical activities and other nonprofessional tasks they are expected to undertake. Here are some questions to ask:

  • Do case managers perform utilization management?
  • Are they assessing delays in services or intervening to prevent delays in services?
  • Is it their responsibility to check orders and call the physicians with results of tests?
  • Do they monitor medical necessity and intervene with the physicians to say that the situation no longer meets the lower level of care requirements?
  • Do they work with physicians to assist in documentation to meet compliance requirements?
  • Does their job include discharge planning?
  • Do the case management activities extend to setting up transportation, arranging for home health and durable medical equipment, and making the patient’s next appointment with a physician?
  • Are the case managers monitoring protocols?
  • Do case managers collect information for the Joint Commission on Accreditation of Healthcare Organizations core measures?
  • Are case managers responsible to see that there is compliance on risk-related issues, such as alerting someone to risk-related pain management?