Time studies facilitate case assignment
Average out the times for each task
A time study is one way to measure productivity at the same time you reduce the disparity in assignments between your case managers.
"Case managers know instinctively about how much time it’s going to take to manage some patients. That’s why they get so stressed out when they think there is no way they can get everything done in one day. A time study that shows how much time each task may take is a way to show that they may be right — they can’t do it all in one day," says Teresa C. Fugate, RN, BBA, CPHQ, CCM, manager for Pershing, Yoakley & Associates, a Knoxville, TN-based health care consulting firm.
Making a list of case managers’ activities
Start your time study by listing each activity that case managers perform.
Assign each case manager the job of keeping track of all the activities they perform each day for each patient and the time involved for each activity during a certain time span.
To avoid frustrating your already busy staff, Fugate recommends performing the time study one day a week for five weeks so every day of the week is covered, and average the time. Using historical data, come up with the numbers and types of diagnoses you can expect to have.
Assign a time-based system for each activity. For instance, a new review may take an average of 20 to 25 minutes. A continuing stay review looking at just one episode may take only 10 minutes.
"Once you do the time study, there are indications based on patient demographics that will give you an idea of the possibility of acuity level," Fugate says.
The person who makes the assignments each morning should look at the demographics and determine the acuity level for each patient based on the time studies.
"A calculated task may take 30 to 40 minutes for one patient and only 10 to 15 with another, depending on their acuity level and the activities that are likely to happen with the patient," says Fugate.
For instance, if a patient has commercial insurance, the person who makes the assignments knows the case manager will have to make an insurance call.
The assigner generally can tell how in-depth a psychosocial assessment will be by the age and diagnosis of the patient. He or she knows which core measures on the care path are being monitored for the Joint Commission on Accreditation of Healthcare Organizations and how much time that will take.
"They know, based on demographic information, the sort of time each individual patient will take. This way, the patients can be divvied out based on the amount of time it is estimated will be involved in taking care of the patient that day," she adds.
For instance, if a patient is 70 years old with a history of congestive heart failure and previous readmissions within the last few months, this is a red flag that this patient is likely to consume a lot of a case manager’s time.
Based on time studies, you may know that the chart review for a new patient will take 20 minutes, a full assessment will take 20 minutes, and an assessment of the psychosocial issues is likely to take 20 minutes. If it’s a Medicare patient, the case manager won’t have to make an insurance call, but he or she may have to set up durable medical equipment.
At lunchtime, the supervisor should look to see whether the time it is taking for each patient is running close to the anticipated time. He or she can make adjustments and reassign patients if necessary.
"The system is time-driven," Fugate says.
At the end of the day, the case managers can anticipate what they have to do tomorrow and how much time it can take. They can enter that information on a simple data entry system that the person making the assignments the next day can use.
For instance, a case manager may say she has six patients remaining that can be expected to take a total of two hours time.
The supervisor who makes the assignments the next day looks at how many hours the case managers will work and how much time the patients left over from the day before will take, and bases the assignments on that.
An acuity system allows supervisors to enter anticipated time, then enter the actual time it took and compare the two.
"They can adjust their time-study data and do more training to help people better anticipate the time it takes to manage the care of each patient," she says.
As a bonus, if case managers are paid by the hour, the supervisors can look at the time studies as a way to reduce overtime pay.
The time studies give case management supervisors a chance to look at any type of nonprofessional activities, such as sending out letters, making copies, and waiting on hold on the telephone. These data can be used to justify hiring clerical workers, Fugate says.