Physician-specific CM pays off for hospital

Patients, physicians like continuity of care 

A physician-specific case management program provides continuity of care for patients and creates a close working relationship between case managers and physicians at Nazareth Hospital in Philadelphia.

Nazareth Hospital is a 253-bed community hospital where many patients are admitted multiple times by the same primary care physician, often moving through the hospital’s continuum of care from critical care to a medical-surgical bed, says Monica Eckhardt, RN, BSN, director of care coordination and emergency services.

The hospital made the decision several years ago to assign case managers (known as care coordinators) and social workers by physician.

"Our model has evolved from a utilization management model to a true case management model," Eckhardt adds.

The care coordinators work with the same physicians and the same patients, following them as they are transferred from floor to floor or department to department as they move through the continuum of care.

"Before the implementation of the physician-centric model, the care coordinators did not follow patients as they moved from telemetry to med-surg to a critical care bed. On many occasions, patients were seen by as many as three different care coordinators who would have to become familiar with the patients’ plan of care. With the physician-specific model, the care coordinator is assigned from admission and follows them throughout the continuum of care to discharge," Eckhardt says.

An added benefit of having the same care coordinator manage a patient’s care no matter where he or she is moved in the hospital is that patients and their families see a familiar face and have a greater level of comfort, she adds.

"Any hospitalization creates a stressful situation for patients and their families. Our goal is to make it as easy as possible for them by ensuring the continuity of the case management process. Switching case managers and social workers at every level of care is more stressful for the patient and the family," she says.

The model gives the care coordinators an opportunity to build a relationship with the patients and their families that continues over time instead of having to build a rapport each time the patient is admitted to the hospital.

When patients are readmitted, they already know their care coordinator and vice versa. The care coordinator is familiar with the patient’s history and knows what problems to look out for, Eckhardt adds.

The hospital has nine care coordinators who work in acute care and typically manage the care for 17 or 18 patients at a time. The number of physicians to whom they are assigned depends on the volume of patients that physician admits. For instance, one care coordinator works with 10 physicians. Another is assigned to the patients of just three physicians who admit a lot of patients.

"As our relationship with the physicians has grown and improved, our outcomes and patient care have improved. When a care coordinator is off on vacation, the physicians say they feel lost without them. It’s a nice working relationship that pays off for the hospital and the patient," she says.

The physicians work closely with the care coordinators and rely on them to be their eyes and ears on the floor throughout the day, Eckhardt notes. Some physicians even call the care coordinator before a patient is admitted, notifying them when to expect the patient and discussing the plan of care. All of the care coordinators are available to go on rounds with the physicians, either in person or by telephone.

"Physician-specific case management builds trust with the physicians who work with us. They see the care coordinators as a resource that can make their lives easier," Eckhardt says.

The care coordinators work closely with the nursing staff. "They’re seen as resource people, and the nurses call them up when difficult situations arise," she says.

When the care coordinators arrive at the hospital each morning, they look at their caseloads and set priorities as to which patients they will see according to acuity and patient and family needs.

"They facilitate the plan of care and assist the social workers in making the discharge arrangements," Eckhardt explains.

In addition to working with the physicians to whom they are assigned, the care coordinators have a close relationship with the hospital’s clinical effectiveness physicians, two part-time physicians who work with the admitting physicians to develop and coordinate the patient’s plan of care.

The care coordinators spend a lot of time on the floor, she says.

"A lot of case managers don’t go to the bedside. Ours go to the bedside and develop a rapport with the patients," Eckhardt notes.

In addition to the acute-care coordinators, the hospital has disease-defined care coordinators, including a stroke care coordinator, an orthopedic surgery care coordinator, and a general surgery care coordinator who provide specialty care.

There are two care coordinators who work in the emergency department, coordinating care and discharge planning and notifying the care coordinators in acute care when a patient is being admitted. The emergency department care coordinators work 11 a.m. to 11 p.m. and cover six days a week.

All of the care coordinators in the hospital have tools available for quick communication, including Nextel mobile phones.

Eckhardt was a nurse manager at Nazareth Hospital eight years ago when the organization decided to develop a case management department. "I knew that case management was a good opportunity, and I wanted to get involved," she points out.

She and another nurse were the organization’s first care coordinators.

The organization started out with disease-specific case managers who specialized in respiratory, cardiac, and orthopedic surgery case management. After nine months, the hospital staff and the case managers looked at how the model was working and decided to switch to a physician-specific model, Eckhardt says.

"Through the years, we’ve piloted other models, but we believe that the physician-centric model is the most advantageous for our patients," she explains.

The hospital is collaborating with a payer source on a pilot project to develop a way of sharing information between insurance case managers and the hospital’s care coordinators.

The hospital’s chief operating office is a nurse who often joins the morning rounds. "She has a unique awareness and appreciation for the duties of the care coordinators," Eckhardt says.