Ease caseload burdens with support staff

Enlist business office to coordinate with payers

To boost the efficiency of your case managers, experts recommend enlisting the help of qualified support staff capable of easing clerical and information management burdens.

"It’s very possible that those case management departments that have support staff like secretaries and health information management professionals can do more hands-on, one-on-one case management," says Patrice Spath, ART, BA, a consultant in health care quality and resource management with Brown-Spath & Associates in Forest Grove, OR. "Are you responsible for things like calling back insurance companies? If so, you may not have as much time to do other things. Case managers who have the right support staff at their disposal might be able to case-manage more people per day than those departments who own some of their secretarial and data management things that could be given away."

At Brookwood Medical Center in Birmingham, AL, a clerical liaison in the case management department manages the paperwork and handles communications related to nursing home placement. "We really just want the case manager to be coordinating care and doing those aspects of critical thinking that require them, so that they’re not bogged down too much by some of this back-and-forth faxing of paperwork and verification," says Sue Esleck, MSN, RN, administrative leader, care continuum at Brookwood. "The same thing’s true for insurance paperwork."

Nevertheless, given the current climate of lean case management budgets and doing more with fewer resources, many case management departments aren’t always able to hire the support staff they need, says Sharon Berkley, RN, case manager at Mercy Center for Healthcare in Aurora, IL. "What I do a lot of right now is put together a lot of the clinical pathways and make disease management tools, and then I disseminate them out and educate," she says. "What falls in the hole is the data collection, monitoring and then reporting. You need to have a system in place to help you do the quality assurance and reporting of what you’ve done."

Medical records personnel can help

Some organizations address the problem by enlisting medical records personnel to work with case managers in performing call-backs and other activities that require some clinical understanding, "but not necessarily at the level of a social worker or discharge planner," Spath says.

Another important factor is to include a representative from the business office as a liaison to case management, Berkley says. "Someone needs to be able to pull in the financial aspect and know the payer source, because that tends to come more from patient accounts," she adds. "Someone needs to understand how the bottom-line cost is reflected in decisions about the patient. Not that you’re going to treat the patient any differently, but how you resource support services is impacted by their payer source."