Merger gives CMs tighter focus, network resources
Merger gives CMs tighter focus, network resources
Expands role beyond the hospital walls
The merger of Methodist Hospital and Park Nicollet Clinic in 1993 could well be a model case management success story. The result of that merger has been a decrease in average admission costs -- from $7,500 to $5,500 -- and a 26% reduction in costs for Methodist's top 12 DRGs, measured by patient volume.
When merger negotiations first started in 1989, case management, termed care facilitation at 426-bed Methodist, was only beginning to evolve, explains Kay Uran, RN, CQAURP, director of patient/family support services. Uran supervises 4.5 full-time-equivalent case managers for the St. Louis Park, MN-based hospital, which is now part of HealthSystem Minnesota (HSM), the holding company created after the merger of the two organizations. Park Nicollet's merger with Methodist Hospital added a clinic, primary physician network, medical foundation, and institute for research and education to the hospital system.
"We were trying to get out of the fog of 'What are we, and who are we working for?' The confusion that a merger creates was happening in parallel fashion to us getting the case management function grounded in the organization," explains Uran.
The merger allowed the case managers, called care facilitators at the newly created HSM, to focus more on critical pathway development and individual patient problem-solving. The merger also helped care facilitators build a network of resources not only throughout the organization, but beyond the walls of the facility and into the community, says Uran.
Before the merger, case management was performed on a small scale and the case managers were "almost mandated" to keep the program within the walls of the hospital, says Uran. "Because the program grew in the inpatient environment, we had a lid on it to remain inpatient. But now, the larger organization has opened a whole new range of options so that the care facilitator doesn't feel like [he or she] must stay within the boundaries of the building."
Managing across the continuum
The care facilitators now are responsible for managing patient care throughout the continuum of care, including the physician clinic and home health care.
"Our care facilitators now are responsible for looking at the whole picture. The merger has created an environment that isn't we/they." Uran says.
The merger has given care facilitators more accountability for patient care because the care facilitators follow patients throughout the health care continuum, says Uran. "They can no longer say, 'When they're out of our setting, they are no longer our responsibility,' and they know they will work with the patient again in home health, for example, on a regular basis."
Care facilitators also work more closely with the physicians. For example, patients who require additional care beyond the hospital stay are seen in the clinic. Care facilitators coordinate the transition of care from the hospital to the clinic, which may require a different physician. The care facilitator helps coordinate the transition of care from one physician to another.
Care facilitators also participate in critical path development, although the facility's 10 pathways were initiated by multidisciplinary teams led by clinical nurse specialists. Paths are used by utilization review nurses and the care facilitators.
The care facilitators "then only have to be on the alert for either a call for help because now the patient has deviated from that path or assistance in using the paths," Uran says.
Another key role of the care facilitators in the redesigned facility is serving as a community resource for patients. Care facilitators are knowledgeable about community resources patients can use, for example, after they are discharged. Outpatient services offered through the physician clinic and home health visits are examples of resources care facilitators may coordinate for patients.
Cost reductions
A physician staffing change plus lower lengths of stay overall, due to the use of critical paths in the hospital, led to a tremendous cost saving for the hospital.
"One of the reasons we were able to reduce costs by 26% for our top DRGs was a complete redesign of how our clinic physicians cover patients in the hospital," explains Carol Hobart, hospital spokeswoman. "Some of the clinic physicians now work full time at the hospital. In turn, a few of our doctors opted not to do any hospital coverage at all and were willing to take on more responsibility in the clinic."
HSM's new program will be put to the test in 1997 when large employers in Minnesota move to a voucher-based program. Employers in the Minnesota Business Care Action Group will provide employees with vouchers to shop for health care directly rather than buying care through managed care organizations. The merged clinic and hospital program is designed to help HSM gain patients it otherwise might have lost in the impending change. *
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