2004 Salary Survey Results
Case managers still are fighting to prove their value
To see tables illustrating the 2004 Salary Survey results, click here.
Challenges, opportunities are in the future
Salaries for case management are increasing, but the vast majority of case managers are working far more than the traditional 40-hour week, according to the results of the 2004 Case Management Advisor Salary Survey.
The 2004 survey was mailed to readers of Case Management Advisor in the June issue. More than half the respondents (58%) were case management directors. Almost all others were case managers.
Respondents to the survey report putting in long hours. In fact, more than 80% report working more than 40 hours a week, with 21% working more than 45 hours a week.
At the same time, 95% of respondents reported an increase in salary during the past year. The highest percentage (47%) reported getting a 1% to 3% raise, followed by 37% whose salary increases were between 4% and 6%.
About 63% of respondents to the survey report salaries in the $50,000 to $80,000 range, with about 5% reporting salaries in excess of $100,000 and 21% reporting pay of less than $50,000.
Salaries still are an issue when it comes to recruiting and retaining experienced case management staff, case management directors say.
Disparity in pay by region
Case management departments have problems recruiting at some hospitals because pay for case managers is less than the pay for staff nurses, says Toni Cesta, PhD, RN, FAAN, vice president, patient flow optimization for North Shore-Long Island Jewish Health System in Great Neck, NY.
There’s a big disparity in pay for case managers both by region and by organization. Sometimes case managers are paid at the clinical nurse specialist level; sometimes at the management level, and sometimes at the staff level, Cesta adds.
"In a lot of areas, case managers don’t make what nurses make, and that makes a big difference," adds Mary Ellen Beasley, RN, BSN, division director for case management for HCA’s 15-hospital West Florida division with headquarters in Palm Harbor, FL.
Beasley has had to replace five case management directors in the last year because they found jobs that paid more or changed careers paths.
"Some of them left nursing altogether, going into real estate or other professions. It wasn’t just about moving up to be a nurse or case manager at a different facility," she says.
Not enough experienced case managers
Finding an experienced and competent person to fill the case management director’s job presents a major challenge because case management is a fairly new field and there aren’t a lot of experienced people available, Cesta adds.
"It’s difficult to run an integrated case management department. A lot of people have been plopped into case management by default. It takes years to really understand the complex job of case management. We just don’t have people who started out as an assistant director and came to move up to director," she says.
Case management directors find the nursing shortage another challenge to finding experienced staff to manage patient care.
"You can’t just walk into this type of job. You need a wide body of knowledge, and it takes a while to get somebody trained," says Sharon Simmons, CRNP, MSN, CNOR, director of clinical excellence for St. Vincent’s Hospital in Birmingham, AL.
Multiple skills are needed
Often, administrators think that case management is less difficult than nursing because it doesn’t involve direct patient care, Cesta points out.
On the contrary, a good case manager is someone who has extensive clinical experience and multiple skills, she adds.
"Case managers are being asked to do more and do it faster and better than ever, " Beasley says.
The question is: Just how much more can case managers take on and still do it appropriately, she adds.
Case management has become a complex specialty as regulations and requirements have increased, Cesta points out. "When people look at it from the outside, it looks fairly simple. Many people don’t understand the relationship between finances and case management. If the hospital doesn’t give the case management department the money it needs to function well, it’s shooting itself in the foot," she says.
Cesta is a firm advocate of an integrated case management model, which she says typically produces the best outcomes and is more user-friendly to physicians and staff.
The problem with integrated job functions is that in many hospitals, the caseloads have not been adjusted, she adds.
Not enough time in the day
"When role functions increase, caseloads should get lower. If you do a time and motion study and look at how long it takes to accomplish all the tasks the case managers are expected to do, you can easily see that there’s not enough time in the day," she says.
Case management departments need to have floating staff who can take over the caseload when someone is absent, rather than spreading out the cases among the regular staff already struggling with a caseload of their own.
"If you double someone’s caseload, they become useless. Case management departments should have a provision in their budget for floating staff," Cesta says.
A change in title only
When she speaks at conferences, Cesta often asks her audiences to raise their hands if they were a utilization review nurse on Friday and a case manager on Monday.
"It’s not uncommon. The titles change and nothing else changes. It was a problem 10 years ago, and it’s still happening. It’s a product of administrators who don’t understand case management," she says.
Case managers need an advocate, someone who can educate hospital leadership about their value to the organization, Cesta says.
Case management departments often face budget cuts because they’re not revenue-producing departments and the organization’s financial people don’t recognize their value, Simmons adds.
That’s why she makes it a point to produce a monthly report for her hospital’s executive team detailing what the case managers do and tying a dollar figure to their accomplishments.
She has compiled data on denials, length of stay, and case mix index before the case management department was started four years ago and compares it to current data.
"We’re able to show improved reimbursement based on documentation improvement and to track days we saved by intervening and moving patients out of the system," she says.
As a result, Simmons has been able to pay competitive salaries and offer flexible hours to retain her experienced staff.
Case management roles are changing dramatically, reports Jan McNeilly, RN,CPHQ, CPHE, principal for clinical advisor services at Premier, Inc. hospital alliance, a San Diego-based hospital purchasing group.
Roles are expanding
"Case managers are no longer concentrating on discharge planning and utilization review. They’ve taken on more responsibility, including being involved in what’s going on clinically with the patients, coordinating care, and making sure that documentation is correct," she says.
Many of the facilities that contract with Premier, Inc. have increased their case management departments, she says.
"There’s a huge focus on length of stay and the types of beds that patients are in while they’re in the hospital. The case managers are making sure the patient is always at the right level of care," she says.
Case managers are going to be needed more than ever as the health care consumer, whether it’s an individual or a corporation, becomes more aware of outcomes and cost-effective care, Simmons says.
"Case managers are going to be the driving force in improving outcomes, and they need to sell themselves to the administration that way," she adds.