Contracting case managers benefits NY facility
Contracting case managers benefits NY facility
Outsourcing employees is win-win for everyone
Within the span of a year, Lenox Hill Hospital in Manhattan found a creative way of cutting its length of stay by almost two days while saving upward of $500,000.
Lenox Hill, a 652-bed acute care facility on Manhattan’s upper east side, entered the world of case management nearly 10 years after most hospitals across the country already had successful programs up and running. But that hasn’t put a damper on the hospital’s ability to implement its own flourishing case management department via Visiting Nurse Service (VNS) of New York, the largest nonprofit home health agency in the United States.
Two years ago, Lenox Hill contracted with VNS for case managers who handled managed care patients, and the positive outcomes encouraged the hospital to expand to a similar program focusing on all medical patients.
Managed care success encourages expansion
When Lenox Hill and VNS sat down and began to hash out how they were going to develop an outsourced case management department, the two organizations agreed on a number of principles, including the contention that all patients do not need a case manager. They then developed criteria for assigning case managers. The decision to place a patient with a case manager could be based on a clinical need, a physician’s request, or a variety of other reasons, says Patricia Dee-Kelly, vice president of managed care for VNS.
"What we found is that, years ago, when people had UR [utilization review] nurses in the hospital, their primary focus was justifying how many days the patient could stay in the hospital," Dee-Kelly says. "In today’s world, it isn’t a question of justifying how many days they should be there; it is a question of how do we move things along from a clinical management perspective to get them out."
For example, she says, when elderly patients enter the hospital, "everything happens to them, from being disoriented to getting weaker and being susceptible to other infections while they are there," Dee-Kelly says. "And it is just not the best place to be. So the idea is to get them in, take care of what needs to be taken care of, and then get them out."
To do this, VNS employs a specific type of case manager. "We worked really hard to hire the right individuals for this role," she says. "We hire someone who is articulate, has a business focus, and is ready to work with physicians — and not in a punitive way, [because] that’s not our approach."
The program is obviously working, because after nearly a year, Lenox Hill is saving money, the average LOS has dropped by 1.8 days, and the hospital is pleased with the results, says Wayne Keathley, vice president/operations of Lenox Hill Hospital.
"The cost of our outsource arrangement varies by volume, and we only pay for case management services when we need them," he says. "We have no overhead expenses. We were more concerned about the value of a successful program, however."
On a long-term basis, Dee-Kelly says the savings would be considerable, given that the case managers can help transfer patients in and out more quickly and efficiently.
How they make it work
Lenox Hill currently has six to 10 case managers handling between 15 to 20 Medicare patients each.
The case managers are not employees of Lenox Hill, yet they are not considered "temporary" workers, Dee-Kelly says. Although the program is only a year old, she says the case managers can stay in their current positions as long as they like, just as any employee of the hospital would.
Working as an outsourced employee tends to be a benefit, Dee-Kelly says. "They have one mission. They know exactly what the object is, and they know clearly what the goals are," she says. "They don’t get involved in the politics of the hospital and all that other stuff. The program actually has greater credibility with physicians, since it’s tied more to service to them and their patients, rather than traditional care management programs."
Dee-Kelly adds that the case managers have worked tirelessly to develop some creative care plans to better serve the patients.
For more information, contact:
Patricia Dee-Kelly, vice president of managed care, Visiting Nurse Services of New York, New York City. Telephone: (212) 290-3886.
Wayne Keathley, vice president/operations, Lenox Hill Hospital, New York City. Telephone: (212) 434-2080.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.