Who Needs A Hospital Care Manager?

by Marianne Ramey, Senior Partner
Published on Nov 23, 2015

The professional practice of hospital case management is a collaborative process between the patient, the physician, and members of the clinical team to pro-actively influence and advocate for a safe, cost efficient, clinically effective progression-of-care through the acute episode of care and into the community. The question is: Which patient would benefit most from this service?

The standards of care management practice are quite comprehensive and extensive.  Care management practiced in accordance with those standards  (as opposed to functional models) is generally too expensive to provide to every hospitalized patient and is typically not needed by most.  But then the question arises, how to identify those patients who are at greatest risk for progression-of-care practices that put the patient at clinical risk, that adds financial rsk for the patient and the organization, and generally delays transition?

Hospitals with sophisticated data warehouses are now able to abstract data from multiple sources to generate a composite  score within 24 hours of admission that indicates the level of risk. Bits and pieces of descriptive elements taken from multiple sources such as the ADT data base, ED assessment, H&P, admission meds (degree of polypharmacy), previous visits to the ED or admissions to the hospital, etal,  are electronically transformed into a usable metric. Since most hospitals do not have access to this new and exciting innovation, the next best practice option we've encountered, and one that seems to work well, uses the initial patient assessment as the primary screening tool to select patients for care management.   No new forms are needed; no new processes are required.  With just some modest refinement to the facility's current assessment tool, at risk patients who may benefit from the care coordination activities of a care manager can be identified.   

We urge care managers to get together with their nursing colleagues and review the current parameters of the assessment tool to make sure that objective indicators are embedded and can be electronically mapped to generate an automatic referral to the case management office. We've even seen hospitals embed a tool such as a modified L.A.C.E. into the assessment to help with the process.

This innovation is smart on so many levels:  It serves as a first level screening tool to identify patients who would benefit from care management oversight;  it streamlines the care management referral process so that a care manager can be on the case promptly, and it may also serve as a first level discharge screen, though that depends upon the scope of the final rule changing the CoP discharge planning standards.