The Business of Hospital Case Management

Why Should You Attend:

This webinar will discuss the business aspects of the case management department, from reimbursement to potential penalties. It will review the role of the leader in identifying which data points to track and where to report them. It will also help the RN case manager and social work case manager in understanding their impact on outcomes and which outcomes they should focus on to assist the department in providing the most optimal results.

This webinar will focus on the transition of hospital case management departments from purely process oriented to outcome driven. The case management department has become one that is viewed as a strong collaborator in ensure payment by payers—federal, state and commercial.

A business plan is critical as a business dashboard is developed. The business dashboard sets the scene for strategies and enables the department to keep their eyes on the goal……on those outcomes!

As strategies are in place, it is important for the case management team to know their role in the business of their department and how they have impacted outcomes. Likewise, they need to know if they should continue their processes or “tweak” them for improvement.

Areas Covered in the Webinar:

• Hospital case management: The initial focus
• Transitioning to case management financial functions
• Hospital reimbursement
• Payer relationships: National, state and commercial
• Treating hospital case management department as a business
• The impact of your operations on your hospital’s bottom line: Case management leader, RN case manager, social work case manager, physician advisor
• Developing a case management business plan
• The case management business dashboard
• Business dashboard: Where are the results reported
• Business dashboard: What do the results mean to the leader, the RN case manager, the social work case manager, physician advisor

Who Will Benefit:

• RN case managers
• Case management leaders
• Social workers
• Physician advisors
• Executives responsible for case management department

Bev Cunningham
Consultant, Case Management Concepts LLC

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

Topic Background:

Case management began as a solution to decreasing length of stay. Early on “critical paths”, which later evolved into clinical paths, identified what should be provided to patients each day of their hospital stay—all based on the diagnosis or procedure. There were few regulations and hospital accounting systems were not capable of providing cost data that could be used for understanding resource utilization. Even quality data was not aggregated and tracked—and certainly not reported. The real reports were volumes. Volumes of patients, volumes of patient days, reimbursement by payers were all most of what were seen.

As time has marched on over the past thirty to forty years, hospital data systems are much more complex and able to track information that we all use to understand where we are with our outcomes. We look at outcomes for the hospital and outcomes for each department. Rules and regulations have evolved, and we track our compliance to those. Quality metrics are also tracked and analyzed. Case management leaders must now understand the business of their departments, understand what to collect, where to find the data and the report their outcomes.

RN case managers and social work case managers must understand their department outcome results and how they can impact improvement in those outcomes.

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