Best Practice Case Management Models In The Acute Care Setting Including Staffing Ratios

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The Centers for Medicare and Medicaid Services (CMS) has instituted linkages between cost and quality through value-based purchasing and other cost-saving measures such as payment penalties for high readmission rates. These changes have created the first links between the cost and quality of health care. These factors now require that case management models begin to change and adapt. The early case management models no longer meet the needs of the changing healthcare landscape! It is for this reason that hospitals and healthcare systems must look thoughtfully and carefully at the design of their case management models, the roles used, and the staffing ratios of their case management departments.

No hospital can afford to remain stagnant in an environment that seems to be changing at a lightning pace. While the Medicare programs had remained fairly constant for many years, CMS now routinely changes the penalty and reimbursement structure in addition to adding new expectations such as the Two-Midnight Rule, and other similar rules and measures. Nevertheless, it seems that the case management department often seems to be the last department to be updated or enhanced to meet the new challenges imposed by the Affordable Care Act and Value-Based Purchasing.

Selection of the most appropriate model will depend on the needs of the organization, the available resources, and the expected goals and outcomes. Each case management department should ensure that they have correct roles, functions, and staffing ratios. This program will provide you with the tools that you will need to identify the changes or upgrades you may need to make in your own case management department.

This program will review contemporary, best-practice, case management models. The program will begin with the contemporary case management roles used in hospitals today. This will be followed by a model review which will include descriptions of the two most commonly used models, the key differences between the models, as well as how they should be designed and structured. This will be followed by the pros and cons of each model and how the department might be designed to accommodate each model. The best practice staffing ratios for each model will be discussed as they apply to the roles of the RN case manager and the social worker as well as strategies for optimizing existing resources.

The program will conclude with a discussion of the steps needed to re-engineer a case management department and tips for identifying the best model for your organization.

Learning Objectives:

• Understand the best practice case management models in the acute care setting.
• Review the processes for each model.
• Review the roles for case management models and how they apply.
• Describe the best practice staffing ratios for RNs and social work case managers.
• Review the pros and cons of each model.
• Apply your knowledge in adapting to a best practice model.
• Describe how to integrate the RN and social work case manager in best practice models.

Areas Covered in the Session:

• Why change your structure now
• Model of care definition
• Contemporary case management roles
• Comparison of two models
• Integrated model
• Access point case management in the integrated model
• Collaborative / Triad Model
• Departmental structure
• Staffing ratios in both models
• Key differences between models
• Similarities between models
• Advantages and disadvantages of each model
• Key planning and implementation steps

Suggested Attendees:

• Directors of Case Management
• Directors of Social Work
• RN Case Managers
• Social Workers
• Directors of Quality Management
• Vice Presidents of Nursing
• Directors of Finance
• Vice Presidents of Operations
• Hospitalist
• Physician Advisor
• Case Managers
• Directors of Patient Flow
• Director of Revenue Cycle
• Chief Financial Officers
• Chief Operations Officers
• Chief Medical Officer
• Nursing Home Directors
• Director of Home Care
• Vice President of Case Management

Presenter Biography:

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company that assists institutions in designing, implementing, and evaluating acute care and community case management models, provides education on case management and related topics, and on-site assistance to case management departments.

The author of nine books, and a frequently sought-after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.

Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management  Program and Post-master’s Certificate Program in Case Management at Pace University in Pleasantville, New York.  Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

Snippet From Our Previous Session