Posts Tagged ‘length of stay’

Integrated Case Management Scripts Keep MSKCC Patient Care Team on Same Page

February 1st, 2018 by Patricia Donovan
Healthcare Scripting

MSKCC scripting improved the consistency of patient communication and staff efficiency.

To help ensure its patients receive consistent messages, Memorial Sloan-Kettering Cancer Center (MSKCC) has developed a series of scripts for use by its integrated case management team. Here, Laura Ostrowsky, RN, CCM, MUP, MSKCC director of case management, describes some scripting scenarios employed by the state-of-the-art specialty hospital.

There are a variety of ways we’ve done scripting. For example, there was a time when a case manager would meet with a doctor and the doctor would say, “I think we need to set up hospice for this patient.” The case manager then would go into the patient’s room and say, “I’m here to help you to set up your discharge plan. I know you’ll be going to hospice.”

And then the patient would say, “What are you talking about?”

One thing all case managers know is that when you go into a patient’s room, especially if someone told you they said something to the patient, you first must confirm what the patient understands about that previous conversation. If it turns out that they didn’t understand what you were told to talk about, then you don’t have that conversation. You go back to the staff member that sent you in there and discuss it. Perhaps you schedule a family meeting to discuss that issue.

We also developed scripts not only for preadmission staff, but for all staff trying to get approvals from insurers for high-cost medications and for procedures. We work with them to identify how to answer questions from the insurance company or insurance case manager so that those tasks can be handled by the doctor’s office or admitting department rather than by case management.

The approach of our length of stay reduction teams, while not exactly scripted, is concerned about consistency of message. The teams came up with the steps and planned the patient education material with the imperative that we never overestimate a length of stay, but rather err on the short side.

The imperative is that everybody speaks to the patient the same way. The case managers make a point to tell the team, “Don’t make promises we can’t keep.” That’s not exactly scripting, but it keeps everybody on the same page. For example, don’t tell a patient they are going to have plenty of help at home. Or that they will get home care and someone will be there every day, because you don’t know if that is going to happen.

Instead, you can say to the patient, “We are going to see if you are eligible for home care. I am going to send the case manager in to see you. They will check your benefits and go over eligibility. We will do our best to get you the services you need.”

Source: Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care

integrated case management

Integrated Case Management: Elevating Quality and Clinical Metrics with Multidisciplinary Team-Based Care details the framework and implementation of the service-based multidisciplinary program MSKCC adopted to ensure that the care it provides to more than 25,000 admitted patients each year is both cost-effective and cost-efficient.

Food for Thought: Nutrition Programs Reduce Hospital Visits and Readmissions by Vulnerable Populations

August 18th, 2017 by Patricia Donovan

Malnutrition is a social determinant of health that negatively impacts health outcomes.

It’s a difficult statistic to digest: one in three people enter the hospital malnourished or at risk of malnutrition, a state that impacts their recovery and increases their risk of health complications and rehospitalizations.

Two studies this week highlight the clinical benefits of addressing patients’ nutrition needs before and during hospital stays as well as savings that can result from identification of social determinants of health (SDOH) like access to nutrition that drive 85 percent of health outcomes.

In the first, a study of elderly Maryland residents by Benefits Data Trust, a national nonprofit based in Philadelphia, found that when it comes to low-income seniors, access to quality food via food stamps can also save money by reducing the number and duration of hospital visits and nursing home admissions.

In the second, research published in American Health & Drug Benefits journal and supported by Abbott found that when Advocate Health Care implemented a nutrition care program at four of its Chicago area hospitals, it showed more than $4.8 million in cost savings due to shorter hospital stays and lower readmission rates.

The Benefits Data Trust research found that participation by low-income seniors in the federal Supplemental Nutrition Assistance Program (SNAP) cut their odds of hospital admissions by 14 percent. The food stamps also reduced the need for ER visits by 10 percent, and cut their likelihood of going into a nursing home by nearly one quarter.

Finally, SNAP participation also led to an 8 to 10 percent drop in the number of days a patient who was admitted remained in one of these facilities.

As a result, hospitals and health care systems such as Advocate Health Care are looking at the value of nutrition to improve care and help patients get back to living a healthier life.

Starting in 2014, Advocate Health Care, the largest health system in Illinois and one of the largest accountable care organizations (ACO) in the country, implemented two models of a nutrition care program for patients at risk of malnutrition. The nutrition-focused quality improvement program, which targeted malnourished hospitalized patients, consisted of screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence.

The leader in population health found that by doing so, it reduced 30-day readmission rates by 27 percent and the average hospital stay by nearly two days.

More recently, to evaluate the cost-savings of the Advocate approach, researchers used a novel, web-based budget impact model to assess the potential cost savings from the avoided readmissions and reduced time in hospital. Compared to the hospitals’ previous readmission rates and patients’ average length of stay, researchers found that optimizing nutrition care in the four hospitals resulted in roughly $3,800 cost savings per patient treated for malnutrition.

Given the healthcare industry’s appetite for value- and quality-based programs, SDOH screenings and the fortification of nutrition programs in both community and inpatient settings appear to be just what the doctor ordered. However, while a 2017 study on Social Determinants of Health identified widespread adoption of SDOH screenings by providers, it also documented a scarcity of supportive community services for SDOH-positive individuals.

Infographic: The Growing Demand for Case Management

September 23rd, 2015 by Melanie Matthews

The Growing Demand for Case ManagementThe increase in insured populations combined with a growing number of Medicare beneficiaries underscores the need for inpatient case management services, according to a new infographic by McBee Associates.

The infographic outlines the four key reasons why an adequately staffed case management department is important for hospitals.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

The Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: How Much Does a Hospital Stay Cost?

December 4th, 2013 by Jackie Lyons

Approximately 18.4 million Americans had an overnight hospital stay last year, with an average stay of five days.

Despite the treatment needed, the average price per visit was around $9,700. Still, the cost is considerably different for those who are insured versus those who are not, according to a new infographic from Intuit. This infographic details the specific costs for insured versus uninsured patients, as well as overall costs related to different insurance plans.

How Much Does a Hospital Stay Cost

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You may also be interested in this related resource: Leading a Hospital Turnaround: A Practical Guide.