Preparing Case Management for the Future
“The past is behind, learn from it. The future is ahead, prepare for it. The present is here, live it.” Thomas S. Monson
The pandemic and its continuation provide immense learning opportunities for case management teams (regardless of the practice setting) by exposing strengths and weaknesses within the arena of care coordination for patients, hospitals, and healthcare systems.
Many healthcare systems valiantly and quickly implemented telehealth and other forms of technology to communicate with patients and other team members. They stood up new processes and staffing models to accommodate the patient surges and to protect team members.
Nevertheless, all of this comes at a high monetary cost. The thrust of this Insight, briefly reviews the financial impacts on healthcare systems while taking a detailed look at the implications for case management. Fully understanding the ramifications makes it easier to assuage the potential reverberations and be a step ahead. This Insight provides a “case management plan” using the nursing process. It is a step-by-step plan for an assessment, diagnosis, possible interventions, and evaluation to promote a healthy case management department ready for the future.
Financial Impacts of the Pandemic
Many hospitals have only a 60-90 day cash flow, which is not sustainable, even though Medicare payments increased by 20% for COVID-19 cases. Hospitals’ average loss per COVID-19 case is approximately $1,200. For some hospitals, it might be as high as $6000-$8000/case.
The American Hospital Association projects at least $323.1 billion in lost revenue for 2020. As of the third quarter of 2020, 17 rural hospitals closed, outpacing the total closures for 2019. Minimally, 36 hospitals have filed for bankruptcy. Hospitals and health systems report an average decline of 19.5% in inpatient volume, 34.5% in outpatient volume, and 40% in emergency department utilization relative to baseline levels from 2019.
Even skilled nursing has experienced an 11% decline in occupancy since the onset of the pandemic.
The above losses do not include supply chain costs, pharmacy-associated expenditures, wage, labor spending, or uncompensated care debts.
Implications for Case Management
According to The Chartis Group’s Financial Recovery Survey, 85% of health system executives identified cost reduction as one of their top three priorities for addressing the impact of COVID-19. In addition, 90% of the executives plan to meet cost reduction goals in less than 12 months. Fifty percent of the executives plan to meet their target in less than six months.
The survey also detailed strategies executives expect to employ to overcome the financial losses. Some examples of those blueprints include optimizing the workforce, strengthening the supply chain, enhancing throughput, revisiting management structure, and improving the care team.
Many of these strategies have direct case management implications. Hence, the need to start assessing and planning interventions for:
· sealing newly found cracks in the processes or practices;
· generating new ideas and methods for conducting business, case management, and care coordination practices within and outside the organization;
· affirming or reaffirming relationships with partners, internally and externally; and
· recognizing and responding proactively to the driving forces: patients, families, communities, regulations, and money.
Integrated Care Strategists recommend using the assessment tool (below) as an initial step in evaluating and planning to overcome the opportunities for improvement. The tool uses the nursing process as a framework. It is not all-inclusive, nor does one size fit all. It is a starting place to accelerate the organization’s overall revenue recovery strategy while enriching care coordination.
Lastly, share the findings and results. Be the beacon for the organization’s mission and success.
For additional support, review Strategies to Elevate Every Care Coordination Practice and Achieving Successful and Sustainable Transformation or contact Integrated Care Strategists.
