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Effective Emergency Department Case Managers play an important part in determining the decisions that significantly impact the bottom line for hospitals and healthcare systems. Utilizing a dedicated ED Case Manager will aide clinicians in the all-important decision to admit or not, and to determine the level of care required. According to a white paper published by Change Healthcare, there is clear evidence of significant ROI for hospitals with an ED Case Management program. ED case managers have been shown to reduce Emergency Department wait times and length of stay, perform transitional planning for alternative care and a whole host of other services designed to maximize care, compensation and client satisfaction.

Emergency Department Case Management can be broken down into 4 main components:

GATEKEEPER

This role is the first line of defense against inappropriate admissions. Case Managers screen patients using criteria for acute care admission established with the clinical staff. A complete buy-in by the medical staff is critical for the success of this process. Within this step is the liaison with admitting physicians and document management resulting in speed, efficiency and accuracy.

PATIENT FLOW

Coordinating and facilitating the patient’s movement through the Emergency Department. Included but not limited to this, is obtaining medical records, facilitating tests, treatments and medication procedures, Acute Care bed management, communication with patient and family to reduce anxiety and offering alternatives to admission.

CARE ASSESSMENT

Once the decision is made that a patient meets the acute care criteria, a standardized Case Management Assessment would be completed. This serves as a one-stop location for information from the Emergency Department, family and any other sources. In addition, initiation of an insurance review and discharge plan will aid the In-patient Case Manager. This step also includes an awareness of High Utilization Patients; those patients who visit the E.D. every 1 to 3 months in order to determine the cause of potential readmission.

DETERMINING REIMBURSEMENT DIAGNOSIS

Monitoring the documentation started in the Emergency Department for accuracy and completion for coding and reimbursement purposes. For example, when an actual diagnosis is unclear, the ED Case Manager works with clinical staff to ensure any ruled-out diagnoses are documented. This can help avoid 3rd party payer denials.

Ideally an Emergency Department Case Manager would be a permanent assignment, not a rotation or on-call position. This would also require a strong working knowledge of medical terminology and procedures. Additional functions an ED Case Manager performs are referrals to community agencies for other sources of care such as rehabilitation or skilled nursing facilities, home care staffing and adaptive services and counseling.

NHS Solutions has a readily available pool of qualified Case Management Leaders. Contact us to learn more about this or any other Healthcare Leadership Role your facility may be looking to fill. We are able to quickly present qualified candidates so that our clients can maintain quality of care while conducting their search for a permanent placement.