Carol Everhart, RN, MS, MMI, the director of clinical informatics at Curaspan Health Group in Newton, Mass., speaks with us about the importance of empirical data. Everhart works with case managers, educating them about the application of data and information technology as it relates to discharge planning.
Case In Point: Case managers have many responsibilities, with limited time to take on additional charges. Why should they make any time for data?
Carol Everhart: Data gives you business intelligence to help you make better decisions. The right decision can save you time, because the data has given you a clear roadmap to follow. Regularly receiving, reviewing and reacting to data enables you to make more of a difference. I really believe strongly in this. I even went back to school to get a master’s degree in medical informatics. Data matters, and case managers should embrace it.
Where’s a good place to start? What should I look at first?
Preventable readmissions. Knowing your readmission rates and where readmissions are coming from allows you to implement process improvements that can have a tremendous impact. First look at why patients are being readmitted from home by diagnosis. Are changes in your discharge screening process needed? Look at readmissions from nursing homes and home health by volume and diagnosis. Does there need to be a change in hand-over process or education for the nursing staff? You also need to look at geometric length of stay for working DRG—estimating and planning for discharge. You should use this guideline for appropriate LOS and use it to prepare patient and transition level of care for the ready date.
We’ve found, for example, that hospitals regularly reviewing monthly reports with detailed readmissions-related data lowered their preventable readmissions substantially and saved a lot of money.
What other data should be at the top of my priority list?
Understanding your payer and patient mix is critical on a daily basis. What percent of your caseload is on Medicare? There are a lot of nuances and you want to be sure you’re hitting your requirements. What percent is Medicaid? If 65 percent of your caseload is Medicaid, you will likely set your staffing differently because of the daily requirements. For example, you may find you need a PRN because caseloads are high.
A utilization review should also take place daily. If you’re looking at someone every three days, this could be a missed opportunity. If a patient is progressing faster, they may be ready to go and you’ll never know it. And if you’ve got someone classified as a specific DRG—and the patient is sicker than you initially thought—it allows you to reclassify into a different DRG category. You need to understand if someone is at the right level of care. As an example, if you have someone in the ICU one day too long, you’re losing money. Data helps you capture and review a patient’s progress—if their progress is faster, you can move them along.
What’s the best way to get this data?
With the availability today of technology that automatically captures and displays data, case managers are better equipped than ever to review data, identify trends and either take corrective action or codify a best practice. It’s really important, though, that the data is easily accessible—in a meaningful way. For instance, generating a provider scorecard can help you track metrics like turnaround time, number of referrals and number of bookings by post-acute facility. That information can help you decide which provider relationships need more attention.
What’s a best practice for using data?
Review your key metrics every day—build a dashboard and measure against it. If you approach this willy-nilly, you’re never going to see how well you’re doing. Also, be sure you understand what’s important to hospital leadership so that at any given time you have answers to the key questions. You can accomplish a lot with data: improve the quality of care, help make a positive financial impact on your facility, and build credibility for yourself as a forward-thinking case manager.