Average Inpatient CM case load?

Specialties Case Management

Published

Specializes in Case Mgmt; Mat/Child, Critical Care.

Happy New Year to all!!

I am transitioning to a new role, from primarily DCP to full on Case Mgr...where we do all roles.

I am curious...what is the average inpt case load for acute hospital CM's to carry?

Do you see every single pt/chart?

How often do you chart on your pt's...q 24hrs? Q 48hrs? Or...?

We are going through a major transition; our mgr has a lot of good education/experience but has never managed inpatient/hospital case mgmt, nor worked inpt case mgmt...insurance co only.

We currently have a system, but, as I said, we are transitioning to the full role of CM/DCP combined.

I occasionally do CM but usually DCP.... my role is crazy, busy. I'm wondering how it will be to have the added responsibility of the UR/UM, Medicare/Medicaid reviews, etc. Current case load runs about 20 +/- for CM's and the DCP's, typically 2 on per day cover the whole house. Personally, I feel like we need more DCP's....but transitioning to this new system, my mgr thinks it will resolve the issues...

Just trying to garner some input, different points of view, etc....

Many thanks to all....and have a safe and Happy New Year!

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Specializes in Oncology, Hospice, Research.

Moondancer,

Another RN Case Manager & I share a 36 bed floor, mainly oncology & ortho patients plus we are responsible for a women's health unit that has beds for up to 20 pts. The women's health unit rarely has any discharge planning though as most admits are young, relatively healthy pregnant women admitted for PIH or pre-term labor, stuff like that. Our main responsibilities there are doing new patient admit notes and continuing stay reviews.

Typically we just divide our main floor and each take 18 patients but we help each other a lot. I never, ever tell a doctor or staff nurse that "that's not my patient". We both print out the census for the whole floor and we step in to assist each other as needed and neither of us leave for the day unless we are both done. The Case Management Department has a couple of social workers who do discharge planning for all of the unfunded patients.

We don't do insurance reviews generally as we have an administrative assistant who takes calls and faxes clinical information as requested. She will occasionally (maybe once a week) ask me to take a call from an insurance case manager when it just isn't clear what is going on from the notes. I admit this seems very cushy to me as any other hospital case management job that I have had required we also do the insurance reviews.

Finally, we do an initial admit note within 24 hours of admission and do concurrent reviews q3 days for pt's who are in in-pt status. If someone is in observation status we review them every 24 hours.

Good luck with your new role!

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Specializes in Case Mgmt; Mat/Child, Critical Care.

Thanks, that's very helpful. It's great that you and your co-worker work together so well! We're like that at my hospital as well. We just deal w/a ton of indigent, homeless, unfunded patients...DCP can be challengiing...LOL :)

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Specializes in ICU/CCU/MICU/SICU/CTICU.

I do inpatient care management that includes UR as well as DCP. Our hospital case managers are broken into service areas. I am in the general surgery area that includes vascular, ortho, GI surgery, ent/plastics/oral surgery and neuro surgery. There are 5 of us in that group. Ent/plastics/oral are considered one.

How do you manage to do everything............ I usually start my day doing the UR. I talk with the physicians about each patient on service... dcp needs or not........ I review the chart to make sure they are meeting criteria........... I put all of it in the computer program (we call it cerme)........... then I head to the floor. Once I am on the floor, I work with the residents and attendings... I make rounds with them, I talk with the patients as needed, lining up things for post discharge......... ie home care, SNF or rehab placements, follow up appts with their primary care physician etc. I also have the help of a social worker who helps facilitate the referrals for post discharge.

I chart on my patients as needed. If I talk with a family/patient about their needs or their preferences, I chart it when I finish making rounds......... we use computer charting, so anyone can see what we talked about. If a patient is in the hospital for an extended period of time, I usually chart at least twice a week on them... to update my notes and the plans. We have to see every new inpatient within 24 hours of admission or on the first business day. Once you get a "method to your madness" you will find that you have more time than you think to do things. Don't get me wrong, there are days when all I do is put out fires........ but, I also know that I can push some things to the next day if I need to.

I have contact on a daily basis with everyone involved in the care of the patients........... bedside nurses, family, pharmacists, therapists, consulting services... you name it. Lots of times if the bedside nurses cant get an answer to a page, they come to me........ I page the resident and they answer me... I ask the questions and things get done. I also help orient the residents to our particular service........... they change once a month, so it gets aggravating at times............ just when they get where they need to be, they change and I have to start all over again........lol

My service has a 30 bed unit........ not counting the SICU............ most times we avg 25 patients........ there are times when we have many more than that. Not too long ago, all 30 floor beds were full and we had about 10 patients in house that were on other units, and 9 of the 18 SICU beds were ours........... those instances are rare...but it does happen.

Hope this helped.......

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Specializes in Case Mgmt; Mat/Child, Critical Care.

Cardio...

Thanks for your input. It sounds like 20-25 is about the average case load for inpt CM's. We have a ton of uninsured/indigent pt.'s so that makes life a little harder...and only 1 SW, who helps as much as she can. I like the idea of the unified role...it just seems like you're more 'in the loop' w/what is going on w/the pt.

Thanks again!

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Specializes in Case Managemnt, Utilization Review.

I work on a 40 bed medical unit- I am responsible for 20 in pt all discharge planning, except those that are going to another level of care, our social workers handle that. I work in an urban medical center and have all the no insurance issues. It took me about 8 mos as a newbie to get used to all the functions of my role. The unified role keeps you in the loop, but wait till you see how busy you are, I end up working 10-12 hrs a day. I know there is no one else who can do my job or follow up tommorrow.

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Specializes in HH clinical mgmt, med-surg, GI.

I just started as a new case manager on an ortho floor in an acute care facility. We have a UM person that sees the private insurance patients, and I deal with the Medicare pts, self pays, and VA pts. We have a SW that also helps out and helps with facilitating the transfers to nursing homes and rehab centers. My floor has 26 beds, but I think the average pt load is more like 20. I had 23 Friday, but only 17 today.

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Specializes in Case Mgmt; Mat/Child, Critical Care.
I work on a 40 bed medical unit- I am responsible for 20 in pt all discharge planning, except those that are going to another level of care, our social workers handle that. I work in an urban medical center and have all the no insurance issues. It took me about 8 mos as a newbie to get used to all the functions of my role. The unified role keeps you in the loop, but wait till you see how busy you are, I end up working 10-12 hrs a day. I know there is no one else who can do my job or follow up tommorrow.

edgwow,

It is a crazy role,isn't it? I hear you about the long hours, I do the same.

Thanks for your reply!

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Specializes in Case Mgmt; Mat/Child, Critical Care.
I just started as a new case manager on an ortho floor in an acute care facility. We have a UM person that sees the private insurance patients, and I deal with the Medicare pts, self pays, and VA pts. We have a SW that also helps out and helps with facilitating the transfers to nursing homes and rehab centers. My floor has 26 beds, but I think the average pt load is more like 20. I had 23 Friday, but only 17 today.

Thanks rnkris, for your reply. :) Do you like it so far? It is a busy role and I really like it...although sometimes the challenges want to make me pull my hair out...LOL! :p

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we have a pilot going in our facility.

3 case managers responsible (insurance reveiw, 6 questions for screen as to what should be refered to sw)

1 case manager associate( gets auth, faxes ,pris, phone calls writes in disharge notes of canopy home care and pri auth information order equipment

nurse RATIO 1:17 1:16

they should do all the requested reveiws and all their news. We would like them to get 1/2 of their reveiws in canopy meeting criteia. this may include the requested reveiws and their news. they also document in the discharge note of canopy. comment greatly appreciated

does anyone have cm on the weekends? does anyone do 12 shifts?

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Specializes in Case Mgmt; Mat/Child, Critical Care.

We have the option of 8 or 10hr shifts. We have coverage 7 days a wk. Weekend staffing is down to 2-3 CM's, same w/holiday's...shorter hours less people.

we have a pilot going in our facility.

3 case managers responsible (insurance reveiw, 6 questions for screen as to what should be refered to sw)

1 case manager associate( gets auth, faxes ,pris, phone calls writes in disharge notes of canopy home care and pri auth information order equipment

nurse RATIO 1:17 1:16

they should do all the requested reveiws and all their news. We would like them to get 1/2 of their reveiws in canopy meeting criteia. this may include the requested reveiws and their news. they also document in the discharge note of canopy. comment greatly appreciated

does anyone have cm on the weekends? does anyone do 12 shifts?

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this is for WREN how did you train the assistant to the review.s do you get a lot of denials???

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