Starting up new CM/UR department

  1. I received my CMC over a year ago and worked in ER case management for the past 12 months. It was a new position so I didn't have any prior orientation and had to learn on the job. I have recently taken a position in a small hospital to start the CM department. I have researched the net to find material on what I would need to do my job. I have had to devise a CM plan, job description, policies and am in the process of forming a multidisciplinary team to develope clinical pathways. I have not yet developed a strategic plan, since I don't have a clue how to proceed. I am monitoring length of stay, 72 hour and monthly readmits with the same dx. or related dx., unplanned outpatient surgical admissions, observations converted to admissions, one day admissions and correct criteria for observation and admission, including intensity of service & severity of illness. I coordinate any discharge plans with the social worker. I also plan to monitor the frequent flyers. I do an initial screening on high risk patients to identify needs. Since I have one particular MD whose average los is 6-7 days and is extremely resistant and "nasty" to any suggestions, etc, I have run a cost per client verses the DRG payment report and submitted it to administration. We have a nurse who calls all patients after discharge from the hosptial and ER to find out their status on the 1st and 3rd day. The hospital has been opened 7 months and is in the process of developing it's community outreach programs.
    If anyone can think of anything that I may be missing, please let me know! I could also use help with an outline of a strategic plan and any samples of clinical pathways on the top 10 DRGS. This is certainly a learning experience and I have a long way to go and any suggestions and help with forms would be greatly appreciated. Please feel free to email me.
    Susana
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  2. 3 Comments

  3. by   OKT3RN
    Hi! When I saw your post I couldn't believe it. An inner city hospital has just hired me to do this same job. It is a new position too and I would have to develop the postion /job as well. Basically they are having pts put on obs who shouldnt be and/ or are having pts stay too long on obs and in essence not gettting reimbursed for them. They want me to cut the red ink. I am wondering if I made the right choice by accepting this job but dont know so I decided to give it a shot. I start Sept 4. I also work everyother weekend. Do you? Luckily you have some experience whereas this would be my first job in case management. I only have a little experience as a Heart Transplant Coordinator and worked with medicare/medicaid pts so know a lot of community resources. I could really use some help from you in how you went about setting up everything and what resources were most valuable to you! For starters just reading your post was quite helpful, but not sure how you did al of that. I would be so appreciative for any pointers/tips! Also if you find the clinical pathways plese let me know. I too am looking for these. (I have done some work on this with transplant pts though) Anyway, wish I could help you more but in the future perhaps we can help each other as I get more experience. By the way, I have read that Duke University Medical Center has already got a great team doing this same job there. I contacted them about 2 weeks ago regarding help in this matter and similar questions re: pathways etc but they have not replied so far. I will let you know if they do.
    Cindy
  4. by   DianeRNOCN
    Hi I saw your post, I work in a NYC hospital as a CM.. We are now about to start of CM of the ER and I have been picked tp help start up this project. If you could email me with some infoprmation on ER CM comapred to hospital inpatient CM I would be greatful.... thanks so much diane DianeRNOCN@aol.com
  5. by   bernarma
    Anyone ever done case management in a clinic setting?? If so curous how it differs or how it may be similar to hospital or insurance cm.

    Thanks.

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Starting up new CM/UR department