Attention all discharge planners. I need an honest opinion

edgwow · Dec 4, 2008

The hospital DCP not only deals with the annoying pt and family, but at my hospital, all the pts think they are "entitled" to free things or services covered by insurance. This is rarely the case. I can not change the fact that your copay for IV infusion is 100 dollars eery time a nurser comes out, I know you need it, but you have the insurance that has a poor DME benefit. I can't arrange for a ride home for you just because your family doesn't feel like coming to get you. You state you need a commode, a shower chair, a wheelchair,wheelchairs are near impossible to get, commodes are only to be used if there is a flight of steps that the pt must use in order to get to the bathroom. Shower chairs are not a covered expense in most DME benefits.

The best of the most annoying is the large population of uninsured, who need home care supplies, nursing but have no insurance and need to have medications filled, free clinic advice, DME providers do not give a pt on medicatiod application oxygen.

The doctors make discharge plans regardless of the pts insurance. Ie, a doc wants a pt to go home on lovenox, you call the pharmacy and the copay is $800.00, so now pt can't afford it, so plan changes, you wasted 2 hours finding out if the pt has coverage for it and finnd out they do but can't afford it. Or try getting free medications for an illegal ailian. Good luck, so much work.You set up IV abx fax scripts and right before they leave, they now need po abx instead. Call the infusion co back explain the plan changed. My very favorite job is setting up home O2 Bipap and there is not adequate documentation in the chart, need a hospital bed ., the discharge planner must have one in her back pocket since no one thinks that you need to have documentation for it.

Love the calls from the pt 3 days post discharge saying, I need a commode, I didn't get all my perscriptions, my pharmacy won't fill a med. Like you have time to figure this out.

The DCP gets credit when things go smoothly and flack for every other debockled discharge plan. The nature of the beast, and DCP is a beast, is the discharge plan has a right to change until the pt actually walks out the door, regardless of what was previously set up. I spend the bulk of my day doing discharge planning, details, details, details, and unhappy families, under stress families and lots of IV antibiotics after 3 pm on a friday afternoon.

I think it is amusing that the DCP gets flack from the nurses when the ambulance transport is late, like I have any control over that. Also a blast is pts going home and they have no gas electric or running water, or they are not getting help and need new housing. DCP a huge hot mess most of the time.

edgwow · Dec 4, 2008

P.S. to my above post

The only reason I ever stay late, past my 81/2 hrs is discharge planning problems, average I stay is about 10 hrs a week, no OT of course and after a pt is discharged the family still sometimes haunts you.

SanFrannurse · Dec 4, 2008

Hi Edgwow

Thanks so much for your comments. Sounds like DCP sucks! :banghead: I hear people who say they love the challenge but I think it depends on if you have a life or not. I currently work as a CM for an insurance company and I get so many calls at 6pm and 7pm from DCPs needing something emergently b/c a plan had changed. I like my 8-4:30pm job and I never have to stay a minute over. How long have you worked as a DCP? Thanks for responding.

edgwow · Dec 4, 2008

I'Ve been a discharge planner for a year, but I also share the DCP responsibility with the utilization review responsibilities also. Do you want to be challenged every day? At 45 yrs old, I would like to settle in and just do the job without extra aggravation. Can we trade jobs? LOL

MaritesaRN · Dec 24, 2008

Hi I am currently a nurse case manager for an insurance company in SF. I have been working there for 4 years. I got a job offer at a hospital for discharge planning. I worked on the floor for 2 years and then got a case managemnt job with the insurance company. I have no experience in DCP. I know what DCP entails and the frustrations with the job. The pay differential b/w the jobs is not that big of a difference and the only thing that would have me lean towards the hosp DCP job are the better benefits. (insurance/pension/etc). Everyone I know who is a DCP says about their job, "I like the utilization review but hate the DCP."
My current job is practically easy. No real thinking involved. Our medical director can be a pain however. We don't have to interact with family members.I have flexible hours. I always leave by 5pm and never have to work overtime, holidays or weekends. I never dread work and am not confined to walls all day since I am in the office during the day and at the hospital in the afternoon. I also get paid overtime if I ever need to work overtime. The problem is the volume of paperwork I do, it feels too corporate at times, we don't really have a say in decisions, we do have to deny patients, benefits aren't the greatest.
The thing that holds me back from taking the hospital job is that I will be confined in the hospital, having to deal with family might annoy me, feeling like there's a lack of resources would frustrate me, working overtime and not getting paid overtime would also suck.
If anyone can give me their opinion, it'd be helpful in deciding. It's such a tough decision for me to make b/c I want to try DCP but am afraid I'll hate the job once I accept it.

:smokin: I do not know if I can help you, but telling you of my short experience might give you a glimpse ow a hospital DCP / case manager. There is such an overlap in this position ...it is hard to draw a line. I know of one who is very busy, adn very frustrated. she makes plans for patients needs to d/c patient, then the doctors change the orders in the last minute...and you have to start again to track one w/ little time , before D/c. Also I was a case mgr. and one patient got an order to d/c w/ some DME---- arrangements like this usually goes to the discharge planner, but she missed it and the very disorganized supervisor blame me for missing it! There should be a clariffication as to where your job starts and when does it stop? Using both CM and Discharge planner to plan for the same patient is a waste of time....know where the cut off is.

Wren · Dec 28, 2008

Hi SanFran Nurse,

I am a hospital case manager and probably 50% of my job entails discharge planning. The other 50% or so involves what I think of as regulatory compliance.....making sure that new admits meet criteria to be in inpt status and doing continuing stay reviews. The posters below have done a good job of outlining some of the real challenges of the job but I have to say that I still love my job a lot. I have done insurance case management and hospital case management and I far prefer hospital case management.

One BIG advantage that we have at my hospital though is that we have social workers who manage all of the uninsured patients. So I am never scrounging for resources for someone who doesn't have insurance or is homeless. It is hard to set up IV ABX for a guy who lives under a bridge! :banghead: I'd have second thoughts about this job if I had to do that. We still have patients who have poor insurance that while they theoretically have a home health benefit, in reality no home health company will take the business because the pay is crummy. Yes...some families and patients are difficult and present with their list of demands and entitlements but still at the end of they day I am very happy with my work. For every difficult patient I seem to have 10 that I genuinely help and are grateful. I am also blessed that I have a good relationship with the staff nurses, techs and charge nurses on my units and don't catch flack from them. I know how hard their jobs are and they appreciate the complexities of mine.

So....my long winded advice to you if you decide to look closer at hospital case management is to ask a LOT of questions during your interview. Find out exactly what you will be responsible for. I am on call about once every 6 weeks and usually work about 8-5 and I rarely miss lunch!! My case load is sharing a 36 bed ortho & chemo floor and a 12-20 bed women's health floor with another case manager. Our floors turn over fast and I typically have 10-12 new admits a day and that many discharges....just to give you an idea.

Good luck! :nurse:

edgwow · Dec 28, 2008

I always have 20 patients for all utilization and discharge planning needs that go home. If someone goes to any type of alternative care setting, they are managed by the social worker. My job would be more manageable if there were 1 more social workers for the unit. We have rounds for an hour a day, 5 staff meetings a month and I turnover 8-10 onto a discharge list every day from a med surge unit.

Do any of the utilization nurses out there use canopy to document?

RNentrepreneur · Dec 29, 2008

If you dislike doing a lot of paperwork be sure to ask about this during your interview. Perhaps some of the previous responders could also comment on the paperwork involved in DCP. I think there is also a great deal of paperwork in this position. As an onsite case manager following up with patients once they are discharged I obtain a great deal of paperwork from the DCP.

MaritesaRN · Dec 29, 2008

I always have 20 patients for all utilization and discharge planning needs that go home. If someone goes to any type of alternative care setting, they are managed by the social worker. My job would be more manageable if there were 1 more social workers for the unit. We have rounds for an hour a day, 5 staff meetings a month and I turnover 8-10 onto a discharge list every day from a med surge unit.
Do any of the utilization nurses out there use canopy to document?

To cap the responses, I believe it is important to know as to who else are the player in the game, and what they do...then clariffy what is your job description among these players and look for overlaps. what do the social workers do aside from finding alternative for care for the uninsured. Is there a separate discharge planners? the hospital that I worked with used LVN's for this. The case manager does UR.....and I tell you this is plenty

!!!! . If your area is within a lot of medical or medicaid patients, and you do not want them to overstay as med nec...then the CM should be able to call and pass it on to d/c planner and if more complicated to soc. worker. Where I work , there was no definition or lines that separates the overlap----and if you have a supervisor that is so disorganized and just keeps making new forms to add up to the paper work , intead of making it efficient, she burdens the system w/ unnecessary , redundant datas.............so I think you need to "interview " the supervisor or the manager of the CM dept. When I saw this, ( she was oblivious of the needs and concerns of the case managers, since she was too busy justifying her position w/ other useless and duplicating paperwork) .

Why do I know this? I was working in VA and was the inpatient coordinator, transfer coordinator, and the UR reviewer. I worked very closely w/ the floor case managers, and with the ER physician to help expedite transfers from an overflowing ER. I also entered datas from Interqual criteria and made a quarterly report to the boards from my data of the percentage of compliance of inpatient criterias. I was the first and the guinea pig for this project , and the medical director helped me make it work. She supported me when the doctors were chewing me alive.... she mandated the order or else.......smoth sailing from there on.

Diffferent players w/ well defined duties/roles was clear, and this made working as a team a wonderful experience.

bottom line....the supervisor /manager must work with you and not against you. good luck! do not be afraid to ask questions....an interview must be a two way process and you should interview your employer as well. :)

TedinAlabama · Feb 8, 2009

Hello from Alabama. We in the Case Management Department of our 440 bed hospital all have the title of Case Manager. We are RN's, one LPN, and Social Workers. There are a group of RN's that are Clinical Documentation Specialists, and that is all they do. The LPN and the Social Workers do discharge planning. The RN's do discharge planning and utilization management. We are separated in our "area of expertise" so to speak, either doing discharge planning or utilization management. I dislike discharge planning with a passion for all the reasons listed in previous posts, but really love doing utilization management, and ususally that's all I do. Sometimes, of course, the discharge planners are swamped and I help them out. We usually have staff meetings once a month, but can have more if we need to get together and talk about things like difficult discharges, etc. We have been looking for a web site that case managers can get together on and "compare notes". Unable to find one I lauched a site called CaseManagerTalk.com. It is a free web site where case managers (either medical facility or insurance company) can exchange information, post their personal stories, post important information and updates, and there's even a chat room. It is a new site, so I haven't had many visitors. Please come and check us out...and sign the guest book.

Thanks

MaritesaRN · Feb 9, 2009

Thank you , I shall visit. Doing utilization just about the majority of my nursing career, and very good at it. But when I worked in this particular for profit facility as a case manager, I was so flabergasted due to the lack of proper orientation, lack of proper division of staff, lack of equipment ( some have no computer to work before or after the day. I did not even have my own phone to do my business,) and I felt embarrassed when floor staff have to drop what they are doing to give me the msg in the back room...the worse part of this is the incoming supervisor had no organization , she did not give priority to the equipment needed by the CM...instead she is so busy making more forms to fill, as though we did not have enough paper work. some are duplicates of what the hospital already have. She required a "report" each day ........I find this micromanaging , of which is devastating in this area and specialty. Aside form this , there is also a report once a week w/ the staff & physicians of patients that are overstaying......noted most of this patients were medicaid and some patients do not really have a home to go home to, and medicaid or medical pays minimal of which makes it even more intense. I truly feel that admission should be able to catch this "complex" admission and a social worker assigned to these patients from the beginning since there is a big placement issue , and not later.

It sounded that your facility is quite organized, hearing about the divisions and so on.....it makes a big difference if the system is in place and a good supervisor that helps her staff instead of making it more complex! A big diference !!!!