CM and MD communication

[RN010101]

Hi everyone!

I'm new in Case Management, and I was hoping for some advice on how you approach and speak to MDs in regards to the patients not meeting criteria. I have heard that many MDs don't like to hear the word "criteria" so I was curious on how CM nurses get their point across that the patient may need to be either discharged or admitted for inpatient care and/or if they are already inpatient, how to communicate that the patient needs to be discharged?

Thanks!

[SummerGarden, BSN, MSN, RN]

To answer your question, you can ask him/her questions: "Why is this patient still here?" "What are we doing for this patient?" If he/she does not meet criteria the answers are nothing or something that can be done in an outpatient setting. In both cases, you can follow his/her response with "Did you know that I can arrange for DME/HH/SNF/IV ABX/Dialysis/etc. for the patient so he/she can discharge now?"

By the way, are you new to nursing too (a new grad)? I am an experienced clinical nurse and case manager. I speak to MDs the same way I talked to them when I worked bedside; with confidence!

If you speak with confidence, it does not matter what words come out of your mouth. Similarly, if you do not speak with confidence, it does not matter that you did not use the word "criteria"; he/she will still ignore your request for discharge orders.

Know your resources, know your procedures, know your networks/vendors, know how to think critically, and speak with confidence. Good luck.

[RN010101]

[COLOR=#666666]Thanks MBARNBSN!

I appreciate your advice and feedback. I am not a new grad, but still have trouble speaking confidently because of my personality. It is a skill that I am trying to cultivate, and hopefully I will achieve it soon.

[d'cm]

RN010101, I also found those conversations the most difficult things a hospital case manager has to do especially if your hospital is still dependent on independent practitioners for admissions. Those docs have to be treated with kid gloves. Admin is way more interested in keeping them happy than LOS. Unless you have established yourself as a veritable institution on your unit rhetorical questions like MBARNBSN asks are usually not well received. I liked to keep it as collegial as possible e.g. Ms SoandSo is looking pretty stable, can I help you with discharge planning?

[nurseprnRN, BSN, RN]

It's an ignorant physician who doesn't know that reimbursement is determined by contract with the insurance carriers (including Medicare/Medicaid), and that the hospital will also be looking at unreimbursed days per physician/physician group.

They can learn this from you first, and if they choose to disregard your factual statements that patients do not meet criteria for inpatient care and must be discharged to a lower level of care or to home by 11:00am (or whatever it is) and "we get audited," they will get to hear it from the hospital CFO. It is perfectly OK to remind them of that with your most sincere smile. (You can tell yourself that the smiles are for you, not for the docs, but it looks to them like you are trying to save their butts.)

[d'cm]

Grntea, what you say and how it is said truly depends on the culture of the hospital and the individual physician. I have had the exceptional experience of working in 2 of the top 10 worse hospitals in the country for overutilization ( as measured by the Dartmouth Atlas expenditures in last 2 yrs life) so I would have to admit my experiences are not typical.