Q&A: Blaming the case manager for a longer than expected length of stay
Q: Is it the case manager’s fault when a length of stay is longer than expected?
A: Holding case management professionals accountable for specific outcomes within their assignment, such as length of stay (LOS), is unfair and usually impossible unless they have the authority to intervene in difficult situations. The case management director has enormous influence in these matters. Of course, there are days when the director is not supported by other directors or administrators in the hospital. These are the “showdowns” that make or break the morale of a department. For example, if case managers cannot get physical therapy to respond in a timely way for evaluations that are necessary to transition patients to a skilled nursing facility (SNF) level of care, the director must be able to go to the director of physical therapy (PT) and discuss the trend and its implications to LOS. The director of PT may have several reasons why the department cannot supply therapists so readily, such as the VP to whom the PT director reports has told him or her that the PT budget must be cut. When case management departments find out this kind of news, they want to give up, because different edicts (cut LOS, cut PT staff) are at cross-purposes with each other and there is no resolution. So a patient remains in acute care another day or two, and a case manager becomes apathetic.
It is these showdowns that create an urgent mandate for the director and executive team to revisit the drivers and rationale for beginning the case management department in the first place. Constant struggles and conflicts may indicate a time to evaluate the department in light of changing needs of the patients, families, hospital, physicians, and community.
For more information, see Case Management Models: Best Practices for Health Systems and ACOs, Second Edition.
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