Q&A: Outcomes and standards of practice

Q: Case managers used to evaluate their work in terms of tasks completed or length of stay (LOS). Now that LOS has more than a financial meaning, what are some meaningful outcomes case managers can use to set goals for their work?

A: In the early days of case management, no matter what the care setting, case managers were struggling to demonstrate their value to organizations that didn’t understand their worth or the job they performed. Much of the case manager’s unit of work was measured by the task associated with the work, and the outcome measures were a measurement of the actual tasks completed. For the acute care hospital case manager, length of stay (LOS) is the metric that is omnipresent. The LOS metric is one of the easiest to track and trend and is an outcome measure in most, if not all, acute care hospitals. However, the value of LOS over time acquired more than a financial meaning. The case managers and the hospital administration team recognize that the longer patients remain in the hospital, the greater the risk of acquiring a nosocomial infection, suffering a fall, or becoming confused. Once the imperative to reduce LOS was tied to decreasing the risk for patients, the interdisciplinary team was more likely to adapt the goal.

The Case Management Society of America (CMSA) includes outcomes as one of the Standards of Practice. “The professional case manager, through a thorough individualized client-centered assessment, should maximize the client’s health, wellness, safety, physical functioning, adaptation, health knowledge, coping with chronic illness, engagement, and self-management abilities” (Case Management Society of America, 2016).

The standard is demonstrated by the following:

• “Created a case management plan of care based on the thorough individualized client-centered assessment.
• Achieved through quality and cost-efficient case management services, client’s satisfaction with the experience of care, shared and informed decision-making, and engagement in own health and healthcare.
• Evaluated the extent to which the goals and target outcomes documented in the case management plan of care have been achieved.
• Demonstrated efficacy, efficiency, quality, safety, and cost-effectiveness of the professional case manager’s interventions in achieving the goals documented in the case management plan of care and agreed upon with the client and/or client’s family caregiver.
• Measured and reported impact of the case management plan of care.
• Applied evidence-based adherence guidelines, standardized tools and proven care processes. These can be used to measure the client’s preference for, and understanding of:
  • The proposed case management plan of care and needed resources;
  • Motivation to change and demonstrate healthy lifestyle behavior; and
  • Importance of availability of engaged client, family or family caregiver” (Case Management Society of America, 2016).

For more information, see Case Management Guide to Population Health. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.