Managing Patients with an Extended Length of Stay

Why Should You Attend:

This webinar will assist the hospital case management leaders in developing department strategies—roles, model, interventions—that can decrease both the number of extended length of stay patients, as well as the number of days for that patient group.

Also discussed are the case manager roles that can coordinate the transition of extended length of stay patients. Key collaboration opportunities, including physicians, ancillary services, nursing, and post-acute care providers, will be examined.

Strategic roles for case management leaders, RN case managers and social work case managers, as they work with this patient group, will also be a part of this webinar.

Areas Covered in the Webinar:

• Determination of length of stay
• Length of stay versus expected length of stay
• Definition of extended length of stay (LOS)
• Why decrease LOS?
• Determining factors for extended LOS
• Predictive model of a patient’s length of stay
• Assessing patient for potential for extended LOS
• Key roles in decreasing extended length of stay patients
• RN Case Manager
• Social Worker
• Complex Discharge Planning Specialist
• Clerical staff
• Attending physician
• Physician advisor
• UR Committee
• CFO/Executive responsible for case management
• Avoidable days in the extended LOS patient
• Strategies to decrease extended length of stay patients
• The outcomes dashboard for extended length of stay patients

Who Will Benefit:

• RN case managers
• Case management leaders
• Social work case managers
• Physician advisors
• Executives responsible for case management department

Bev Cunningham
Consultant, Case Management Concepts LLC

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

Topic Background:

Case management began as a solution to decrease length of stay. As time has progressed, case management moved to a focus on discharge planning, utilization management, care coordination and resource management. Each of these require the case manager, whether an RN or social worker, to focus on these four roles and develop strategies when a patient requires intervention due to some sort of barrier.

In the transition time of early utilization review (the focus on decreasing length of stay) and the contemporary case management programs that we see now, patients have certainly become more challenging. The Medicare population has grown and with this growth we are seeing patients that are far more complex with diseases than we have ever seen in the past. Additionally, insurance coverage, whether it is commercial insurance, Medicare, Medicaid, or a managed plan, has more rules and regulations that determine potential denials and/or decreased reimbursement. There are still patients with no coverage at all. Patients are also encumbered with the social determinants of health, which include economic instability, education, food, neighborhood/physical environment, community/social context, and health care system barriers. Rarely do we see patients with just one determinant. Rather, we see patients with a multitude of these determinant barriers.

These challenges all contribute to patients extending their hospital stay, with some of them extending their stay because the barriers are nearly impossible to overcome. This requires a hospital case management department to be strategic in patients with extended lengths of stay. The strategies should include identifying barriers before the patient ever reaches the “extended” description.

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