Care Management Associates (CMAs): Care Management Model Optimization Authors: Barbara Wilson, BSN, ACM-RN and Charissa Simpson, ACM-RN | Mercy Hospital Oklahoma City | Inpatient Care Management
Introduction/Purpose Inpatient Care Management daily workflow is built upon four foundational principles: assessment, care coordination, discharge planning, and data management. A major challenge to Care Management operations is balancing notice distribution compliance with effectively meeting patients’ needs. Utilizing CMAs to assist with notice distribution compliance optimizes the Care Managers’ time and leverages their skillset for patient/family interaction.
CMS Conditions of Participation require that rights and protections are communicated to beneficiaries through notices given by providers. Three notices were chosen for this project: Medicare Outpatient Observation Notice (MOON), Important Message from Medicare (IMM) and Patient Choice of Post Acute Services.
Each fiscal year since FY 15 has seen an increase in the overall volume of discharged patients, thus an increase particularly in IMM and Patient Choice distribution of Notice letters.
Conclusion The CMA role supports the Care Management Team with distribution of regulatory notice letters and other clerical tasks, thus creating improved staff efficiency and regulatory compliance. As a result, Care Managers and Social Workers have the opportunity to leverage their skillsets more efficiently to be directed toward patient assessment, care coordination, discharge planning and transition of care.
Objectives Reorganization of CMS notice delivery and clerical tasks to the CMAs increased compliance rates from FY2016 to FY2018 by:
Improve overall compliance on regulatory notice distribution. Develop a formalized process for distribution of regulatory notices to patients. Demonstrate an achievable solution that enhances quality of service and improves staff efficiency. Next Steps: we have expanded the role of the CMAs to include assistance with sending post acute referrals for placement and DME, data collection for department metrics, and documentation of barriers to discharge during Interdisciplinary Care Rounds (ICRs) We are currently conducting a pilot for CMAs to schedule follow-up PCP appointments prior to discharge home from ED.
6.3% Social Workers
Care Managers and Social Workers spent time preparing and distributing regulatory notices along with other clerical tasks which reduced the amount of time spent directly involved with patients and their families. The first CMA was added to the team in July 2016. Hypothesis: If we supplement staff with nonlicensed personnel to complete clerical tasks and other tasks that do not require an RN or MSW skillset, we will see higher compliance on regulatory notice distribution as well as incidental quality of service improvement and enhancement of patient and co-worker experience.
Staff efficiency and Quality of Service
What we learned • Develop standard work to clearly define roles and responsibilities. • Determine metrics at beginning to avoid retrospective collection of data. • The process has a higher rate of sustainability when the coworkers are engaged in the development of the workflow and standard work. • Create scheduled observations and monitoring process for improvement. There are no disclosures or conflicts of interest to report.
Barbara Wilson, BSN, ACM-RN Charissa Simpson, ACM-RN Mercy Hospital Oklahoma City