At one community hospital in the Midwest, case management was overstaffed and operational problems resulted in poor utilization of critical care and inpatient beds. As a result, the organization was planning to build new facilities to accommodate critical care patients. Insurance denials were numerous and many days of care failed to meet medical necessity criteria. Furthermore, weak leadership and departmental oversight lead to inefficient processes and inadequate education for staff.

CRAFTING A SOLUTION

To remedy these issues, Compass Clinical Consulting deployed a case management consultant charged with implementing departmental change. The first key action was a reallocation of case loads. The hospital’s case managers were given a higher, more appropriate number of cases. Simultaneously, staff members were trained to better evaluate cases to improve reimbursement.

SEEING THE RESULTS

Better evaluation of cases lead  to a higher level of reimbursement and significantly shorter stays. Most strikingly, the hospital was able to dramatically improve its utilization of beds, eliminating the need for a new facility.

So far, these changes have resulted in more than $10 million in savings for the hospital.

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