CDI and Case Management Combo

edited May 2016 in CDI Talk Archive
Anyone have a model where the above are combined positions?

Specifically, everyone is a case manager and case managers are responsible for point of entry reviews for status, utilization review, core measures, CDI and DC planning in addition to the more traditional roles of a case manager?

Am extremely interested in your thoughts, models, staffing ratios and experiences.

Arguments for and against?

Please feel free to reply to me here or in a off line email as below.

Thanks so much!
c

Carla Fowler
Colquitt Regional
229-891-9363

Comments

  • edited May 2016
    Until about 3 years ago we had model like this. We had social workers for "complicated dc plans" which no one ever really understood what that meant. We had nurses for CDI, UR/UM and dc planning. We had 3 social workers and 4-6 nurses for an ADC of about 150. We had about enough time to do an initial CDI review but that was about all. Alot of post-dc CDI follow-up. The UR "hold list" was enormous. We covered M-F then went to a call rotation on the weekends. Our CDI consultant petitioned for years to go to a dedicated CDI model. The combined model didn't work too well for us. As they say, we were jack of all trades and master of none. Core measures were never really a big part of our role as we have a separate Quality Dept that is responsible for those.

    We then got away from CDI for about a year. Sr Leadership realized how that was affecting the bottom line and we reinstituted a CDI with a dedicated CDI group, a dedicated CM group for UR/UM/status reviews and a dedicated SW group for dc planning about a year and half ago. It worked very well for about a year but as time goes on, case managers and CDI are issued extra tasks here and there and our time is becoming more stretched. Having worked as a case manager for years and now dedicated to CDI, I will say that I much prefer a separated case management/CDI model for the nurses. It allows for more of a concentrated focus.
    Feel free to contact me directly if you have questions I might be able to help with.





    Karen McKaig, BSN, RN, CCM, CPUR, CCDS
    Case Manager
    Clinical Documentation Specialist
    Baxter Regional Medical Center
    Mountain Home, AR 72653
    870-508-1499
    kmckaig@baxterregional.org

  • edited May 2016
    Karen's email sounds exactly like the history of our Case Mngt and CDI programs:). For a while, the CDI Specialists would get pulled to case manage if someone was out since most of us were case managers first. We now have a dedicated CDI team which is much more effective and we haven't gotten pulled in a long time-thanks to our new director. I certainly don't mind answering any questions if you want to give me a call.
    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org

  • edited May 2016
    Hi Carla, have worked with this model, very similar. It is not
    something I advocate. No one person can do a thorough, decent job with
    all those criteria in mind at the same time. So while CDI and CM should
    be communicating on an ongoing basis, each one is trained specifically
    to do a very specific job. Additionally, physicians find it confusing
    at best.

    Donna

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com

  • edited May 2016
    Hi I agree with Donna I had to fill in for case management/UR and it doesn't work well as the discharge planning ends up taking up a lot of time, and the physicians did find it confusing when I was no longer covering.

    Diane Draize RN, CPUR,CCDS
    Clinical Documentation Specialist

    Ministry Door County Medical Center
    diane.draize@ministryhealth.org
    920-743-5566 ex 3143

    We earn trust by working together as One Ministry to keep PATIENTS FIRST in everything we do

  • When we began our program, we had the same questions. We are housed in the same department as the Care Coordinators, social worker and UR Nurses, so it is tempting. Everything we heard/read suggested that it was in the best interest of the CDI team to have it be separate. While I think it may make sense to administration to combine these roles what really ends up happening is that Clinical Documentation always takes the place last in line when people have other duties. This means, it rarely gets done. Our department has decided to keep it separate and we also do not review for HQA indicators or anything else.

    Katy Good, RN, BSN, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Office: 928.214.3864
    Cell: 928.814.9404


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