Pros and Cons of Case Management

Unknown
in CDI Talk Archive
Hi Everyone,

I was wondering if those of you who work within the Case Management department can share with me the pros and cons of that model. There is a case management consultant visiting us that want to look at our program which is currently under HIM.

I feel working within HIM keeps our program "pure". We have direct dialogue with the coders and also are part of the RAC team and help with insurance reviews. Currently we work closely with quality regarding some core measures.

Comments

  • dvitalone1dvitalone1
    edited May 2016
    We are under Case Management but that is because my CM Director is the one who implemented the CDI program. The HIM dept wasn't really on board. Even though we are under Case Management out function is purely CDI. We are not involved in any Case Management matters.

    Dawn M. Vitalone, RN
    Clinical Documentation Improvement Specialist
  • kmaritankmaritan
    edited May 2016
    For my first 3 years as clinical documentation improvement specialist we were under Case Management. I knew nothing else at the time but, during the 3rd year, there was pushing to have us do some UR tasks, crossing over. I did not like this as it took away from performing the CDI job and securing needed documentation to impact the cases. Please note about 2 years ago or so (archives of CDI Talk can be checked) there was discussion re this issue. The concensus was the CDI programs work best when dedicated solely to CDI.

    After these 3 years, I moved to a different health system and the CDI Program was under Coding in HIM. I hugely enjoy this model and have learned so very much. It has been great to have the coders and their expertise right across the hall. We need to remember that our job is to secure the documentation and that it is the coder who signs their name to the final coding and have to answer to their superiors and auditors about why they chose the codes. They know sequencing rules, coding guidelines, etc. I have learned so much from our coders and coding auditors this past 3 years but there is so much more to learn from them. (I am an RN.)

    So last year, after experiencing being under HIM for 2 years, the same thing happened at this second health system where administration moved us out of HIM to be under Case Management. So a year has passed with my being back under CM. Now truly knowing both models I can attest to the fact that I feel CDI Programs function best under HIM. I agree with your statement about keeping the CDI program "pure". There are also undertones that we may be facing being asked to also do some UR functions in the future which is very unsettling to me.
  • tiffany_susantiffany_susan
    edited May 2016
    Ideally, I think the program should be under quality, and independent. I
    realize that is the ideal world, but it does keep the CDS's focused on
    their jobs and does not confuse their roles. The more aware a facility
    gets of what we do, the more they would like to add to our roles. My dept
    is independent under quality, and I am very involved with coding, the RAC
    team, case management, core measures, etc..... Good luck!
    Thank You,
    Susan Tiffany RN, CCDS
    Supervisor Clinical Documentation Program
    Guthrie Healthcare System
    phone: 570-882-6094, pager #465
    fax: 570-882-6768
    email: tiffany_susan@guthrie.org
    "Twenty years from now you will be more disappointed by the things you
    didn't do than by the ones you did do. So throw off the bowlines. Sail
    away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
    Discover." Mark Twain
  • stacy.vaughnstacy.vaughn
    edited May 2016
    I agree with the program being under quality. That is how it is done
    here. I have been under HIM also.

    Stacy Vaughn, RHIT, CCS, CCDS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052
  • twoodstwoods
    edited May 2016
    I work in case mgmt but I talk to my coder at least 3 times a week and the HIM director at least twice a week. We are small so it still works well.
  • NormaBNormaB
    edited May 2016
    We are located under HIM and are involved in CDI only. Our HIM department reports to Finance. There is some emphasis on reimbursement but we are sloooowly pulling away.

    I can see this position joining with UM. I use my UM background daily to do my job. Although I no longer use Interqual I am still looking for "criteria".

    We also have more focus on coding. It cuts out the middleman quite nicely. I don't have that many questions for coders because of my coding background. Only when I disagree with their PDx or if they didn't code info. I went after so diligently to have documented.

    We tried combining positions UM/CM/DP years ago. But the part that always "went to the wayside" was UM.

    I think that would happen with combining CDI with something else as well.

    Our thought has always been to get all coders on the floor as CDI. You could have a completely well-documented chart coded and drop your bill the day the patient is discharged.

    N Brunson, RHIA, CCDS
  • Unknown
    edited May 2016
    It is good to get these different perspectives. I am under quality but reside with the coders. Any chart that ends up with a different DRG than mine is routed back to me the same day it is coded. No record is finalized until we agree.

    My focus is more on SOI/ROM than HIM has been and it has been a great learning experience for both of us (coders & CDS). I appreciate being separate from HIM and at the same time being in their office.

    Charlene
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