BY: STEPHANIE CLARKE-MAHONEY Does Case Management Work?

Where are the savings potentials MRI outpatient saves $700 compared to inpatient. Unnecessary tests and workups increase length of stay and costs. Adverse reactions and quality issues in the hospitals will no longer be paid for by Medicare. Medicaid and private insurance will follow suit.

The medical community has made case management necessary.

Case management acts as a form of checks and balances in healthcare.

Sample Clinical Pathway ER: Admit with Pneumonia, chest x-ray. Start IV antibiotics send to floor. Day 1: Continue IV hydration and antibiotics and O2 therapy at 3L. Bedrest. Day 2: Continue IV hydration and antibiotics and reduce O2 therapy to 2L. Bedrest. Day 3: Discontinue IV hydration. Change IV antibiotics to oral antibiotics. Ambulate halls and discontinue O2 monitor saturation level. Day 4: Discharge home with instructions to remain hydrated, continue oral antibiotics, ambulate ad lib, and follow up with primary MD.

Cost Savings for ER Costs and Inpatient Costs.

Cost Savings for Readmissions

Medical Directors Can Make a Difference. Medical knowledge of rare diseases. Speak with primary doctors to remove barriers with case management. Assist with continued length of stay at the hospital. Deny medical requests from ordering physicians.

Disease case managers can increase positive pregnancy outcomes.

Home monitoring with Matria. Total parental nutrition for excessive vomiting administered at home.

Home contraction monitoring with Matria. Monitoring is done over the phone for early and false labor.

Chronic diseases Case managers educate members on checking blood sugars, what the results mean, and when to get help.

Quality Care Only those days that are necessary are covered. No payment for hospital acquired illnesses and injuries.

CASE MANAGEMENT IS NECESSARY FOR CHRONIC, TERMINAL ILLNESSES. IT IS NECESSARY FOR COST SAVINGS IN THE HOSPITAL AND THE EVENTS TO DECREASE READMISSIONS. Conclusion