Jackson Medical Center Improves Case Management Processes

December 2012
National Rural Health Resource Center (The Center)

Jennifer Ryland, Chief Administrative Officer of Jackson Medical Center (JMC) in Jackson, AL wanted to further their success by improving their case management processes. Case management allows for an interdisciplinary team approach while requiring physician alignment and promoting the patient and family experience. The Case Management Society of America defines case management as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

Case management is a key position in a hospital with multiple tasks to manage and it has a direct impact on quality of care, compliance and revenue. Case management should also be a part of a hospital's performance and quality improvement processes. A true case management process starts with chart review and the determination of potential needs based on provider and nursing documentation. This is followed by a meeting with the patient and family as needed to ensure that all aspects of the discharge planning have been addressed. Then the case manager meets with the physician to discuss their plan and findings that may assist or interfere with the plans. With all of these responsibilities, a hospital needs an efficient, well-organized case manager.

Ryland shared the following information about their case management project with RHPI.

Q: Why did you choose to focus on case management for your RHPI project?

A: A Case Management project was chosen because we felt our Case Management program was lacking the processes needed to have a strong effective program. The Case Manager had become very overwhelmed with the increasing demands for consistent effective discharge planning to reduce readmissions and the increasing/changing admission criteria resulting in a higher percentage of patients placed in Observation services.

Q: What is your hospital's current status with regards to implementing the recommendations made during this project?

A: We have currently implemented approximately ninety percent of the recommendations made during this process and are continuing progress during the coming year. The Care Manager resigned her position shortly after our project began. The new Care Manager was able to enter into the role with the tremendous advantage of having Mary Guyot's (Stroudwater Associates Consultant for this project) findings and recommendations, as well as, set action plans. Some of the greatest successes have been: revising our Discharge Planning Process to include discharge planning initiated within 24 hours of admission; revising our Discharge Follow-up process; and, training Shift supervisors on Interqual criteria giving us the ability to get the patient in the right bed status on admission around the clock.

Q: What were the anticipated outcomes of this project? Has your hospital been able to document any of these outcomes?

A: Some of the anticipated outcomes were:

  • Improved processes for the Case Management department to improve documentation and ensure CMS compliance
  • Initiate a discharge follow-up process for 85% of discharges meeting criteria for follow-up

We have been able to document accomplishments for the outcomes above, as well as others. The new processes, including the discharge follow-ups are working great. We are already seeing a reduction in our readmission rate, better communication between providers and a decrease in the number of admission status changes.

Q: What are the expected next steps towards adopting your consultants' recommendations? Is there a sustainability plan?

A: We will continue to implement many of the recommendations this coming year. Continuing to work on readmissions and revising Case Management processes.

Q: Is there anything your hospital would do differently if you were able to repeat this experience?

A: No, this was a great experience for us. Mary did an outstanding job and really gave us a clear picture of where we were and where we needed to be.

Hospital Spotlight

Uvalde Memorial Hospital Strategizes SRHT Implementation

June 2018

UMH successfully incorporated the ten action items recommended in their 2017 FOA strategic plan. The teams modified time frame goals to coincide with the strategic plan to stay focused on the implementation.

Hospital Spotlight

Delta Memorial Hospital’s SEAL Team

May 2018

Delta Memorial Hospital was spotlighted in November 2017 for the progress on their QI project. Read this next spotlight which talks about their SEAL team, charged with the task of impacting patient experience.

Hospital Spotlight

Delta Memorial Hospital: SRHT Project Well Under Way

November 2017

After only six months of their SRHT QI Project implementation, DMH is reporting successes including the start of a chronic care management program, creation of a patient satisfaction committee and an innovative approach to leadership rounds.

Hospital Spotlight

Coteau des Prairies Keeping Services Close to Home

August 2017

CDP staff is more aware of the ways they impact the financial success of the hospital. There is increased trust of the new leadership team, as well as, improved communication and problem solving.

Hospital Spotlight

Monroe County Hospital Achieving Outcomes

April 2017

Monroe County Hospital completed a Quality of Care and Transition of Care SHRT Project in 2016. Read about their progress on this project.

Hospital Spotlight

Pender Community Hospital Surpassing Project Goals

May 2016

Melissa Kelly, CEO of Pender Community Hospital in Nebraska shares ways they utilized the recommendations from a Financial Operational Assessment to “jump to new system of delivery and payment.” They describe how they are setting goals around preventative services and trying to change the community’s view by changing communication with the community about prevention.

Hospital Spotlight

Spotlight on Cibola General Hospital

February 2016

CGH completed a QI and TOC Project in 2015. Bob Phillips, CEO and co-CNOs share how they used the recommendations to prepare to be a part of an ACO and creating processes to support population health.

Hospital Spotlight

Spotlight on Missouri Delta Medical Center

June 2015

MDMC shares successes and lessons learned from an RHPI FOA in preparing for a new payment and care delivery model and discusses next steps for participation in a shared savings plan and/or ACO.

Hospital Spotlight

Spotlight on Tallahatchie General Hospital

April 2015

Jim Blackwood, Administrator of TGH, discusses ways they used an RHPI FOA to focus on developing leadership abilities, especially regarding handling the “business” end of their departments.

Hospital Spotlight

St. James Parish Hospital’s Lean Project Success

December 2014

St. James Parish Hospital worked on a Lean Process Planning & Value Stream Mapping RHPI Project. The team chose to focus on medication management and medical necessity.

Hospital Spotlight

LaSalle General Hospital Improves Clinical Processes and Revenue Cycle

February 2012

This project helped to provide assistance with evaluating clinical processes that impact the revenue cycle, prioritize needs, develop action plans based on the identified needs and implement a plan to improve clinical processes and thus the revenue cycle.