Transitioning Your Clinical Manager Into PDGM Case Management. It’s A Whole New Ballgame And We Are In The Bottom Of The 9th!
Kenyon HomeCare Consulting • March 16, 2021
When the Conditions of Participation changed, what changed in the role of your clinical manager? Nothing? Maybe the name changed from nursing supervisor to clinical manager? This needs addressed prior to PDGM. Business as usual can happen, but you aren’t going to be paid for it. Let’s look at true clinical management the way CMS wants it to be.
The Nature Of Clinical Management:
The mistake seen often in agencies is the term clinical management being confused with case management. Case management models had a nurse with a caseload of patients he or she handled from admission to discharge. The nurse made her schedule of visits based on the visit frequency in the care plan. That same nurse called insurance companies and got visit authorization and made sure someone could cover if she was off work. The of the clinical manager is a different story.
As CMS completed and continues with ongoing auditing, there is still a disconnect with managing patient care as a whole. Enter the requirement of clinical manager. CMS wants to see the nurse manager being engaged in all forms of clinical care. The intention is the clinical manager critically works through care planning and care delivery. It is a hands-on process regarding every care plan. Don’t make the mistake that the best clinical manager is your best field nurse. It is a big difference between managing a patient load as a staff nurse to critically managing care of your patient census.
Ok, So How Do I Develop A Great Nurse Into A Great Clinical Manager?
Make sure your expectations are clear. Second, your clinical managers can’t be nurses in the field full-time. In so many small agencies, nurse supervisors or DONs are in the field daily. Clinical management requires time, coordination, changes to orders, and driving delivery of patient care. It is unrealistic for your clinical manager to do all of this while maintaining a patient load herself.
Have a great second person to assist with clinical management. We realize an assistant clinical manager has to be named, but often these individuals are not filling the full shoes of the clinical manager. You need someone as clued into the entire clinical management paradigm to make the system work consistently. The investment to train simultaneously will easily cover the cost. If you don’t invest now, then the cost of catching up will be much more than you thought.
Develop case coordination that makes sense for all clinical disciplines. Your clinical managers need to work well with therapy and the home health aides involved in care. Develop a system where all disciplines work together towards all the goals on the care plan so clinicians don’t have tunnel vision for just nursing, rehab, or personal care. It really needs to focus on a joint coordinated effort to be successful in PDGM world.
Let Kenyon Homecare Consulting Help You!
At Kenyon Homecare Consulting, we have senior consultants with decades of experience working to educate agencies and helping with organizational change. This is the time to get the help you need before PDGM starts. Call us today at 206-721-5091 or contact us online for your free 30-minute consultation to see if we can help with your clinical management goals!
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Today, this article will look at little different than out typical articles. We all know the costs of losing employees and trying to hire and train new ones. It is exhausting and expensive. So, we think about our wages and benefit packages all the time. What can we do differently that makes people stay? We can’t change the job and we don’t want to keep people that don’t like the work itself. So, how do we acknowledge employees in a way that is valuable to them and that our businesses can afford to do? 5 Things To Consider About Employee Recognition At Your Christmas Party: 1. Years of Service: These can be based on milestone work anniversaries (5, 10, 15 yrs, etc.). If a person has been at your agency 11 years, you pull them up and acknowledge them in the group of employees who have been there at least 10 years up until the time they hit the 15 years landmark. This way longevity is recognized yearly. 2. Special Employee awards: Now, this may be difficult if your staff is very small, but acknowledge the employee who has gone the extra mile in the job they do. Tell the story. The employee needs to know when the employer is proud of the work that has been done. Consider a plaque or certificate. Don’t minimize the value of the employee having them to display. 3. Acknowledge all employees in the mix: Because we are a clinical industry, the administrative staff is often overlooked on day-to-day operations. Ultimately, don’t miss the chance to acknowledge the employee who was able to catch billing errors or collect on a large account. Staff doesn’t like to hear about money, but those types of collections keep Christmas bonuses in place! So, make sure the other staff knows the accomplishments of the finance department or the office manager that every caller loves to speak to. Don't ever forget the IT staff that is on call more than any clinical person in your agency! 4. Letters from the administration: Add a personal note to your staff either collectively or individually depending on the size of your agency. If you are larger, there are employees you don’t often see or get to talk to on a regular basis, so take the time so send a note with that Christmas bonus. 5. Consider the Christmas bonus: Listen, some of you can afford to do substantial monetary bonuses and that is fantastic. However, if you are not in that position, consider something in its place. Maybe small gas cards go with the letter from administration. With the cost of groceries, consider something that helps with the costs of daily living for employees. Big box gift cards in your area will always be used. You may do a lot of these things on a yearly basis to employees. All this being said, it doesn’t mean there aren’t reasons for acknowledgement throughout the year. However, your annual Christmas party is a good way to do it collectively. Between your annual party, write the individual cards to employees when you hear a patient interaction worthy of praise. Or, maybe you buy a gas card for the employee who has picked up extra shifts and always shows up on time. Ultimately, employees will feel valued. You will not regret the time, effort, and energy put into these efforts. Merry Christmas! If you want help with recruitment and retention strategies for your agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online today.
When you think in practical terms, what does your ICD 10 coding mean to the clinicians in your agency? It probably isn't as important as you would like. Realistically, your nursing staff cares about hands on patient care. If you want the code itself to be more meaningful, then you need to attach the concepts of patient care to the ICD coding. You may think the code itself goes hand-in-hand with the care, but this is not always true. As a clinician, there are concepts within the nursing care plan that are automatic and some that are instinctual based upon the body system causing the need for care. It's a given that medication, diet, and disease process teaching are going to be in the care plan (or should be). When you get to disease process, our experience shows the clinician doesn't always run deep into the specifics of the disease when it could lead to valuable interventions being included in care. For example, when clinicians do a care plan related to cardiac disease, are the interventions very broad to include all things related to any type of cardiac disease? If you have a patient with right sided heart failure versus left sided heart failure, how many nurses would assess the patient differently? Would your nurses change the frame of mind to look for distended neck veins or anorexia and nausea if the patient had right sided failure? Would they be in the head space of considering whether the patient's appetite changes are more about just having been in the hospital than about potential venous stasis in the abdomen? The point is that although there are certain interventions that would be the same regardless the type of heart failure, picking up on different symptoms and critically thinking through the cause is often missing in the hustle and bustle of the day-to-day. This is not a judgment on the capabilities of the nurses but more about how our nurses are trained to consider care planning and assessment. We have people for ICD 10 coding now. Most nurses are not in the ICD coding manual looking up their own codes anymore because of the specificity that wasn't the same 25 years ago. So, the nurses go out with an H&P from the hospital or doctors office and develop a care plan. It isn't necessarily with the coding in mind. So, we need to get back to basics when it comes to coding and clinical care. We need to train out staff to look harder at the coding. Our coding departments need to have open communication with clinicians and understand the concepts of care planning to understand if things are missing in the care plans. What about your clinical manager's role? Are these things considered when reviewing care plans? What about your record review process? Are your ICD 10 coders nurses that understand care planning and is it part of the coding process to review the care plan? These are things to consider when you look at your clinical practice as well as your coding solution. At Kenyon Homecare Consulting , we have a comprehensive ICD 10 coding department that can provide education to clinicians, accurate ICD 10 coding, care plan and Oasis review. Call us at 206-721-5091 or contact us online to see if we can help you merge the code with the clinical practice in a way to improve your outcomes and your bottom line. We will offer 5 free recodes to any agency that would like us to check the efficacy of their current coding system or talk about becoming your coding solution.