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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In the rapidly evolving landscape of healthcare, the burden of care is increasingly shifting from clinical facilities to the home. As the population ages, the prevalence of chronic conditions—such as heart disease, diabetes, and respiratory disorders—has reached unprecedented levels. For home care agencies, the quality of service is no longer just about assistance with daily living; it is more and more defined by the clinical competencies and disease-specific knowledge of your field staff. Chronic disease education for home care staff is not a luxury, is a strategic necessity that directly impacts patient outcomes, caregiver confidence, and the business’s bottom line. 1. Enhancing Clinical Outcomes and Safety Home care staff are the "eyes and ears" of the healthcare system. When aides and clinicians are highly educated on chronic disease processes, they can identify subtle shifts in a patient's condition before they escalate into emergencies. · Early Intervention: An educated caregiver can recognize the early signs of fluid retention in a Congestive Heart Failure (CHF) patient or skin changes in a diabetic patient, allowing for proactive adjustments rather than reactive ER visits. · Medication Adherence: Understanding why a medication is prescribed for a specific chronic condition helps staff reinforce the importance of adherence to the patient, reducing the risk of complications. 2. Reducing Hospital Readmissions Hospital readmission rates are a primary metric for home health success. Chronic diseases are the leading cause of "revolving door" hospitalizations. By providing specialized education, agencies empower their staff to implement Evidence-Based Practices at the bedside. When staff can effectively manage symptoms and educate patients on self-care, the likelihood of a patient staying stable at home increases dramatically. This not only benefits the patient but also strengthens the agency’s reputation with referral sources like hospitals and physician groups. 3. Boosting Staff Confidence and Retention The home care industry faces significant challenges with staff turnover. Often, burnout is fueled by the stress of feeling unprepared for complex patient needs. Knowledge is Empowerment: When staff members receive robust training, they feel more confident in their roles. This professional growth fosters a sense of value and belonging within the organization, leading to higher job satisfaction and lower turnover rates. 4. Improving Documentation Accuracy In an era of increased regulatory scrutiny, clinical documentation must be precise. Education on chronic diseases ensures that staff members use the correct terminology and focus on the most relevant clinical indicators during their assessments. · OASIS Accuracy: For Medicare-certified agencies, a deep understanding of chronic conditions leads to more accurate OASIS scoring, which directly influences reimbursement and quality ratings. · Audit Readiness: Well-educated staff produce notes that clearly reflect the necessity of care, making the agency much more resilient during regulatory surveys or audits. 5. Bridging the Communication Gap Effective chronic disease management requires a multidisciplinary approach. A caregiver who understands the nuances of a disease can communicate more effectively with: · Physicians: Providing clear, clinical updates that help doctors make informed decisions. · Family Members: Offering clear explanations and peace of mind to stressed family caregivers. · The Internal Team: Ensuring a seamless transition of care and consistent messaging across all disciplines. Conclusion Investing in chronic disease education is an investment in the agency’s future. By elevating the knowledge of the frontline workforce, home care providers can transform from basic service agencies into high-value clinical partners. In the end, the goal is simple: providing the highest quality of life for patients in the comfort of their own homes, a goal that can only be met through a highly trained and knowledgeable staff. If you do not know where to get comprehensive education for Chronic diseases, contact Kenyon Homecare Consulting at gkenyon@kenyonhcc.com or call 206-721-5091. We are here to help
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