PURPOSE:
To convene a structured and purposeful meeting of care providers, post acute service providers, and business sector representatives to identify strategies or interventions to facilitate the patient’s progress toward an outcome previously determined by the case manager in collaboration with the attending physician, primary nurse and patient.
1. Meeting participants should include physician advisor, case managers and representatives from lab, dietary, Physical therapy, home care, social work, psych services, pharmacy, pastoral care, medical records and business office. (other reps as indicated by patient status-ie: heart station, RT, OT, etc.)
2. Invite some key community service representatives such as SNF, rehab, sub-acute, hospice, home care.
3. Limit meeting to precisely 1 hour - hold in same place and same time each week (if time is an issue, perhaps it can be a brown bag conference so that participants can have lunch at the same time)
4. Identify a maximum of 4-5 patients and notify members in advance of patient name.
5. Invite the primary nurse caring for patient. (not the charge nurse or head nurse but the nurse actually taking care of the patient - this is an effective strategy to educate and engage the nursing staff into clinical resource management activities)
6. Formally invite (written memo) attending physician &/or medical director of service area.
7. Rotate conference leadership on a weekly basis among Case Managers. The designated case mgr coordinates the agenda for each meeting. [Another CM must keep track of time]
8. Begin with the primary nurse’s review of patient background, status, medical treatment goals, current plan of care and patient responses.
9. Medical records rep should then identify primary ICD and working DRG and bring up any issues related to documentation (this is essential if hospital has - or is contemplating - a concurrent coding process)
10. Business office rep should then report on expected reimbursement, charges to date, acute & post acute care benefits and any payer issues.
11. Each discipline should then review findings specific to its area and make recommendations that could facilitate outcome and improve cost-effective care. For example, lab may question why certain tests keep getting ordered or pharmacy may suggest an alternative medication that is less costly and has evidence-based effectiveness in light of lab results.
12. Finally, encourage attending physician to initiate new plan of care to achieve desired outcome. (In the absence of the attending physician, get endorsement of physician advisor and then case manager will bring conference recommendations back to attending physician)
13. Case Manager conference leader should document outcome of conference with specific recommendations and action plan.
14. If plan is approved by the attending physician, the primary nurse will then be accountable to coordinate updated plan of care on behalf of entire team.
15. Documentation of conference is retained in office files but statistical information concerning outcomes should be kept to demonstrate effectiveness/impact of the meetings.
