The Efficiency Measure, as part of the Value-Based Purchasing measures, was implemented by the Centers for Medicare and Medicaid Services (CMS) in order to hold hospitals accountable for their length of stay and cost per case. This measure represents the first time that CMS has held hospitals responsible for these measures. Case managers and social workers must be active participants in managing these measures in order to help their hospital ensure that they are not penalized for poor performance in these measures.
As CMS is now measuring how hospitals are performing in the use of these measures, case management professionals need to understand how their practice can contribute to improvements in these important measures. As lengths of stay are short nationally, new and innovative ways of maintaining or reducing length of stay and cost must always be considered. One key strategy is care coordination. Case management professionals must remain current and this starts with an understanding of how care coordination can impact the Efficiency Measure and your hospital’s bottom line.
By attending this session you will learn your hospital’s own efficiency measure and what it means.You will understand how to improve your length of stay and cost per case through better care coordination.You will gain insights into how cost across the continuum of care affects your hospital’s cost per case. Finally, you will gain a better understanding of where your case management department may have the biggest impact on reducing your own cost and length of stay and how to positively affect your case management practice.
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department’s efficiency and effectiveness.
The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
Dr. Cesta has presented topics on case management at national and international conferences and workshops. Her books include “Nursing Case Management: From Essentials to Advanced Practice Applications”, “The Case Manager’s Survival Guide: Winning Strategies in the New Healthcare Environment”, “The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice”, “Survival Strategies for Nurses in Managed Care” and “Core Skills for Hospital Case Managers”.