athena forum hospital cm directors summer2015
TRANSCRIPT
Athena Forum Institute®
2015 Discover Athena Forum Tour!”Company-Directed Training for Hospital Performance”
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The Journey of CM Improvement Begins on Athena Forum.
Dear CM Director,
Our philosophy is that a CM Director can achieve goals at a faster rate
with a better educated staff.
Thanks to all the CM Directors contributing to this presentation.
Welcome!
TOM RASMUSSEN
Thomas A. Rasmussen
CEO & PublisherSenior Fellow, Jefferson School of Population Health
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Human Capital
“Knowledge workers need knowledge. Knowledge workers are different from factory workers.
Knowledge workers can advance the strategic direction of your business.”
Peter Drucker
The Essential Drucker®
“Staff education is an essential function of leadership.”
Joint Commission
Hospital Accreditation Manual
Define Management!
“Management is getting work done through others.”
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CM Director
CM Team
Social Workers
UM Reviewers
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The Education Multiplier Effect
When ONE CM completes ONE CE course = “advancing one’s practice.”
When the ENTIRE team completes the same course = “improving organizational performance.”
~ “Company-directed training is the tide that lifts all boats.”
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Design
Athena Forum was designed in 2008 by 400 CM Directors as a Management Tool.
Athena Forum has 3 Personalities/Features to Improve Organizational Performance:
1. Management Tool: CM Directors assign courses to steer the team to hospital priorities.
2. CE Machine for Staff: Staff love Athena Forum for 700 CE accessed from any computer.
3. Clinical Reference Tool: 7,000 page database is searchable (“21st Century PDR” says CM).
Pricing
4 Levels of Hospital Educational Site Licenses:
1. ALPHA hospital ( > 500 licensed beds) $7,500.00 per year
2. BETA hospital (300-499 beds) $5,500.00 per year
3. CHARTER hospital (100-299 beds) $3,500.00 per year
4. DELTA hospital, med group, SNF ( <99 beds) $1,100.00 per year
All benefits available to all hospitals:
Complimentary Management Orientation webinars
Complimentary Staff Orientation webinars
Unlimited enrollments for all employees at site; hospitals can add or delete personnel at any time
24/7 access to all 700 CE certificates (RN, SW, ACM & CCM; certs instantly printable from online
Accessible from all mobile devices (e.g. Nook, Kindle, iPad) at any Wi-Fi location
Tuition pricing for personnel outside the hospital: see “ACO Presentation” or contact [email protected]
Athena Forum Value Proposition: Invest a little – go BIG on staff performance.
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Return-On-Investment Part 1
Many hospitals forecast a conservative ROI of 10 X Athena $3,500.
3 cost-savings examples from 3 CM Directors: Annual Savings:
1 Athena Forum’s course “Hospital Revenue Cycle” instructs case managers
on reducing avoidable days. Reducing only 10 days a year @ $2,000 saves $20K. $20,000 per year
2 Athena Forum’s course “Discharge Planning”: instructs case managers on
improving level of care (LOC). Assume one inpatient bed @ $2,000 vs. one SNF bed
@ $375 = $1,625 savings X 10 transition orders = $16,000 savings per year. $16,000 per year
3 Athena Forum’s course “Improving Heart Failure Management”: instructs
case management teams to reduce HF re-admits by 20%. Assume avoiding 10
Medicare penalties on HF re-admit claims X $1,000 each = $10,000. $10,000 per year
Total savings: $46,000 per year
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ROI Discussion Part 2
“We’re seeing declines in hospital readmissions – coordinated with our course assignments to our 9 hospital
CM teams. This is a great value.”
Barbara Ashton RN MSN
Regional Director Case Management
HCA Mountain Division
Salt Lake City, UT
“We’re forecasting improving claims by $100,000 a year. The price of high morale? Priceless!”
Mindy Owen RN MS CCM
Director Case Management
Dartmouth-Hitchcock
Lebanon, NH
“We’re training 380 care coordinators among our 80 medical groups all over Minnesota. 21st Century convenient.”
Sue Robinson RN MS
Manager ACO Education
Allina Health Accountable Care Organization
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Benefits to Member Hospitals
5 Benefits most frequently reported by 850 CM Directors on Athena Forum:
1. Elevated core competencies of case managers
2. Improved outcomes
3. Reduced avoidable days
4. Improved claims
5. Reduced readmissions risks
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Maximizing the Power of Staff Development
CM Directors on Athena Forum report 3 essentials to maximize the power of staff development:
1. CM Director should assign courses to steer the team (popular pacing is 1 module per month).
2. CM Director should lead monthly discussions (for staff compliance & hospital’s procedures).
3. CM Director should delegate details of staff completions (to admin, senior CM or an educator).
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Athena Forum Supports Your ACO
The Affordable Care Act requires hospitals in an Accountable Care Organization to:
1. Demonstrate your preventive care program for our covered Medicare seniors in community,
2. Demonstrate your chronic care delivery network for covered seniors in community,
3. Demonstrate your staff coaching process to adhere to Medicare’s 5 Patient Quality Measures.
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Sample Implementation Memo
MEMO TO: CM Staff
FROM: CM Director
DATE: January 2, 2015
SUBJECT: Staff Performance Program 2015 with Athena Forum
As mentioned, we’re launching a new staff development program with courses on Athena Forum. This is a mandatory program for
all CM staff and will improve our organizational effectiveness as all staff will be taking the same courses as we move forward.
This is also a new and free employee benefit. We’ll be discussing topics at monthly staff meetings. We look forward to improving
all our CM services to patients, families, nursing and payers.
2015 Staff Performance Program Advancing Practices & Team Performance______________________
JAN CM Express on Athena Forum Our CM team has a unique responsibility to get reimbursed for the pt care we deliver.
Mod B: Improving Claims This impacts the hospital’s revenues! We’ll discuss THU JAN 29 MTG 3pm. Bring CE
FEB Hospital Revenue Cycle Reducing avoidable days is an important task for us. Leadership supports.
Mod B: Hospital Cash Flow Print page 35 for the MTG. We’ll discuss THU FEB 26 MTG 3pm. Bring CE cert.
MAR Heart Failure Management 1 HF care is complex and expensive. The better we assess our HF Pts, the better care
Mod B: HF Assessment we provide Print chart “Family History Pertinent to HF.” Bring cert to MTG 3.26.
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Athena Forum Care Management Series® Slide 1 of 2
CM Express [for new hires] Establishing Your Professional Identity
Mod A: Essentials of Case Management Mod A: Essentials
Mod B: Importance of Claims Mod B: Critical Thinking
Mod C: Resource Management Mod C: Emotional Intelligence
Mod D: Transitions of Care / Patient Experience Mod D: Conflict Resolution
Mod E: Leadership
Discharge Planning Mod F: Difficult People
Mod A: Philosophy & Standards
Mod B: Patient Centered Approach to DP Hospital Revenue Cycle
Mod C: External Forces in DP Mod A: Industry Cash Flow
Mod B: Hospital Cash Flow: Claims, RAC, Avoidable Days
Ethics in Case Management
Mod A: Ethical Standards of Practice Patient Advocacy
Mod B: CM Ethics in the Hospital Setting Mod A: Advocacy & Care Management
Mod C: Ethics in the Telecare Era Mod B: Right Care Guidelines for our Patients
Mod D: Ethics in Large Corporate Cultures Mod C: Key Components to Care Success
Mod E: Ethics in the Community Health Setting
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Athena Forum Care Management Series® Part 2 of 2
Commercial Population Healthcare [SEP2015]
Mod A: Chronic Care Management for a Population
Mod B: Healthcare Analytics & Metrics for Success
Mod C: Tele-health Coaching & Care Transitions
CM Power! [for advanced case managers; SEP2015]
Mod A: Essentials of a High Performing Case Manager
Mod B: Improving Claims as the CFO Would Like Them!
Mod C: Optimizing Resource Management
UM
Mod A: Standards & Regulations in UM
Mod B: Payers, Contracting & UM
Mod C: Quality of Care & UM
Senior Care Series® [Q1 2016]
10 courses for improving care & improving claims on
Medicare’s Top 10 hospital admission clinical conditions.
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Excerpt from Athena Forum’s Population Health[Mod A: Prior Authorization – Case Study “Leroy J. – “Is Admission Related to ESRD?” partial page 34 of 36 pp]
The Hospital CM contacts the MCO CM to let her know Medicare has not approved the admission. According to the
Hospital CM, Medicare does not feel the respiratory event was related to ESRD, and they also have determined the
patient does not meet criteria for admission. The case has been sent for review.
The hospital CM is requesting an authorization and acknowledgement as primary payer from the MCO. The MCO CM
requests additional information from the hospital CM, specifically regarding the patient’s intensity of service since
admission. Hospital CM provides the following documentation:
With the exception of IV Reglan and IV Zofran in the ER, the patient has received only oral medications, subQ
Heparin prophylactically, and subQ insulin since admission
No hydration has been required
Vital signs: BP ranges from 185/84 to 191/74, HR 86-92, R 16-24, O2 sat 100% on room air. No supplemental
oxygen has been required
PRN medications have been ordered, but none given since admission
MCO CM advises HCM that intensity of service documented does not meet medical necessity guidelines for
inpatient status. A denial letter is sent specifically for the inpatient stay.
Athena Forum Clinical Care Series® Slide 1 of 3
Asthma CV Risk: Stroke & MI
Mod A: Prevalence & Pathophysiology Mod A: Prevalence & Pathophysiology
Mod B: Assessment Mod B: Stroke & The Care Manager’s Role
Mod C: Treatment Mod C: MI & The Care Manager’s Role
Mod D: Care Manager’s Role in Asthma
Colorectal Cancer Diabetes
Mod A: Prevalence & Pathophysiology Mod A: Therapies
Mod B: Symptoms & Management Mod B: Assessments & Complications
Mod C: Treatments & Interventions Mod C: Pharmacologic in Diabetes Care
Mod D: CM Role & Pharmacologics Diabetes
COPD Ebola Virus Care Management
Mod A: Prevalence & Pathophysiology Mod A: American Societal Response & Ebola Assessments
Mod B: Assessments & Complications Mod B: Infrastructure for Control & Care; Legal Issues/Ebola
Mod C: Pharmacologics in COPD Mod C: Patient Education & Reimbursements Ebola Care
Mod D: Care Manger’s Role
Mod E: Pneumonia EOL & Palliative Care
5 Modules on Patient Goals, Care Mgmt, Regs, CM Role.
COPD rates are rising in women.
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GI Disorders Obesity Management
Mod A: Ulcerative Colitis Mod A: Prevalence & Pathophysiology
Mod B: Crohn’s Disease Mod B: Assessments & Complications
Mod C: Diverticulitis Mod C: Treatments & Interventions
Mod D: Care Manager’s Role in Obesity Management
Heart Failure Pain Management
Mod A: Prevalence & Pathophysiology Mod A: Pathophysiology of Pain
Mod B: Assessment & Complications Mod B: Acute Pain
Mod C: Treatment & Interventions HF care Mod C: Chronic Pain
Mod D: Case Manager’s Role in HF care Mod D: Types of Chronic Pain
Mod E: Cancer Pain
Multiple Sclerosis
Mod A: Prevalence & Pathophysiology
Mod B: Symptom Management & Rehab
Mod C: Disease & Relapse Management
Mod D: Care Manager’s Role in MS
Athena Forum Clinical Care Series® Slide 2 of 3
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Athena Forum Clinical Care Series® Slide 3 of 3
Rheumatoid Arthritis Women’s Health
Mod A: Prevalence & Pathophysiology Mod A: The Perimenopausal Years
Mod B: Assessments & Complications Mod B: Complications in Menopause Care
Mod C: Treatments & Interventions Mod C: Sexuality in Maturity
Mod D: Care Manger’s Role Mod D: Care Manager’s Role
Sepsis Care Wound Care
Mod A: Prevalence & Economics Mod A: Prevalence & Pathophysiology
Mod B: Pathophysiology & Assessment Mod B: Assessments & Complications
Mod C: Sources & Predispositions Mod C: Treatments & Interventions
Mod D: Prevention & Treatment Mod D: Prevention Strategies
Mod E: Care Manager’s Role in Sepsis Mod E: Care Manager’s Role in Wound Care
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Athena Forum Behavioral Health Series®
Improving Outcomes in Abuse Management
Mod A: Domestic Violence 1
Mod B: Domestic Violence 2
Mod C: Child Abuse 1
Mod D: Child Abuse 2
Mod E: Elder Abuse
Mod F: CM Role in Abuse Reporting & Management
Improving Outcomes in Depression Care
Mod A: Prevalence & Impact
Mod B: Pathophysiology of Depression
Mod C: Non-pharmacological Treatments
Mod D: Pharmacology in Depression Care
Mod E: CM Role in Depression Care
Harm Risk Behaviors & Suicide Prevention
Mod A: Prevalence & Societal Impact
Mod B: Pathophysiology & Associated Mental Disorders
Mod C: Assessment & Prevention
Mod D: Treatment Management
Mod E: CM Role in Suicide Prevention
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Accreditations: 100% Volume for RN, SW, ACM, CCM
Athena Forum offers 700 CE contact hours for RN, Social Work, ACM and CCM professionals.
RN: Co-Provider with SutterHealth University by American Nurses Credentialing Center [ANCC]
RN California: Approved Provider with California Board of Nursing
RN Florida: Approved Provider with the Florida Board of Health in Nursing.
Social Work: Approved CE Provider by the NASW, Michigan, California.
ACM: Approved Provider by the ACMA (American Case Management Association)
CCM: Approved Provider of CCM CE by the CCMC (Certified Case Managers Commission)
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Case Study#1 The Strategic Staff Development Program
1. Assess Department Weaknesses
- High LOS at “X” days – commercial payers complaining.
- Heart Failure Re-admits too high – Medicare financial penalties will grow.
- Avoidable days too high – costs $thousands monthly
- Need CM clinical skills – RN managers on units say our CM clinical skills are rusty.
- Denials too high -- Need better percentages, especially with BlueCross.
- Problems with RAC auditors incoming – rumors not good.
2. Develop Positive Strategy
- Lower the LOS to “Y” days
- Reduce HF re-admits by 20%
- Improve denial management to “Y”%
3. Assign Athena Forum Courses to Case Managers for Improved Competencies - Discharge Planning & UM & Hospital Revenue Cycle
- Heart Failure Assessments, Treatments & Case Manager’s Role in Reducing HF Re-admits
- Principles of Case Management & Standards of Practice
4. Discuss & Integrate Performance Program
- Delegate to senior case manager implement discussions on courses & hosp policy. Consider Gift Certificates to Best Buy, etc)
- Invite guest speakers from hospital, payers, RAC auditors, others. Outside perspectives add value.
- Listen for opportunities to make process improvements.
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Case Study #2 Tackling Hospital Priorities
Case Study 1: Reducing HF Re-Admits by 20%
Timeframe: 4 weeks: SEP 2015
Athena courses: Heart Failure: Pathophys, Assess, Treatments, CM Role
Discuss & integrate: 4 Staff Meetings: SEP 2015
Guest Speaker: Hospital Cardio Nurse Practitioner
Case Study 2: Improving our UM Program
Timeframe: 8 weeks: JUN 2015
Athena courses: UM: Pre-Admission Reviews, Concurrent Reviews, UR, Transitions
Discuss & integrate: 4 Staff Meetings: JUN 2015
Guest Speaker: UR Manager from BlueCross
Case Study 3: Improving Sepsis Care & Reducing LOS
Timeframe: 4 weeks: AUG 2015
Athena courses: Sepsis Care & Resource Mgmt
Discuss & integrate: 4 Staff Meetings: AUG 2015
Guest Speaker Hospital ICU Director
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Case Study #3: Reducing Avoidable Days
CM Director:
“Our 350 bed hospital has an
unacceptable level of avoidable
days at 50 days a month. At
$1900 a bed night that’s
$95,000 monthly in losses.
That’s $1.1M yearly.
“I assigned your course on
Hospital Revenue Cycle to my 28
case managers.
“My goal was to reduce avoidable
days 30% within 4 months. I have
total support of VP Operations.”
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Case Study #4 The Book of the Month Club
Case Study 1: Improving our CM in the ED Program
Timeframe: One month.
Athena course: “Book” - Principles in Case Management: CM in the ED
Discuss & integrate: CM Lunch & Learn meeting end of month.
Book Club Discussion Leader: CM Director: “CM’s are thinking like management – fantastic!”
Case Study 2: Improving our Utilization Mgmt
Timeframe: One month.
Athena course: “Book” - UM: Pre-Admission Reviews & Concurrent Reviews
Discuss & integrate: CM Lunch & Learn meeting end of month.
Book Club Discussion Leader: CM Director: “CM’s have the best ideas on process improvement.”
Case Study 3: Improving Our Claims with Prior-Auth
Timeframe: One month
Athena courses: “Book” - MCO Prior-Authorization
Discuss & integrate: CM Lunch & Learn meeting end of month.
Book Club Discussion Leader: CM Director: “CM’s have new energy and confidence about prior-auth.”
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Case Study #5 Competency Program for Social Workers
CM Director:
“Our Social Workers can benefit from improving competencies in clinical care and CM business. In 2015 I’m launching
a Social Worker Competency Program -- using 10 courses from Athena Forum. Each of our 5 Social Workers will be
required to complete the following 10 courses on Athena -- at the rate of about one course per month (sooner if they
want to). I’m giving them a vacation break in August and Holiday break in December.
“Each Social Worker will submit the 10 SW certificates from Athena to our Dept Admin -- who will then file the certs in
Personnel Jackets. When I meet for performance reviews in December, I will expect to see 10 certificates as proof of
performance. And of course, they can print each cert a second time for their license. Win-win. Big picture is that we
can now offer our Social Workers a new resource in clinical ed so they can contribute more to our dept performance.”
Social Worker Competency Program with 10 Athena Forum Modules 2015:
1 JAN: Hospital Revenue Cycle: Hospital Cash Flow 6 JUN: CV Risk: Stroke & MI
2 FEB: Discharge Planning: Patient Centered DP 7 JUL: Heart Failure Care: CM Role
3 MAR: MCO Continuum: Prior Auth 8 SEP Pain Mgmt: Pathophysiology
4 APR: Asthma Pathophysiology 9 OCT: Wound Care: Case Manager’s Role
5 MAY: COPD Pathophysiology 10 NOV: Sepsis & LOS
Case Study #6 Core Competencies & Compensation
Multi-Hospital System (5 hospitals) in Seattle area
CM Director: “Athena Forum education is our core staff competency program for our 100 CMs.”
CM Director: “I assign 10 Athena modules yearly. Certs get filed in each employee’s HR file.”
CM Director: “During annual performance review meetings < 10 certs = no raise.”
CM Director: “With staff changes, a maternity leave and a transfer, we’ve had 100% compliance.”
CM Director: “We don’t measure all metrics, but we see noticeable improvements in 5 teams.”
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21st Century Learning by Case Managers
Starbucks: “About once a month I take my laptop to Starbucks with their Wi-Fi and read a course
on Athena. No one bothers me plus I get to sip on my Grande Latte while learning something new”
Case Manager, San Fran, CA.
Hospital Medical Library: “It’s quiet in the library, so I go down the hall once in awhile to take a
course on Athena Forum with my laptop. I only wish the librarian allowed me to eat a sandwich
there, but you can’t have everything in life.”
Case Manager, Seattle WA
Late Night at Home: “I’m married with 2 kids and am on 2 church committees plus the job, so
time is precious. I have learned that when the boss assigns a course, I am able to take a late
Saturday night at home to read a course on the site. It’s my quiet time for learning.”
Case Manager, Newark NJ
Early Morning Cubicle: “When the boss assigns a new course on Athena Forum I show up super
early the next morning in my cube and take the course ASAP. Good business concepts.”
Case Manager, Atlanta, GA
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What does excellence sound like?
“Thank you for the training this morning, it was exactly what we needed.” CM Director VA
“Our team is ecstatic to have such an amazing tool at their fingertips.” CM Director WY
“Athena has exceeded our expectations. Keep up the good work!” CM Director TX
“The format of Athena Forum is very user friendly.” CM Director CA
“Conversations are getting more professional. Social Workers love this.” CM Director IL
“We know it. We trust it. We love it.” CM Director TN
“Starbucks is the new Learning Café for our younger gen case managers.” CM Director WA
“Athena is the tide that lifts all boats.” CM Director NY
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Athena Forum Management Team
Tom Rasmussen Barbara Leach MS RN Mindy Owen RN CRRN CCM
CEO & Publisher Director Nursing Education Vice President EducationSenior Fellow Past President CMSA
Jefferson School Population Health Former Chair CCMC
Janice Graham Ellen Fink-Samnick MSW LCSW CCM CRP Danae Manus MPA RHIA
Director Web Operations Director Social Work Education Director Course Design
Sarah Hill Kim Billings Beverly Gulvin
Director Hospital Marketing Manager, Hospital Sales EAST Manager, Hospital Sales WEST
Athena Forum® LLC
EIN # 20-5544409
Rockville, MD 20850
TEL 301-279-2160
Athena was the mythological Greek goddess of wisdom and prudent warfare.