Athena Forum Hospital CM Directors Summer2015

Athena Forum Institute®

2015 Discover Athena Forum Tour!”Company-Directed Training for Hospital Performance”

Discover Athena Forum Institute 2015 2

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

[email protected]

mailto:[email protected]


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.”


CM Director

CM Team

Social Workers

UM Reviewers


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.”

Before and After



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.


mailto:[email protected]

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


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


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


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).


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.


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.


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


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.



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.


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




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


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


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)



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.


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


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.”


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


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


Book Club Discussion Leader: CM Director: “CM’s have new energy and confidence about prior-auth.”


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.”



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


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


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.

Athena Forum Hospital CM Directors Summer2015

Documents

Transcript of Athena Forum Hospital CM Directors Summer2015