Case Management - CAH Turnaround Case Study
The Case: Sutter Lakeside Hospital, Lakeport, CA
The Challenge
In 2007, Medicare changed the way it paid for outpatient services. For Sutter Lakeside Hospital in Lakeport, California, the change meant the hospital went from losing 10 cents per dollar/per patient to losing 40 cents per dollar/per patient. In this same year, the hospital lost $850,000 to CMS’ RAC Demonstration Project. Big money for the small hospital. Thankfully, it didn’t take the leadership team at Sutter Lakeside long to realize that something had to give, or it couldn’t remain viable.
Q Solutions
In the wake of the financial challenges Sutter Lakeside Hospital faced in 2007, the hospital decided to pursue Critical Access Hospital (CAH) status. While CAH status wasn’t an entirely unreasonable pursuit for this already small hospital, it did mean that the Case Management function would become increasingly critical. QHR was brought on board to help.
Specifically, QHR consultants:
- Assessed the hospital’s case management, nursing and ancillaries functions
- Reengineered the hospital’s case management function by streamlining processes and procedures, establishing best practices, and identifying the number of people and skill sets needed to position the department for success
- Developed a Physician Advisor role
- Established a Case Management Steering Committee
- Implemented a Case Management dashboard by which the department’s effectiveness is measured
The Conclusion
Sutter Lakeside achieved CAH status just five months after applying and, since then, has had little diffi culty managing its 25 beds effectively. Between the extra money the hospital receives as a critical access hospital and the increased efficiencies inspired by QHR’s recommendations, the hospital has experienced a $3 million turnaround – without discontinuing any services or turning patients away.
“I credit QHR with putting the processes in place that have helped us be as successful as we’ve been,” said Pege. “We couldn’t have done it without our QHR team.
“QHR knew exactly what we needed. Th e QHR team did a complete assessment of our existing processes and procedures, and then helped us implement needed changes so that we could meet a tight deadline for inspection and manage the long-term 25-bed cap.”
