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Caseloads are a primary factor in the quality of case management outcomes. Setting appropriate case management caseloads always has been a hotly debated issue. In December 2000, Atlanta-based American Health Consultants, publisher of Hospital Case Management, and the Case Management Society of America (CMSA) in Little Rock, AR, conducted a national survey of case managers to help clarify some of the issues surrounding the caseload debate.
More than 500 case managers, representing all practice settings, responded to the survey and revealed important information regarding this topic. When it comes to setting case management caseloads, there is no magic number. Average caseloads vary widely, with most falling somewhere between 16 and 75 active cases each month, according to the 2000 Case Management Caseload Survey.
Specific findings include:
Naturally, how many cases a case manager can manage comfortably also depends largely on how the case manager interacts with patients and providers, our experts say. It’s simply common sense that a telephonic case manager will manage a larger monthly caseload than an on-site case manager.
Finding that perfect caseload for case managers in your own organization depends on your definition of case management, as well as your case management goals, industry leaders say. "In addition to being a primary factor in the outcomes of case management, caseloads also are a measure of workload and productivity. They can negatively impact outcomes if they are set too high and the cost of case management services if set too low," notes Sandra L. Lowery, RN, BSN, CRRN, CCM, president of CCMI Associates (formerly Consultants in Case Management Intervention) in Francestown, NH, and president of CMSA.
Historically, Lowery explains, finding the appropriate caseload that optimizes both case manager productivity and case management outcomes depends on several factors, including:
"We also intuitively know that the acuity of the population served will have an impact on the number of cases a case manager can effectively manage," says Lowery. "The relationship between the variables and the outcome is truly the only reliable way to demonstrate what functions are necessary for effective case management, which can the set the standard for an organization’s caseload determinations," she explains.
The Caseload Survey was distributed in the December 2000 issues of several American Health Consultants newsletters, including Hospital Case Management. In addition, the survey tool was available on-line at www.ahcpub.com and www.cmsa.org through mid-January 2001. A total of 522 case managers, representing a wide range of practice settings, responded either on-line or by fax. The largest response rate came from acute care case managers, who composed 36.5% of the total respondents, compared to home health case managers, who composed less than 2% of the total.
Among the other case managers represented in the data set:
An executive summary of the entire data set will be available on-line at the end of March.
[To find the executive summary, visit www.ahcpub.com (click on the "Hot Topics in Healthcare" section) or www.cmsa.org. In addition, a white paper analyzing the data set by practice setting will be released in June 2001.]