July 26, 1996

Case Management’s medical director strives to streamline procedures

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Dr. Michael Koch

Case Management's medical director strives to streamline procedures

Since Dr. Michael O. Koch was appointed the first medical director of the VUMC Office of Case Management, he has worked to apply his knowledge and experience in providing efficient medical care to the entire medical center.

Koch, associate professor of Urology, says Case Management's function in the hospital has been an evolving process.

"Originally, they called themselves Clinical Nurse Specialists and functioned as physician extenders, but the Case Management role is broader now. They're there to facilitate the programs of patient care – patient education, patient flow through the system and patient happiness – and to helf the patient care centers become as efficient and cost-effective as possible."

In a time when hospitals work closely with insurance companies, the pressure is mounting to reduce length of stay and avoid unnecessary costs.

"I hope to help everybody develop programs to keep the patient and insurer happy and produce the best outcomes," Koch says.

Koch's position as medical director was imperative for Case Management to reach higher levels of patient care and to help give an understanding of what physicians need, he says.

"Each department has used Case Management differently. Our role (in Case Management) is to support service lines, which are responsible for the total time of care," Koch says.

Koch's biggest goal is to improve communication between the administration and physicians.

"Physicians should have ready access to a database with all the information – cost, length of stay, amount of anesthesia used, how much blood is lost and so on. Our database in Urology stores 150 items per patient."

Information is available on an access system, which is user-friendly, but Koch says it needs to be customized for each service line.

"We need to treat service lines in different areas differently, and pathways are especially useful with surgery," says Koch.

Another goal of the case management office will be to increase the use of pathways at Vanderbilt, Koch said.

"Dr. 'A' does the same thing as Dr. 'B,' so nurses are always ready with the right equipment. In Urology, everyone knows my radical prostatectomy patients go home on the third day, so we can anticipate what we'll need."

Koch was chosen to take this position as a result of his successful efforts to streamline the Department of Urology. Through case management and clinical pathway development, he dramatically increased savings and developed techniques to reduce blood loss in surgery.

"In early 1993, we at Urology initiated one of the first pathways. We averaged 100 patients per year for radical prostatectomy," Koch says.

After starting the program, charges for radical prostatectomy were reduced by 44 percent, the lowest in the university consortium. Length of stay decreased and quality and patient satisfaction has been superb.

"Also, radical cystectomy dropped 40 percent in charges. We have 13 different pathways in Urology and have increased the hospital's revenue significantly," he said.

Prior to 1993, Urology patients gave self blood donations before surgery, and 80 percent of patients received their own blood in transfusion to replace blood lost during surgery.

"In 1993, we developed a way to avoid any blood donation by patients, and the transfusion requirement, which is supplied by a blood bank, is down to 1.5 percent. As a result, we've drawn a significant amount of regional and national attention, which has played a role in increasing patient volume," says Koch.

The Office of Case Management plays an important role in radical prostatectomies and patient care. They understand how the system works and can guide patients through it, says Koch.

"Case Management wrote a book for our patients with information they need, from an explanation of the hospital to a description of the anesthesia they will receive. Case Management is with them during their entire stay.

"Case Management teaches patients and nurses on the floor about the catheter that is in the patients' bladders after surgery and gives instructions for care at home following discharge. We send out a questionnaire about our services in an effort to hone down on real quality care."

As Koch continues his work as medical director of the Office of Case Management, he knows he has a big job ahead of him.

"My fear is that because of cost issues, hospitals will become heartless and begin to just run patients in and out. Eventually, those hospitals will lose patients," says Koch.

"My goal for VUMC is to be the most cost-effective and give the best care possible so people want to come here."