The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

Respiratory Care Case Management: Economic Impact

Nathan Lewis, CRT & Wayne Wallace, MBA, RRT
Kaiser Permanente Bellflower Medical Center, Bellflower, CA

BACKGROUND: Kaiser Permanente?s Bellflower Medical Center is an acute care hospital serving the HMO?s members in the Tri-Central Service Area. There is an out-patient case management program provided by a single RCP, which serves primarily adult patients suffering from chronic lung disease (predominately asthma and COPD).

Methods: The case management program monitors the patients? control of their underlying chronic lung disease telephonically. Patient care plans are modified using a protocol or the patient is referred to their primary physician for further care or evaluation. Patients? utilization patterns were monitored for a year prior to and post participation in case management. Some patients were new members to the HMO and did not have a complete year of enrollment prior to being referred for case management (thus partial year data was presented). All differences in admissions, ALOS, and days utilized were highly statistically significant p-value < .001. There was no statistically significant difference in the rate of readmissions to the hospital within 7 days as a result of the program. A summary of the program?s results over the past three years is presented in tabular form below:

Fiscal Year
  Prior Post Prior Post Prior Post
Admissions 113 37 1 51 81 115 64
ALOS 7.71 6.24 4.11 4.20 3.89 2.66
Days Utilized 871 231 620 340 447 170

EXPERIENCE: RCP directed case management was able to reduce not only lung related health care utilization but overall utilization as well. Average cost per day of hospitalization (inclusive of facility overhead) for chronic lung disease related DRGs is $1,593.33 at Kaiser Permanente Bellflower Medical Center. This translates to a provisional cost saving estimate of $1,019,731.20 for FY98, $446,132.40 for FY 99, and $441,352.41 for FY 00 respectively. The estimate is limited by the inclusion of non-lung disease admissions in the data.

Conclusions: A program utilizing a RCP as a case manager has demonstrated an overall reduction of hospital utilization by chronic lung disease patients and resultant positive economic impact.


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