8 Priorities of Healthcare Case Managers: Patient Advocacy Tops List

Monday, June 25th, 2012
This post was written by Jackie Lyons

Patients should be the number one priority, and patient advocacy the most important concept for case management, say a group of healthcare case managers recently interviewed by the Healthcare Intelligence Network.  Other priorities voiced by these case managers include the following:

  • Stewardship
  • Discharge planning
  • Honesty
  • Family-centered approach
  • Communication
  • Ethical treatment of all touched by the case management process
  • Encouragement of self-care
  • HIN asked healthcare case managers to share two or three important rules they follow.  Here is what they had to say:

    Hillary Calderon, RN, Senior Manager of Corporate Case Management for HCA: Keep focused on your goals, which should be patient and family first. Implement the right plan for the patient and the family. Remember what is in scope for you to do. Do what you can, and concentrate on that. Don’t get caught up in “extra” duties as assigned, unless it pertains to your goal.

    Linda Conroy, RN, BSN, Clinical Integration Case Manager for Hartford Physician Hospital Organization (HPHO): Always try to understand what the patient is feeling. Allow the patient and family to guide you in what they want and how they want to reach their goals. Do no harm.

    Stacey B. Hodgman, MS, RN-BC, CCDS, CPUM, District Director of Case Management for Kindred Healthcare, Board of Directors for the Case Management Society of New England: First and foremost is patient advocacy. I tell new case managers that if they have a need to be popular, case management may not be the career choice for them. Case managers have an obligation to the patient first, then to the organization. Oftentimes, this can cause conflict between administration and case management.

    Secondly, ensure stewardship for both the patient and for the organization you work for. Ensure that the patient receives the right care, in the right setting, at the right time. Continuing inpatient care in the hospital longer than a patient needs to be there not only places them at risk for hospital-acquired conditions, but also continues to utilize their hospital benefit, and in the Medicare population, this is limited. Hospitals are often paid as a prospective payment system – they receive one amount regardless of length of stay or resource consumption. The case manager helps ensure appropriate utilization of resources and timely discharge planning.

    Lastly, discharge planning is probably the case manager’s most important responsibility. Ensuring resources are in place, that patient/caregiver teaching has been completed, and that they are able to verbalize an understanding of the discharge plan are critical steps in facilitating a safe and appropriate discharge plan. The role of the case manager is to facilitate this through the entire interdisciplinary team. They need to ensure that the pharmacy has reconciled medications, diabetic teaching has been completed by the nurse, equipment needs and use have been reviewed by physical or occupational therapy, care for a percutaneous endoscopic gastrostomy (PEG) tube or wound has thoroughly been reviewed with the patient/caregivers. The case manager also needs to ensure that there is a solid understanding of who the post-discharge caregivers are, what appointments need to be made or kept and a phone number to call if there are any issues that arise post discharge from the hospital. Not only is thorough discharge planning critical to patient safety, but also to preventing rehospitalizations.

    Barbara King, BSN, RN, Co-Founder and President of NurseValue, Inc.: The number one rule in both business and nursing is to always be honest. Next, the nursing process is useful when providing any service: assessment, diagnosis, planning, implementation and evaluation. Lastly, continue to learn throughout your career. You never know when a tiny bit of information will help to solve a pressing issue.

    Barbara (Bobbi) Kolonay, RN, BSN, MS, CCM, Owner of Options for Elder Care, Medical Care Management Services for Seniors: We use a family-centered approach to case management. We work with a very large multidisciplinary team including physicians, holistic practitioners, home care agencies, hospice agencies, attorneys and financial planners. Our motto is to provide the most care and cost-effective service. Statistically, we save the client more money than they spend on our service. We make sure that each and every one of our clients lives and dies with dignity.

    Sonia Morrison, RN, CM, BSN, RN case manager at Salinas Valley Memorial Healthcare System (SVMHCS), Nurse Assessment Consultant and Educator for veterans at Visiting Angels of Santa Cruz: The keys to successful utilization review and discharge planning and collaboration are communication, including written documentation and collaboration with the full team, including the patient, family, doctor, nursing staff and other providers. It is important to assess and educate patients within the first 24- to 48-hours of admission. Balanced self-care allows me to serve my team the best.

    Victoria Powell, RN, CCM, LNCC, CNLCP, CLCP, MSCC, CEAS II, Founder and President of VP Medical Consulting, LLC.: Patient advocacy is always first! Advocacy is the basis of not only case management, but nursing in general. A huge part of patient advocacy involves education. A patient cannot realistically expect to know what he or she wants to do unless they fully understand their options. Once the information is understood, the patient is allowed to make a decision on the direction of their medical care. However, that does not mean the contracted carrier  is responsible for the payment of those services. This is the most difficult thing for our nurses to understand. They are required by their nursing license to advocate for the patient, but at the same time they are responsible for understanding that just because a service is needed does not mean that our client is responsible for providing it. This is why I prefer to hire nurses with excellent critical thinking skills who are comfortable ‘outside the box.’

    Another rule in our company is that we are always working to establish rapport with our patients. Since we work in a highly litigated area (workers’ compensation), establishing rapport is essential in the reduction of litigation expenses. Many times cases are brought into the courtroom because the patient does not understand the process or feels forgotten. Allowing him or her to have a sounding board helps, as does having a case manager to help them understand complex processes or issues. We educate our patients on medically related issues as well as their rights and responsibilities under the state workers’ compensation system. This is just another way that our legal background and training helps to minimize expenses of the cases for which we manage.

    Linda Van Dillen, RN, BA, CCM, Executive VP/Partner of S&H Medical Management Services, Inc.: First, I believe in the ethical treatment of all parties involved in the case management process. Secondly, I work towards an adherence model vs. a compliance model of case management. I strive to ensure all parties have the information they need to make an informed decision.

    Miriam Weiss, MSN, RN, CCM, Care Manager at Amerigroup Corporation, Care Manager Consultant, Per Diem, at CareManagers Inc.: It is important to encourage self-determination, and provide tools to enhance self-care abilities that promote and improve healthier behaviors.

    For more success strategies, and metrics and measures on current and planned case management initiatives, check out 2012 Healthcare Benchmarks: Case Management, a new 60-page resource from HIN presented in more than 70 easy-to-follow graphs and tables.

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