This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.
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
HIN: What was your first job out of college and how did you get into case management?
Stacey Hodgman: My first career out of nursing school was working for the VA Hospital in New Hampshire. I only worked there for a short time before transferring to a local acute care hospital where I worked the night shift to avoid having to place my three children in day care. About eight years out of nursing school, and in addition to working at the acute care hospital, I accepted a part-time job as a work site wellness nurse for a steel manufacturing plant. Although the job title was not ‘case manager,’ I found that my daily interactions with the employees were in fact all about case management. I was listening, evaluating, educating, promoting lifestyle changes and optimal health and found sincere satisfaction in this role. Building trusting relationships that helped the employees make healthy changes to their lifestyle was truly rewarding.
Has there been a defining moment in your career? Perhaps when you knew you were on the right road.
About two years later, a new managed care organization (MCO) came to town. They were hiring case managers. My children were all in school and I loved the idea of working a ‘normal’ schedule and being home together as a family at night. So I accepted a position with the MCO and learned so much about case management, utilization review and the business side of healthcare, which I found fascinating. I couldn’t learn enough, fast enough.
In brief, describe your organization.
I am currently district director of case management for Kindred Healthcare, a national post acute for-profit healthcare company; I work in the Long-Term Acute Care Hospital (LTACH) division. Our company has over 120 LTACHs, 224 skilled nursing facilities (SNF), five inpatient rehabilitation facilities and 47 home care and hospice locations. We consider ourselves to be the provider of choice for patients, post acute care needs.
What are two or three important concepts or rules that you follow in case management?
First and foremost; 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, ensuring stewardship for both the patient and for the organization one works for. Simply said, this means ensuring 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, meaning 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, that 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 appropriate discharge plan. The role of the case manager is to facilitate this through the entire interdisciplinary team; ensuring 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 and/or their caregivers. The case manager also ensures 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.
What is the single most successful thing that your organization is doing now?
We continue to improve our efforts with care coordination and care management as we strategize to become the post acute care provider of choice for our market areas in the country. We are working with the Pioneer ACOs to identify ways we can help ensure progression of care through the continuum and reduce readmissions. This is an exciting time for us, as it is for our nation, as we embark upon a new healthcare delivery system.
Do you see a trend or path that you have to lock onto for 2012?
It is critical that we do not lose sight of what is happening with healthcare reform, and continually plan for the effects it will have on balancing patient outcomes through care transitions along with pay for performance and changes to provider reimbursement methods.
What is the most satisfying thing about being a case manager?
There are so many potential answers to this question! But personally, I would say that as a case manager, I learn something new every day of my practice, that it is continually both challenging and rewarding and there is never a day where I look at the clock and say ‘It’s only 3:00?’ On the contrary, I look at the clock and say ‘It’s already 3:00?!’
Where did you grow up?
I was born and raised in Boston, Massachusetts on the North shore. Being near the sea is something I would never sacrifice!
What college did you attend? Is there a moment from that time that stands out?
I attended Rivier College in Nashua, NH for my undergraduate degrees and George Washington University for my Master’s degree. The most important thing I took away from my master’s program was gaining an understanding of the value of other’s perspectives — perception is reality — and the extremely positive impact that has had on my world view.
Are you married? Do you have children?
My husband and I will be celebrating our 30th wedding anniversary this year. We have three children in their 20’s whom we are very proud of; one is an attorney, one is a teacher, and one is a nursing student.
What is your favorite hobby and how did it develop in your life?
My absolute favorite hobby is travel. I have created a ‘bucket list’ of things I would like to do, places I would like to visit. Hopefully, Italy and Hawaii will be next on our itinerary! I also enjoy research, writing and have an interest in historical fashion trends.
Is there a book you recently read or movie you saw that you would recommend?
I am currently reading ‘Transforming Ourselves and the Relationships that Matter Most’ by Lisa Oz, wife of Dr. Mehmet Oz. I enjoy ‘self-help’ books and always look for ways to better understand human behavior and relationships. As a case manager, it is imperative that we understand human behavior and how we can help influence patients to make lifestyle changes that they want to make while promoting optimal health. Relationships define us both personally and professionally and understanding how to make the best of each one can only lead to a happier, more fulfilling life.
Any additional comments?
I would be remiss to let this opportunity to ‘add a comment’ go by without espousing that I believe case management is one of the top professions for nurses and social workers. Patients need case managers to help them navigate the ever-changing world of access to healthcare and other resources. It is a very rewarding career that is always challenging, never boring and always manages to bring a tear of joy along with those of sadness as we continually advocate and empathize with our patients and families.