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.
Victoria Powell, RN, CCM, LNCC, CNLCP, CLCP, MSCC, CEAS II, Founder and President of VP Medical Consulting, LLC.
HIN: What was your first job out of college and how did you get into case management?
Victoria Powell: My first nursing job was working in a med-surg unit at a local hospital. I had worked at the facility as a nurse’s aide while I was attending nursing school and had been afforded some great educational opportunities. I did not know or understand anything about case management at the time. We had one nurse who worked in utilization review and I did not understand until many years later that this position was within the umbrella of this fabulous thing we call case management.
My first experience with case management was in 1999. I was working as the office administrator for a large orthopaedic group. Many orthopaedic issues are the result of injuries and I was introduced to various nurses who would come to our clinic and attend appointments along with employees who had been hurt at work. Even then I thought all case managers worked in workers’ compensation. I left this role to pursue another job, but made a contact at this time that eventually led to my case management career. One of the physicians’ wives was working as a case manager for a national case management company. They had an opening and she insisted (very strongly) that I consider joining the corporation. I was not interested, but she continued to call and email me about it regularly. I finally decided I would call the company to quiet her requests, but ended up being hired over the phone on that very first phone call!
Has there been a defining moment in your career? Perhaps when you knew you were on the right road.
My father was diagnosed with cancer six years ago. I was at the point in my career when I felt burned out and was looking to do something different. His diagnosis put my plans on hold and I began to manage his care through the spectrum of testing, specialists, surgery, rehabilitation, and so on. The services I provided were no different than I would have given to any other patient. The tasks were not difficult, but this time they were personal.
Somewhere about a month into his diagnosis and treatment, my parents thanked me profusely for my assistance. They explained they did not feel they could navigate the health system without me. With tears in her eyes, my mother stated she was in such a state of shock at his diagnosis that she could not think clearly for herself, much less for him. She described me as a life preserver. I tried to explain that I did not do anything; I just made some calls, collected some records, scheduled some appointments. I thought it was something any daughter would do, but they helped me to understand that their daughter just happened to navigate the healthcare system for a living. It was my training, education, and experience that made these “simple tasks” to me, but I found out just how much of a difference they could make in the lives of others.
Today I remain in case management because of my father’s diagnosis. I found a purpose and now I realize that my entire career has groomed me for the position I now hold.
In brief, describe your organization.
We are a nurse consultant organization providing a variety of nurse-related education and services. We began strictly by providing case management services to workers’ compensation patients, and later expanded into multiple areas including life care planning, Medicare Set Aside allocations, ergonomics and more. We are located in central Arkansas and have a new office opening soon in northwest Arkansas, but provide case management service to Arkansas and the contiguous states. We provide life care planning services nationwide and even abroad.
What are two or three important concepts or rules that you follow in case management?
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.
That does not mean however, that the carrier with which one contracts 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 that service. 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 to 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.
What is the single most successful thing that your organization is doing now?
The one thing VP Medical Consulting does better than most other case management firms has to do with the way in which we approach each case. We have experience in the legal system both within and outside of workers’ compensation. The experience gleaned from working in the legal system means a new way of managing claims. Rather than focusing just on the situation as it stands before us, we are also looking toward the future. It is like a game of chess. Each case decision made now may result in a different outcome and open up new issues which need to be addressed in the future.
In our current state of medical care, the healthcare providers have limited time to talk with the patients face-to-face. The training and experience of our nurses means that in preparing for an appointment, we have fully assessed the situation and have documented the issues in an outline complete with the history of the complaint or condition, the dates and locations of all treatment, and have listed the questions which need to be addressed by the provider at the time of the next face to face meeting. This results in confidence from those we care for and allows the physician to get to the heart of the matter quickly so that all face-to-face time is spent focused on the issues and questions at hand. By reviewing the medical reports following the face-to-face meetings, we also point out discrepancies and have them corrected in a timely fashion rather than allowing misinformation to invade the medical record.
What is the most satisfying thing about being a case manager?
I love being a case manager! Education is such a fun part of my job and I get to meet people of all walks of life with all sorts of issues. I am always learning, whether it be about a disease or condition, a new treatment option, a new resource for information or even traveling to conferences and networking with colleagues all over the United States. Meeting new patients from all walks of life and discovering what makes them special and unique is also satisfying to me.
Where did you grow up?
I grew up right here in central Arkansas in the same neighborhood where I now reside. In fact, my parents built a home in 1976 in what used to be considered ‘the country.’ I graduated high school while living in that home and despite every plan to leave, I never did. I have lived on the same street for 36 years, just moving from one home to the next as our family grew. The neighborhood has grown by leaps and bounds and we are certainly not in the country anymore!
What college did you attend? Is there a moment from that time that stands out?
I began my education at Baptist School of Nursing in Little Rock. It continues today as a diploma program and is one of the best in our state. When I left school to begin work the adage was that a Baptist grad would always get the job before one of the candidates from one of our many other schools. It worked for me. I was so glad to finally be out of school, but as soon as I entered the workforce I suddenly wanted to return to school and listen to my professors once again. I felt like I missed so much and now that I had begun work, the light bulbs were turning on and things like pathophysiology suddenly made sense. I just wanted to return and scoop up the things that slipped passed me the first go around (just without all the exam anxiety).
Are you married? Do you have children?
I am married and we have four adult children; two boys and two girls. Our youngest boy is attending college to become a mechanical or bio-mechanical engineer. The youngest daughter has returned to school and is in a BSN program. Three of our children still reside in Arkansas while our oldest daughter and her family are in Virginia. We are currently expecting our ninth grandchild! Considering neither of the boys are married yet, there could be many more grandchildren in years to come.
What is your favorite hobby and how did it develop in your life?
I have so many hobbies, but rarely have time to pursue them. Currently some friends and I host a monthly “Pinterest Party” where we get together and craft something we saw pinned on Pinterest.com. My husband and I like to travel and we try to get away to a new locale at least once a year. I also love movies, photography, reading, and of course playing with the grandchildren.
Is there a book you recently read or movie you saw that you would recommend?
I usually read nonfiction, but new movie releases got me started on a few fiction pieces recently. I completed the Hunger Games series by Suzanne Collins and also The Help by Kathryn Stockett. As for my non-fiction I have just finished Dave Ramsey’s EntreLeadership. All were excellent and I give them 5 stars each.
