CMSA Today - Issue 2, 2018 - 6

P R E S I D E N T 'S L E T T E R

The Changing Face of
Hospital Case Management
BY MARY MCLAUGHLIN-DAVIS, DNP, ACNS-BC, NEA-BC, CCM

C

ase managers in the acute care setting today are faced with a plethora
of healthcare changes. It is true
that they are not alone, as everyone working in a hospital setting faces challenges.
Patient care is moving to the ambulatory
care setting, and we are seeing a shift of
the sickest and frailest patients occupying
the majority of beds in acute care. As we
all know, there are consequences to every
action, and this shift creates a need for
even greater efficiencies across all care settings - but it is felt strongly in acute care.
We know the old model of combined
discharge planning and utilization management (UM) is not sustainable. There
are many obvious reasons for this, among
them being the complexity, detail and
intensity of utilization management. The
criteria and levels of review and appeals
have made UM a specialty in its own right.
It is tied to financial outcomes and does
not require any patient contact. UM began
as a corporate compliance and financial
function, and that is where it belongs.
Discharge planning is also a relic and is not
relevant in today's world of value-based
care and population health (Daniels, 2017).
An estimated 5 percent of the population use 50 percent of healthcare
resources. The 5 percent are patients
presenting with comorbid medical and
behavioral conditions. In fact, 29 percent
of individuals with a medical condition
have mental health comorbidities (Goodell,
Druss, Walker, 2011; Perez, 2017). These
are the patients in our acute care hospitals, and a case manager tasked with UM
is able to give only an acknowledgement
of the discharge, or arrange a post-acute

Pictured: Shelley Mason, MSN, CNP, RN-BC;
Cortney Weaver, RN, and Tami Maggard,
BSN, RN, CCM (CMSA member), Cleveland
Clinic, Euclid Hospital

REFERENCES
service that may not be feasible, affordable
or effective.
Hospital nurse and social worker case
managers in today's acute care setting need
to collaborate with the patient to design
a plan central to the patient's goals. The
plan must be agreeable to the patient,
reasonable to execute and congruent with
the CMSA Standards of Practice. The case
manager is the advocate for the patient, and
she will not allow a discharge to occur that
is not safe, a question go unanswered or a
medication prescribed that is unattainable
for the patient's level of understanding,
income or way of life.
Many hospitals' leadership teams recognize the value of professional case

"We know the old model of combined discharge planning and
utilization management is not sustainable."
6

CMSA TODAY

Issue 2 * 2018

managers. They understand the importance of linking patients from acute care
to ambulatory care. They appreciate that
case managers, after a thorough assessment and planning with the interdisciplinary
team, transition patients to home care, a
skilled nursing facility or another acute care
specialized hospital. Today's acute care case
managers, now more than ever, must follow
the CMSA Standards of Practice in their own
practice. There cannot be a rote discharge
plan for a disease or a diagnosis.
Hospital case managers must be able to
articulate the purpose of care coordination
and how as a case manager they are willing
to provide this to the acute care population.
Case management leaders must articulate
this purpose to the hospital system executive
team and offer a path for a case management restructure within the system, if that
is warranted. ■

Daniels, S., (2017). The Choice is Yours Care
Coordination or Discharge Planning. Phoenix Medical
Management, Inc., Pompano Beach, FL. http://www.
phoenixmed.net/killing-our-young.html. Retrieved
Jan. 1, 2018.
Goodell, S., Druss, B. G., Walker, E. R., & MAT, M.
(2011). Mental disorders and medical comorbidity. The
Synthesis Project. Robert Wood Johnson Foundation.
Perez, R. (2017). The CMSA Integrated Case Management
Program. Rebecca Perez CMSA, Little Rock, Arkansas.

Mary McLaughlin-Davis, DNP, ACNS-BC,
NEA-BC, CCM
President, CMSA
2016-2018
Dr. McLaughlin-Davis
is the president of
CMSA. She has been a
certified case manager
since 1993; she is a
clinical nurse specialist for adult health and
the senior director for care management for
Cleveland Clinic, Avon Hospital.


http://www.phoenixmed.net/killing-our-young.html http://www.phoenixmed.net/killing-our-young.html

Table of Contents for the Digital Edition of CMSA Today - Issue 2, 2018

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Opioid Use Disorder Case Management Guide
The Integrated Case Management Program: Essential for Today’s Case Manager
Patient and Family Advisory Council: Improving the Delivery of Care
Challenges and Opportunities for Acute Care Case Managers
Social Determinants of Health: Digging Deeper for Barriers in Successful Transitions and Self-Care
PAST PRESIDENTS CORNER
INDEX OF ADVERTISERS
CMSA Today - Issue 2, 2018 - Intro
CMSA Today - Issue 2, 2018 - cover1
CMSA Today - Issue 2, 2018 - cover2
CMSA Today - Issue 2, 2018 - 3
CMSA Today - Issue 2, 2018 - 4
CMSA Today - Issue 2, 2018 - 5
CMSA Today - Issue 2, 2018 - PRESIDENT’S LETTER
CMSA Today - Issue 2, 2018 - ASSOCIATION NEWS
CMSA Today - Issue 2, 2018 - 8
CMSA Today - Issue 2, 2018 - 9
CMSA Today - Issue 2, 2018 - 10
CMSA Today - Issue 2, 2018 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 2, 2018 - Opioid Use Disorder Case Management Guide
CMSA Today - Issue 2, 2018 - 13
CMSA Today - Issue 2, 2018 - 14
CMSA Today - Issue 2, 2018 - 15
CMSA Today - Issue 2, 2018 - The Integrated Case Management Program: Essential for Today’s Case Manager
CMSA Today - Issue 2, 2018 - 17
CMSA Today - Issue 2, 2018 - 18
CMSA Today - Issue 2, 2018 - 19
CMSA Today - Issue 2, 2018 - Patient and Family Advisory Council: Improving the Delivery of Care
CMSA Today - Issue 2, 2018 - 21
CMSA Today - Issue 2, 2018 - Challenges and Opportunities for Acute Care Case Managers
CMSA Today - Issue 2, 2018 - 23
CMSA Today - Issue 2, 2018 - 24
CMSA Today - Issue 2, 2018 - Social Determinants of Health: Digging Deeper for Barriers in Successful Transitions and Self-Care
CMSA Today - Issue 2, 2018 - 26
CMSA Today - Issue 2, 2018 - 27
CMSA Today - Issue 2, 2018 - PAST PRESIDENTS CORNER
CMSA Today - Issue 2, 2018 - 29
CMSA Today - Issue 2, 2018 - INDEX OF ADVERTISERS
CMSA Today - Issue 2, 2018 - cover3
CMSA Today - Issue 2, 2018 - cover4
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