CMSA Today - Issue 3, 2013 - (Page 10)

Care Coordinator Are You Just a Care Coordinator? Take the Bull by the Horns! S ince the inception of Case Management (CM) in the early 1980s, case managers have been contending with operating in the shadows. This article will provide a historical overview of accomplishments and realities of CM within organizations, historical milestones in health care, and address what CM must act upon while the clock is still ticking in order to shape the future of CM. With the inception of Managed Care and HMOs as cost control measures for spiraling health care costs, CM was under the spotlight (Kongstevedt, 1997). CM functions started with a focus on utilization of health care resources that evolved over time to patient or population-centered care. As the role was evolving, territorial battles played out. While HMOs compartmentalized CM work in multiple categories like Disease Management (DM), Continuity of care (COC), and Transitions of Care (TOC), hospitals had a different path. CM turf had two main players early on: Social Work (SW) and Nursing CM. Within hospital systems, this turf battle was clearly visible on two fronts: reporting structure and CM inclusion. CM and SW were either split into two different units/ departments and different reporting structure, or were included under the same department where the lead’s specialty became problematic. If the lead was of SW discipline, nurse case managers were disgruntled. If the lead was a nurse, SW felt like second-class team members, assuming there was team spirit! Thus, the patient and/or patient-centered care was often lost in translation. 10 CMSA TODAY Other territorial battles during this time involved reporting structure for CM as a department and for CM lead. While some had the CM lead report to Nursing – under the premise that case managers are mainly nurses – others had CM report to Finance. Both options proved to be unwise. The reality is that CM is a specialized field beyond nursing skills. No matter how progressive of a leader a Chief Nursing Officer or Executive (CNO/ CNE) may be, s/he will not understand the priority of CM work or the value of CM, which has often been erroneously lumped under non revenue-generating departments. The other extreme was placing CM under the Chief Financial Officer’s (CFO) supervision, which often left a sour taste with case managers and patients. If a case manager went into a While some had the CM lead report to Nursing – under the premise that case managers are mainly nurses – others had CM report to Finance. Both options Issue 3 • 2013 • DIGITAL proved to be unwise. BY STEFANY ALMADEN, PhD, RN, MSN, CCM, CPUM, CMCN patient’s room for an initial discharge plan assessment, s/he was misjudged as someone who was anxious to “throw out” the patient. Unfortunately, fellow nurses fed into that logic and seeped it through to patients and families. Later on came the Medicare Severity Diagnosis Related Groups (MS-DRGs), with the preparatory period of October 2007 through 2009. These MS-DRGs moved CMs into Clinical Documentation Improvement (CDI) roles and reporting into the Quality Improvement (QI) or Revenue Cycle. Another complexity in our health system was to package finances into care or caring. The second turf battle started with the Affordable Care Act and the implementation of initiatives like safe Transitions of Care and avoidance of readmissions. Nationwide, collaborative care has sprouted everywhere, giving rise to care coordination as a key strategy for better patient-centered care. While the care coordination conceptualization is logical, it is not necessarily a new strategy. Case managers have been in that role for decades. The definition of CM and the Standards of Practice for Case Management (SOP) speak to care coordination (CMSA, 2010). Nonetheless, every specialty is claiming that niche, from primary care to Nurse Practitioners — even “SNFists” (skilled nursing facility practitioners). Sadly, case managers are acting as spectators watching all of these turf battles unfold without taking

Table of Contents for the Digital Edition of CMSA Today - Issue 3, 2013

President's Letter
Public Policy Committee
Are You Just a Care Coordinator?
Moving Toward Meaningful Outcome Reporting
Lost in Translation
Association News
Index of Advertisers
CMSA Corporate Partners

CMSA Today - Issue 3, 2013