CMSA Today - Issue 3, 2013 - (Page 5)
President’s Letter
Case Management
at the Crossroads
There are moments in our lives when
we find ourselves at a crossroads.
The choices we make in those
moments can define the rest of our
days. And, of course when faced with
the unknown, most of us prefer to
turn around and go back.
—Lucas Scott
L
ong before I accepted my first
case management position in
1984, there were many social
workers and nurses who developed
care coordination strategies and
established case management as
a vital component of health care
delivery in America. They were the true
innovators of the professional practice
of case management who sought to
balance the delivery of quality health
care services with the necessity of
conserving health care dollars.
Through the years, case managers
have continued to employ strategies
that advanced these important
goals. In doing so, we occasionally
focused more on the cost of care and
reimbursement for required services
than on advancing the quality and
the effectiveness of care provided to
our patients. In some environments,
case managers became the primary
guardians of cost who validated the
appropriateness of care without
consistently advocating for either care
coordination or the quality of care
advanced through each stage of the
health care continuum.
As we move forward, familiar
pathways for the provision of care and
for the appropriate reimbursement
will erode and, ultimately, be replaced
with unique avenues for both care
delivery and funding of necessary
health care services. Even though care
coordination and case management are
mentioned in almost every strategy and
regulation flowing from Washington,
D.C., the legacy of the case manager
as a gatekeeper of benefit dollars and
the conservator of services remains.
I believe that legacy has fostered a
misconception of the primary roles and
functions of case management.
BY NANCY SKINNER,
RN-BC, CCM
In some environments, case
managers wear multiple hats and the
role of advocacy is often buried under
mandates to achieve rapid, rather
than efficient or effective, patient
movement through the health care
continuum. In other environments,
the term “case manager” is relegated
to those professionals and, in some
cases, unlicensed or non-professional
staff whose role is dedicated to
establishing the medical necessity and
appropriateness of care while facilitating
a structure of health care delivery
that conforms solely to the benefit
plan. These steps may not consistently
Case
Management
Issue 3 • 2013 • DIGITAL
CMSA TODAY
5
http://www.naylornetwork.com/cms-nxt/
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
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