CMSA Today - Issue 7, 2014 - (Page 6)

President's Letter CMSA: Health Care's Reimbursement Champion BY KATHLEEN FRASER, RN-BC, MSN, MHA, CCM, CCRN O n Wednesday, September 10, CMSA's National Board, Public Policy Committee along with nearly 60 of its member community of case managers united in Washington, D.C., to address the value that professional certified case managers bring to improving transitions of care with patients and their family caregivers. During nearly 70 Hill appointments, case managers met with their individual representative from the House and Senate with a unified voice for the need for qualified professional case managers to facilitate safer transitions of care for patients. We discussed provider incentives for cost containment with case management and an established case based reimbursement system. The Society's leadership had the opportunity to engage with members of the Health Resources and Services Administration (HRSA) and policy directors at the Executive Office of the President, Office of Management and Budget, to share the same message. Our continued presence in Washington, D.C., as well in our individual state capitals, encourage the development of provisions by clarifying the significance of qualified licensed and/or certified case managers in improving care coordination workflow, processes, and reimbursement. Case management is neither linear nor a one-way exercise but rather a longitudinal approach across health care settings that is imperative to coordinate inpatient and post discharge care. Facilitation, coordination, and collaboration will occur throughout the client's health care encounter. Transitions of Care for people with multiple serious chronic illnesses are critical points for promoting quality of care and reducing preventable, expensive, and debilitating hospital admissions and readmissions as well as avoidable emergency department visits. Most people with multiple chronic illnesses, which are often accompanied by functional and cognitive deficits, cannot 6 CMSA TODAY "Wherever and however they originate, care transitions are about addressing change over time and this must be addressed in health care reform, which must support reimbursements accordingly." manage their care on their own. Wherever and however they originate, care transitions are about addressing change over time and this must be addressed in health care reform, which must support reimbursements accordingly. What are some of the problems with the care continuum between health care settings? There are often misunderstandings or confusion on the part of the patients and their family caregivers about how and who should manage their care. There is also a high incidence of medication errors involving these misunderstandings leading to issues with medication adherence, adverse drug events, and duplication of prescriptions. Frequently patients are scheduled for a follow up visit after being discharged, however they fail to make their appointment because they either forget about it, can't drive themselves and/or do not have anyone that can take them. All of these escalate the hospital readmissions rates that decrease reimbursements and increase penalties - to dangerous levels. Care fragmentation impacts many aspects of the care continuum including patient safety. Medication errors account for many unnecessary readmissions to the hospital. In fact, an estimated 60 percent of medication errors occur during times of transition: upon admission, transfer, or discharge of a patient, according to the National Transitions of Care Coalition (NTOCC). Care transition programs need to account for issues like this by beginning the care coordination process when the patient is first admitted to the hospital. If it doesn't appear that the patient will be able to fully function on their own and they do not have a caregiver they can rely on, then alternative Issue 7 * 2014 * DIGITAL plans need to be arranged so that the patient will have a successful transition. Coordination of care, managing multidisciplinary teams, and achieving better transitions of care are the pillars of effective case management. We provide expertise and clarity to complex medical issues, including identifying obstacles to the delivery of prompt quality health care treatment and coordinating resources. We have come a long way in our educational endeavors but we have more work that needs to be accomplished. Please join us at CMSA in educating everyone we meet on the true health care reform that is case management! Sincerely, Kathleen Fraser, MSN, MHA, RN-BC, CCM, CCRN President, CMSA National Board of Directors, 2014-2016 Kathleen Fraser is the National President for CMSA 2014-2016 and a 3 time Past President of the Houston/Gulf Coast CMSA Chapter. Kathy has been a nurse for 36 years with 22 years in Case Management. She has a background in acute, ER and L&D hospital nursing experience. She began her Case Management in the acute and skilled setting then moved to Workers' Compensation 20 years ago. She can be reached at

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2014

President’s Letter
Association News
CMSA Corporate Partners
Understanding the Chronic Care Management Codes
Improving Care Coordination & Transitions Across the Continuum
Making an Impact on the Hill
Index of Advertisers

CMSA Today - Issue 7, 2014