CMSA Today - Issue 7, 2016 - 25

Organization of Nurse Executives, 2016; CMSA, 2016; Emergency Nurses Association, 2016; National Association of Social Workers, 2013; U.S. Department of Veterans Affairs, 2015). From the scope of federal legislation, the Healthy Workplace Bill (HWB) has been introduced in 31 legislatures across 29 states and two territories, through the United States and Canada. The purpose of the HWB is to get employers to prevent bullying with universal policies and procedures that apply to all employees. In addition, the HWB will provide needed action and support for workforce members in "at will" situations and/or states (Healthy Workplace Bill, 2016). At will means an employer can terminate an employee at any time for any reason except an illegal one or for no reason without incurring legal liability. Likewise, an employee is free to leave a job for any or no reason with no adverse legal consequences (National Conference of State Legislatures, 2016). Table 2 provides a detailing of the HWB FAQs. A map showing the current landscape of bill action can be viewed at the Healthy Workplace Bill website, http://healthyworkplacebill.org/states/. CONSIDERATIONS FOR PROFESSIONAL CASE MANAGEMENT CMSA's revised Ethics Standard (2016) addresses workplace bullying through recognition of a new secondary obligation for all professional case managers: engagement in and maintenance of respectful relationships with coworkers, employers and other professionals. By virtue of their role, case managers intervene regularly with all involved stakeholders of the care process - the patient, his or her family caregiver plus other members of the support system, and the interprofessional team. Courtesy of technology, that interaction now spans the patient's entire personal health record across the continuum of care and may be in person or virtual. Professional communication and the aligned competency of engaging and establishing rapport have been elevated to critical levels of importance in assuring a successful case management process. Should case managers find themselves in a bullying situation, there are three significant steps to work through: * Step 1: Direct discussion between involved parties to confront the actual behavior * Step 2: Seek all available resolution routes through your employer * Step 3: Consider filing a complaint against the colleague with the requisite credentialing body While these situations are never easy to maneuver, using a gradient action plan assures a higher level of support, if not success in managing the disruptive behaviors and those engaging in them. End of Life/Death with Dignity Managing patients living with chronic and/ or terminal illnesses is not new to professional case management. However, what has dramatically changed in recent years is the amount of attention given to assuring that high-quality, cost-effective care is rendered at the end of life. Major challenges are impeding this effort, incorporating growing numbers of older adults, barriers in access to care for certain populations, the expanding cultural diversity of society and a fragmented healthcare systems (IOM, 2015). Add the intense media attention focusing on advocacy by patients and families striving to seize control of the dying process, with heightened attention to the passage of state and national legislation (Fink-Samnick, 2016b). End of life, or Death with Dignity as it is often referred, is front and center as a national priority. DATA AND DEMOGRAPHICS Patients with chronic illness in their last two years of life account for approximately 32 percent of total Medicare spending, with a majority of the dollars going toward physician and hospital fees associated with repeated hospitalizations (The Dartmouth Atlas of Health Care, 2016). More than 25 percent of older adults have given little thought to how they want their life to end, most postponing the decision, or deferring it to their physician (IOM, 2015). While many patients indicate a preference to die at home, more than 55 percent died in the hospital (The Dartmouth Atlas of Health Care, 2016). The numbers for pediatric populations are relatively consistent with those for adults (The Worldwide Palliative Care Alliance and the World Health Organization, 2014). The programming and services to meet the needs of these patients is far from optimal. Even the rapid expansion of palliative care services to address pain control and symptom relief is not as widely utilized as expected (Armour, 2014). Reports show alarming gaps in service access for millions of persons in the United States, whether at home or in the hospital setting. Despite steady growth of hospitalbased palliative care programs, and universal access in large U.S. hospitals and academic medical centers, access to palliative care is uneven (Dumanovsky, et al., 2015). The year 2016 ushered in a number of reimbursement changes for Medicare, for which third-party payers followed suit. It began with new CPT codes in the 2016 Medicare Physician Fee Schedule, reimbursing $86 to discuss end-of-life care in an office visit or the hospital. It would not surprise many case managers to know that in a recent poll of 736 primary care doctors and specialists, only 14 percent actually billed Medicare for those visits. While over 75 percent accepted responsibility to initiate end-of-life discussions, less than 50 percent detailed any formal training on how to engage in these dialogues (Ostrov, 2016). On the hospice front, there have been several major reimbursement changes. One enhancement was the development of a two-tiered per diem payment for hospice care (higher in the first 60 days and lower thereafter). This payment model replaced the per diem model used by Medicare since the start of the hospice benefit. A retrospective Service Intensity Add-on payment was also included to adjust for increased acuity during the final week of a patient's life (Taylor, et al., 2015). There are 141 hospices actively involved in the Medicare Care Choices Model demonstration project. The goal of this effort is to provide end-of-life care and counseling to those patient who are dying, while at the same time receiving treatment to extend their lives. This is an innovative approach that industry experts view as long in coming. The model is being phased in across facilities in two-year increments, over a total of four years, ending on Dec. 21, 2020. One-half of the facilities began back on Jan. 1, 2016, with the Issue 7 * 2016 * DIGITAL CMSA TODAY 25 http://www.healthyworkplacebill.org/states/

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Are You Culturally Competent?
Return to Culture – Return to Healing
Appalachian Culture: A Guide for Case Managers
Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
Diversity of Role Reversal: When the Case Manager Becomes the Patient
INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover1
CMSA Today - Issue 7, 2016 - cover2
CMSA Today - Issue 7, 2016 - 3
CMSA Today - Issue 7, 2016 - 4
CMSA Today - Issue 7, 2016 - 5
CMSA Today - Issue 7, 2016 - PRESIDENT’S LETTER
CMSA Today - Issue 7, 2016 - 7
CMSA Today - Issue 7, 2016 - 8
CMSA Today - Issue 7, 2016 - 9
CMSA Today - Issue 7, 2016 - ASSOCIATION NEWS
CMSA Today - Issue 7, 2016 - 11
CMSA Today - Issue 7, 2016 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 7, 2016 - 13
CMSA Today - Issue 7, 2016 - Are You Culturally Competent?
CMSA Today - Issue 7, 2016 - 15
CMSA Today - Issue 7, 2016 - Return to Culture – Return to Healing
CMSA Today - Issue 7, 2016 - 17
CMSA Today - Issue 7, 2016 - 18
CMSA Today - Issue 7, 2016 - 19
CMSA Today - Issue 7, 2016 - Appalachian Culture: A Guide for Case Managers
CMSA Today - Issue 7, 2016 - 21
CMSA Today - Issue 7, 2016 - 22
CMSA Today - Issue 7, 2016 - Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
CMSA Today - Issue 7, 2016 - 24
CMSA Today - Issue 7, 2016 - 25
CMSA Today - Issue 7, 2016 - 26
CMSA Today - Issue 7, 2016 - 27
CMSA Today - Issue 7, 2016 - Diversity of Role Reversal: When the Case Manager Becomes the Patient
CMSA Today - Issue 7, 2016 - 29
CMSA Today - Issue 7, 2016 - 30
CMSA Today - Issue 7, 2016 - 31
CMSA Today - Issue 7, 2016 - 32
CMSA Today - Issue 7, 2016 - 33
CMSA Today - Issue 7, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover3
CMSA Today - Issue 7, 2016 - cover4
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