CMSA Today - Issue 2, 2012 - (Page 23)

CMSA Ethics Casebook If You Don’t Have a Case Management Plan, Are You Doing Case Management? BY JOHN BANJA, PH.D. L ast year, I participated on a panel at the CMSA annual conference in San Antonio on the “essential” case manager. The gist of our presentations focused on the essential or necessary features that distinguish case management from other health care disciplines. Naturally, our discussion got into the tried and true case management job description which, as if readers of this column need reminding, is that case management is “a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs.” A lively discussion ensued at our panel when a very distinguished case manager said that in order to call yourself a case manager, you not only have to perform all of these functions but that you have to perform them across the continuum of care, not just at some moment in the care process. A few minutes later, someone from the audience shot back, “Well, I only do discharge planning. Am I therefore not a case manager?” I won’t go into the back and forth that followed, except to say that these kinds of conversations are virtually inevitable in the evolution of any important practice profession. However, what happens when a case manager does virtually none of these tasks? I recently came upon such an instance, when I was asked to consult on a workers’ compensation case by the injured worker’s attorney. The injured worker (IJ) contended that the case manager and the program she represented entirely failed him. As I studied the relevant documents, what struck and somewhat depressed me was that the case manager hardly seemed to do anything resembling case management functions – or so it seemed to me as well as to the other, very experienced case manager the injured worker’s attorney hired. What the case manager largely did was gather and transmit medical information to the appropriate parties; she provided billing information to the treating specialists; she advised the IJ to see his treating specialists as scheduled; and she monitored the IJ’s visits but never spoke to any of his physicians. Her primary concern appeared to be the IJ’s returning to work on the day one of his physician stipulated. But other than directing the flow of various documents and having a few perfunctory conversations with the IJ, it appeared she didn’t do anything of a substantive, case management nature that would move the IJ toward that goal. What I felt was entirely missing was the semblance of a case management plan. She left it up to the IJ to choose his treating specialists and inform them of his progress. She didn’t seem to make any attempt to coordinate thoughtful communication among team members. There was no formal assessment of progress; no contingency plan if things didn’t develop as hoped; no evaluation of how things were proceeding in light of the return to work date; and little coordination of anything, except for ensuring that the correct documentation went to the right people. Continued on page 28 CMSA TODAY 23 ISSUE 2 • 2012 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 2, 2012

2012 Public Policy Summit, April 23-24
Aligning Professional Ethics with Innovation: Licensure Portability’s Predicament
Can You Hear Us Now? What’s Happening with the Multi State Licensure Task Force
The Evolving Role of Care Coordination in an Acute Care Environment: Confi rming the Appropriate Utilization of Necessary Services – Separating Tasks from Process (Part 2 of 3)

CMSA Today - Issue 2, 2012