CMSA Today - Issue 1, 2012 - (Page 16)

ACUTE CARE SERIES The Evolving Role An Introduction BY B. K. KIZZIAR, RN-BC, CCM, CLCP AND NANCY SKINNER, RN-BC, CCM of Care Coordination in an Acute Care Environment – C oordination of care through the health care continuum is both an undeniable responsibility and a recognized role of the case manager. Assisting the patient/family/caregiver to navigate complex systems of care can never be considered a simple task. Instead, it must be consistently viewed as an essential function of case management in every practice setting, including every acute care environment. But, it has not always been that role or that function that has guided our practice. In the 1980s, 1990s and, even, as we entered this new millennium, discharge planners and case managers generally focused on maximizing reimbursement and advancing the patient’s timely movement through the health care continuum. It was primarily a role designed to certify the medical necessity and appropriateness of the hospital stay based on intensity of services and severity of illness, CMSA TODAY with little consideration given to transitional processes. This first generation case management focused on throughput. Patients moved from door to door and episode of care to episode of care without a true champion to coordinate that care. And, without a champion, any effort to enhance care coordination was often disorganized and haphazard with patients shuffled from one post-acute environment or provider to another with little advocacy, no established transitional care plan and absolutely no idea that it should not be that way. Patient advocacy blended with fiscal responsibility was always the primary motivation and ultimate goal. Yet, not all acute care case managers received the financial support or education necessary to realize the initiatives integral to achieving that mission or accomplishing those goals. The targeted goal of affecting appropriate transitions of care was rarely an institutional priority. Individually, CMs endeavored to assist patients to be successful as they were discharged to the next level of care and the next provider of services. Unfortunately, the success of This article is PART 1 of a 3-PART SERIES. Subsequent articles will provide insight into the demanding and often unscripted role of the acute care case manager with significant focus on the delivery of care coordination services as the patient moves through and beyond an acute care experience. those attempts was inconsistent. The achievement of quality measures and desired outcomes varied from facility to facility, case manager to case manager and patient to patient. Success was tied more to “heads in the beds” than patient satisfaction. Accomplishments were generally related to a reduction in the denial of submitted claims. But, the days of reimbursement based on diagnosis, length of stay, and level of care are fading rapidly to be replaced with value-based payment systems. Hospitals will no longer achieve financial stability based solely on the quantity of care that is delivered or the number of interventions that are provided. Reimbursement will be tied to the quality of care, the advancement of patient safety through the health care 16 ISSUE 1 • 2012 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2012

Technology U se Transforming the System
President’s Letter
Case Managers and Telehealth – Avoiding Potential Liabilities
Information Technology Takes on “Meaningful Use” for Case Managers
Case Managers – The Biocomputers that Make the Biggest Difference
The Evolving Role of Care Coordination in an Acute Care Environment – An Introduction (Part 1 of 3)

CMSA Today - Issue 1, 2012