Reform puts case management in spotlight
Lawmakers affirm the value of care coordination
All that hard work educating lawmakers, providers, and the public about the value of case management is paying off. This year, the Case Management Society of America (CMSA) has been invited to give input into the health care reform bills under consideration by Congress, the new president of CMSA, Margaret Leonard, MS, RN-BC, says.
"We have been offered several opportunities to move case management into an arena we've never been in before. We have been invited to the table to talk with lawmakers and representatives from the Centers for Medicare & Medicaid Services [CMS] about some of the health care bills being presented to the president," adds Leonard, who is senior vice president for clinical services at Hudson Health Plan in Tarrytown, NY.
All of the bills that have been introduced include the concept of care coordination as a quality standard for health care, Leonard adds.
"Case management is in a very special place. This is our year, our big shot. Everybody who is putting together these bills wants our opinion. The stars are aligned for a terrific year for case management," she says.
Much of the success has been due to the work of CMSA's public policy committee, which has sought to make lawmakers on the local, state, and national level aware of the benefits of case management, Leonard says.
"We've gotten into the legislative game. We are working with partners who have political action arms, and they have been very generous in letting us take advantage of their knowledge and their connections at the Centers for Medicare & Medicaid Services and the Office of Budget and Management," she says.
In addition, CMSA's leadership in convening the National Transition of Care Coalition brought recognition to the organization for bringing together 30 of the biggest players in the health care arena to develop ways to transition patients safely, she adds.
All of the health care reform proposals being discussed in Washington offer opportunities for case managers because they all recognize the importance of care coordination, Leonard points out.
"Care coordination can only help save health care funds. When case managers in the hospital setting coordinate care, they help prevent falls, decubitus ulcers, or other problems that should not occur. Good discharge planning and follow-up helps keep patients healthy after discharge and prevents readmissions," she says.
After discharge, patients need someone to help them understand and navigate the health care system, she adds.
"Even on a good day, it's hard to understand everything about your treatment plan or newly diagnosed disease, whether you're in the hospital or a physician's office. When people feel bad on top of that or are anxious about an uncomfortable test or procedure, all that stress prevents them from taking in the information they need to know about taking care of themselves at home," she says.
Leonard says that often when telephonic case managers call patients after discharge, the patients say they don't remember getting discharge instructions; when prompted, they do remember getting a pink or yellow sheet of paper but say they've never looked at it.
"The nurse in the hospital may have spent half an hour telling them about their discharge plan, but they weren't ready to hear it. After discharge, when they don't have a call button handy and the questions start to arise, someone needs to make sure they understand what they're supposed to do and how to take their medicine. They need to have someone to call with questions and concerns, and that's where case managers come in," she says.
In addition to providing input on health care reform proposals, CMSA has been asked to provide language for a model case management law. The case management model law includes the proposed new case management standards of practice, which includes a list of criteria that must be met before someone can call him or herself a case manager.
The new standards of practice were introduced at the CMSA national conference in June and went out for public comment this summer, Leonard adds.
"However, case management is not going to be included in health care reform just because we've written a model unless we're all out there lobbying for it," she adds.
Teri Trieger, RN-C, MA, CCM, CCP, CMSA president elect, and Carol Gleason, MM, RN, CRRN, CCM, LRC, former board member, are developing a strategic plan for a grassroots initiative to make case management a vital part of whatever health care reform legislation is passed.
"We think this is an opportunity we won't see again for many years. We hope that if any of the proposed bills get passed as part of health care reform, some of the language in our model case management law and our definition of case management will be included," Leonard says.
Leonard urges case managers to visit their senators and representatives to educate them about case management and the National Transitions of Care Coalition. If they can't visit in person, Leonard urges them to make a phone call and talk to their legislators about the benefits of case management.
The CMSA web site contains talking points and information sheets as well as a grassroots handbook that case managers can read to familiarize themselves with the legislative process, how to contact and talk to their lawmaker representatives, and issues that affect case management.
In addition to promoting case management in health care reform, Leonard's agenda for her year as president includes continuing the effort to get CMS to develop a mechanism to reimburse for case management services.
"We've been working for the past 18 months to get CMS to approve CPT codes for certain case management services. After meeting with high-ranking government officials, it's become apparent that CPT coding may not be the right route to take," she says.
All of the health care reform bills being proposed say that case management services are reimbursable, Leonard adds.
"We want the language to incorporate the standards of care and list what services are considered case management services and what the criteria must be for a person to be a case manager," she says.
Leonard says the organization will continue its grassroots effort to push for multi-state licensure for nurses.
Currently, when nurses provide case management services telephonically to patients in another state, they are violating the law unless they also hold a license in that state. Some companies purchase licenses for case managers in all of the states in which they have members, but others choose to ignore the law, Leonard says.
Not being licensed in states where they talk to members may put case managers at risk for financial penalties, loss of licensure, or up to a year in jail, depending on the laws in that state.
"This issue is of major importance to case managers, since many of us work with clients in other states. We are trying to get multi-state licensure enacted in all 50 states. The 24th state passed the measure in July, which was a big milestone for us," she says.
All that hard work educating lawmakers, providers, and the public about the value of case management is paying off.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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