On-the-job training won’t cut it any more, experts say
New CMs need formal education, mentoring
Once upon a time, new case managers received their training and orientation as they rotated through the case management department. One day they were nurses on the unit or case managers at a different hospital, and the next day, after a short orientation session, they were case managers on the unit, sometimes with a full case load.
That’s still the case in some hospitals, says Peggy Rossi, BSN, MPA, CCM, a retired hospital case management director who now is a consultant for the Center for Case Management.
“As I work with hospitals to develop case management training, I’m finding that many have no orientation and that new case managers are assigned to several different preceptors for on-the-job training, often without consistency in their orientation. If the preceptor is doing something the wrong way, the case manager does the same thing,” Rossi says.
Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm, encounters the same situation when she presents case manager training seminars. “I continue to hear from people both certified and not that they never received any formal training in the process of case management. Case management is so important and case managers bring such value to the hospital, saving money and increasing patient satisfaction scores. I don’t understand why hospital administrators fail to recognize the value of formal education to give case managers the knowledge and the tools to do their job,” Mullahy says.
Compliance requirements are so comprehensive and change so often that new case managers need extensive training, adds Beverly Cunningham, RN, MS, vice president of resource management at Medical City Dallas Hospital.
In addition to being responsible for care coordination, utilization management, patient status and discharge planning, in many hospitals case managers may be responsible for documentation improvement and core measures. “I don’t think case managers should be the owners of financial incentives and quality care, but care coordination and collaboration with providers inside and outside the hospital do affect the hospital’s bottom line and case managers need to have a clear understanding of compliance and the goals of the department as well as what case managers do on a day-to-day basis,” she says.
(For a look at changes that may affect case managers that the Centers for Medicare & Medicaid Services includes in its Prospective Payment System Proposed Rule for fiscal 2014.)
“The role of case management is so complex. They have to deal with so many regulations and do so much multitasking that training is critical. Hospitals are so fast-paced that training can’t cover everything, but it can give new case managers a good foundation on which to build,” says Susan M. Almes, RN, BS, ACM, a former case manager, now a training specialist for UPMC, an integrated health system with headquarters in Pittsburgh. At UPMC, new case managers spend one to four weeks on the floor of the hospital to which they are assigned, then attend eight days of classroom training, and spend another six weeks with a preceptor before being on their own.
It’s not sufficient to hire people, provide a week of orientation, hand them a manual, and assign them to a unit, Mullahy says. “New case managers can read books or take online courses, but until they experience working with families with problems, coordinating care for people with mental health issues, or collaborating with physicians, they can’t know what the job is really like,” she says.
Orientation and training depend on the people receiving the training, their experience and their knowledge base, Cunningham says. Nurses from your hospital don’t have to learn the system, but they do need to learn the fundamentals of case management. People with case management experience need to learn your hospital’s system, the responsibilities of case managers at your particular hospital, and how the department works.
Case management training should be a minimum of four to six weeks, even for staff who have had case management experience at other hospitals, Rossi suggests. “New case managers need to know everything the job entails and be acclimated to the hospital, its philosophy, vision, and mission statement,” she says.
Case managers need to be familiar with Medicare and Medicaid, their admission and documentation requirements, continuing stay criteria, and what they cover, Rossi says. “Medicare is the grandfather of utilization, and staff need to be mindful that whatever the federal government requires, state agencies and commercial insurers will follow suit,” she says.
Rossi suggests that, as part of their training, new case managers visit a local skilled nursing facility and follow a home health nurse to learn what care is provided in that setting. In addition, it is important for case managers to learn state code requirements as they pertain to post-acute providers so they can make the right discharge destination choices, she says. For instance, she points out that in California, skilled nursing facilities are required to provide only 3.2 hours of skilled nursing care a day. “If patients need more care, they’re going to bounce back to the hospital,” she says.
New case managers need to be able to pass competencies on hospital policies and procedures, and case managers should be able to demonstrate what they have learned before going out on their own, Rossi says. For instance, have case managers discuss when a Condition Code 44 is appropriate and demonstrate what should be done. If they get part of it wrong, repeat the lesson.
Once case managers are assigned to a unit, the orientation should include in-depth information that is specific to that unit. For instance, if the case manager sometimes will be managing the care and discharge of homeless people, the training should include information on community resources.
Cunningham suggests that case managers identify on an individual basis what they want their staff to learn and meet at the end of each week with the new case manager and the person doing the orientation. During the meeting, they should go over the goals for the past week and set new goals. “Some people will breeze through the orientation, but others may take longer. It works best to address the deficits on a weekly basis rather than waiting until the end of the orientation to find out how well it went,” Cunningham says.
The weekly meetings are time well spent for a leader and satisfying for the new staff member, Cunningham says. “This way everyone is on the same page and we all know exactly where we are. If nobody gives feedback, you may assume everything is going smoothly and that could create a lot of problems in the future,” she says.
Sources
• Susan M. Almes, RN, BS, ACM, training specialist, UPMC, Pittsburgh, PA. email: [email protected].
• Beverly Cunningham, RN, MS, Vice President, Resource Management, Medical City Dallas Hospital. email: [email protected].
• Catherine M. Mullahy, RN, BS, CRRN, CCM, President and Founder of Mullahy and Associates, Huntington, NY. email: [email protected].
• Peggy Rossi, BSN, MPA, CCM, Consultant for the Center for Case Management. email: [email protected].
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