Be an advocate for your patients

Don’t get saddled with extra duties

Whenever there’s something new that has to be done, there’s a tendency for administrators in many settings to assign the task to case management, often with the comment that "they’re already in the patient record."

And that often means that many case managers are so overworked and inundated with tasks that don’t require their level of skill that they don’t have time to do true case management, says Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.

"The largest number of case managers are nurses, and nurses have so many skills that they are called on to do more and more. And unfortunately, nurses, whether it’s their educational background, a cultural phenomenon, or because they are women, accept all the extra jobs they are given and never say no,’ even though they don’t have time to take on new jobs," she says.

Case managers often are asked to perform tasks that don’t require clinical expertise such as faxing, copying, and filing. "When they’re spending their time on paperwork and clerical tasks, case managers can’t spend time with patients and they aren’t going to get good results," says BK Kizziar, RNC, CCM, CLCP, a case management consultant based in Southlake, TX.

Many patients in the hospital are in crisis and cannot speak for themselves, adds Marcia Diane Ward, RN, CCM, PMP, a case management consultant based in Columbus, OH.

"They need somebody who knows the healthcare system to advocate for them. That’s what case managers must be doing, but they can’t do their job properly if they have too much on their plates. We need to get back to basics of case management and make sure people who are acting as case managers have been educated and trained to understand the collaborative role of case management," she says.

Standards of practice

Case managers have standards of practice that they should follow, and they don’t include being responsible for finance-oriented tasks such as utilization review, clerical tasks, or handling paperwork required by payers, Mullahy says. "Hospital case managers can’t walk in to a patient room with a Hospital Issued Notice of Non-Coverage (HINN) and tell patients their stay may not be covered by their insurance and then say that they are there to help," Mullahy says.

Case managers in the hospital setting can have a huge impact on readmission, lengths of stay, and transitions, but not if they are doing other things, Mullahy says.

Case managers in the insurance industry shouldn’t be treated as the claims police, Mullahy adds. "Ensuring cost-effective treatment does not mean simply finding the cheapest scenario. It means being a coordinator, a facilitator, an educator, and an advocate for patients," she says.

Now that hospital readmissions have become the focal point due to reimbursement penalties, case managers are being targeted as the ones responsible for preventing readmissions, Kizziar points out.

"That’s a role they should be taking, but we all need to keep in mind that a successful outcome is not just getting patients out the door. It’s providing the information clinicians or caregivers at the next level of care need to meet patient needs, and following up to make sure the services are in place," she says.

And that gets back to the case manager job description and eliminating all the tasks that don’t fall within the Case Management Standards of Practice, Kizziar says.

Case managers need to take the time to get to know their patients, their culture, their level of understanding, their financial situation, their support system, and their emotional status in order to develop a workable discharge plan, Kizziar says.

"You can’t find these things out by just reading the chart or doing a short assessment. And case managers can’t determine what a patient’s needs will be at the next level of care or the best way to engage a patient in following a treatment plan if they’re spending their time on other tasks that are not specific to their job description and practice standards of case management," Kizziar says.

Case managers are needed throughout the continuum to coordinate care, make sure nothing falls through the cracks, and hand patients off to their counterparts in other levels of care, Mullahy says. "If it’s not possible for one case manager to follow a patient through all settings, there should at least be one point person at every level of care who can take off where their counterpart left off," she says.

Case managers are going to have to be the agents for change and push back when new tasks are dumped on them, Mullahy says.

"We have only ourselves to blame if we are overworked if we don’t educate people on the role of case managers and push back when we are given tasks that are not part of the case management role and function," she says.

Mullahy advises case managers to look for champions in their organization who can speak up for case managers and the roles they should play in healthcare. "One person may not be able to change an organization’s outlook, but a team of people can," she says.

Instead of just asking for more staff, develop a pilot project that demonstrates the outcomes when complex patients have "real" case management, Mullahy says. n