2 minute read
Legal Update II
Elizabeth Hogue, Esq.
The Case Management Society of America (CMSA) published Standards of Practice for Case Management (SOPs) in 1995 and revised them most recently in 2016. Key provisions of the SoPs include: • Identification and selection of patients who can most benefit from case management services • Completion of health, cognitive, and social assessments • Identification of problems or opportunities that would benefit from case management interventions • Collaboration with clients and stakeholders to develop individualized plans • Facilitation, coordination, monitoring, and advocacy to minimize fragmentation in services provided and prevent risks of unsafe care and suboptimal outcomes • Ongoing monitoring to measure patients’ responses • Demonstration of the benefits of case management services
CMSA recently published “The Practice of Hospital Case Management: A White Paper” to provide more details about the provision of case management services in hospitals. Both case managers and post-acute providers need to know about this White Paper because it provides information about what both should be focused on in terms of working together.
The White Paper places emphasis on coordination of care as the future of case management services in hospitals, as follows:
“A new value-based marketplace calls for a new vision of case management that eschews tasks and instead focuses on activities that promote a safe, coordinated journey across the continuum for the most vulnerable patients. Ticking off prescribed
checkboxes is replaced by thoughtful engagement and purposeful planning by individual case managers based on the needs of their patients. Indeed, it could be argued that the generic principle of case management is to ensure coordination of a patient’s case through the assignment of a case manager. Creating a vision of that coordinated journey is a practical approach that will serve as the impetus to align future initiatives, inspire participation and generate new ideas…”
The White Paper goes on to define coordination as: “a deliberate and longitudinal organization of safe, efficient and appropriate care and services for selected patients with multiple needs as they move through the case continuum from acute care to community settings…”
Specifically, both case managers and post-acute providers must focus on care that is: • Safe • Effective • Timely • Patient-centered • Efficient • Equitable
Based upon the above, case managers must become care coordinators in partnership with post-acute providers.
According to the White Paper, the overarching responsibility of case managers as care coordinators is advocacy on behalf of patients. Although the authors of the White Paper acknowledge the difficulties of advocacy on behalf of patients in hospitals, both the White Paper and the SOPs described above emphasize that this obligation of case managers remains paramount.
This new guidance from CMSA makes it clear that hospital case managers must retool into care coordinators. Partnerships between hospital case managers and post-acute providers are essential to accomplish this transition. Post-acute providers must “step up to the plate” to work with hospital case managers to achieve this goal. CM
Elizabeth Hogue, Esquire, is an attorney who represents health care providers. She has published 11 books, hundreds of articles, and has spoken at conferences all over the country.
©2021 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.
