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Visit us at the 2010 NICM/ACMA National Conference

San Antonio is also home to the Alamo

If you are planning to attend the 2010 NICM/ACMA National Conference in San Antonio next week, please stop by the HCPro booth and say hello.

I will be there putting faces to names and covering the sessions for the Case Management Monthly newsletter. We will have several of our case managmement books as well as products from the Association of Clinical Documentation Improvement Specialists at the booth. Be sure to drop your business card into our fishbowl for a chance to win an Amazon Kindle!

For those of you who are not attending, I will keep you up to speed with the goings-on, right here, on Case Management Mentor.

I am looking forward to hearing your Important Message from Medicare concerns at the special forum April 10 from 7:00-7:45 a.m. What sessions are you looking forward to?

Addressing mental health issues improves patients’ physical health

Only five percent of the patient population is complex, yet they account for more than half of healthcare costs, according to Cartesian Solutions, Inc.™. Of that five percent, two-thirds have concurrent mental and physical health issues.

Poor communication between physicians who treat physical issues and providers who treat mental problems can cause complex patients to consume more resources. The lack of communication is due to the reimbursement model; it pays for physical treatments and mental treatments separately

Before the advent of managed care, physicians managed a patient’s physical and mental health problems. Some physicians owned treatment centers for the treatment of alcoholism, eating disorders, and other behavioral health issues, says Rebecca Perez, RN, CCM, CPUM, president and owner of Carative Health Solutions. However, payers realized that those resources were abused and have separated physical and mental health reimbursement, thereby limiting access to mental health treatment.

Limited access has caused a segment of the patient population to remain untreated, potentially causing them to seek more physical health treatment, thereby consuming more resources.

Perez is part of a growing movement addressing that issue by striving for a more integrated care management model that assesses patients’ physical and mental health issues simultaneously.

“The thinking is coming full circle again where we need to treat the patient as a full person and not a disease,” says Perez.

Perez and Roger G. Kathol, MD, CPE, president of Cartesian Solutions, Inc.™,  train case managers to assess a patient’s mental health as part of their interaction with that patient. This enables case managers to ensure the patient’s plan of care includes services that address the patient’s behavioral and psychological needs.

Recognizing how patients’ mental health can contribute to their physical health will go a long way in preventing readmissions, improving patient satisfaction, and enhancing overall quality of care.

Case Management Monthly will cover this topic in more detail in the April issue.

What do hospital case managers do, anyway?

This is a question frequently asked by patients, family members, physicians, and other members of the medical staff.

Many people think that case managers are discharge planners, and that the only time a patient needs a case manager is when he or she has discharge needs. Case management is much more than that. It is important that we make sure that, not only do patients and families know what case management is, but that the nursing staff members know also.

Case managers work in forces behind the scenes, much like the crowd of people in the Verizon commercials. Case management is a hidden resource for patients. Often, the case managers work in the trenches, with their heads in charts, communicating with an interdisciplinary team of healthcare professionals to make sure that the patient is moving smoothly through the continuum of care, and there are no delays or detours in their care. This is usually an unknown aspect of case management.

Hospital personnel and the public need to be aware that case managers are advocates for all patients; they ensure that their healthcare facility and professionals are doing what is truly right for the patient, in the right setting, receiving the most appropriate care, and in the most cost-effective manner. Case management follows the patient’s plan of care to make sure that it is appropriate and timely, that their hospital admission status is appropriate, that their discharge planning is initiated, and that goals are set to meet the discharge plan. It is imperative that the case manager build a relationship with the patient and their families in order to reach a mutual goal of discharge.

It is also important for the bedside nurses to know that case managers are an excellent resource for them in planning the patients’ care and goals. One thing I did at our institution while we were redesigning our case management model was to do a mandatory in-service to nursing staff on how case management affects not only patient outcomes, but the financial outcomes for hospitals.

At our institution this year, we included a station on case management and interdisciplinary rounds at the nursing annual competency testing. Case management had a display booth with information about what case management is and the importance of interdisciplinary rounds. We also had a test for the nurses to complete. The comments we received from staff were very interesting.

Does your institution do anything like this? Are you confident that nursing staff members truly understand what case management is?

And one more important question: Do your physicians really know what case management is?

Time-saving strategies for hospital case managers!

The job of a hospital case manager is complex, to say the least. Between keeping up with regulatory changes, ensuring proper clinical documentation, planning for appropriate discharge, and making sure patients receive adequate care while your facility maintains fiscal integrity, it can be difficult to juggle all that needs to be done.

In an upcoming issue of Case Management Monthly, we’d like to feature the top ten time-saving tips for hospital case managers from you, our readers. Help your fellow hospital case management professionals beat the stress of their job and optimize their time by sharing your best time-saving strategies. Send your tips to Managing Editor Janelle Randazza; all selected entrants will be featured in the June 2009 issue of Case Management Monthly and will receive a free copy of the issue.