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BEST IN CLASS
CASE MANAGEMENT NEWSLETTER
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"A
Timely E-News Bulletin for
Aspiring
Case Managers
Winter 2011
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"Best in Class Case Management: Not Just a Phrase"
By
Catherine M. Mullahy, RN, BS, CRRN, CCM
Have you notice how many things
are "Best in Class" today? It's become the catchall
phrase for so many service providers, which is exactly the problem. For
too many, it's a simply a phrase. Even within the case management
profession, the lines between what is "Best in Class" case
management and what is not have become very blurry. It is critical that
within our profession, we all know exactly what "Best in Class"
represents. More importantly, we need to practice true "Best in
Class" case management.
 Let's
start with what "Best in Class" case management is not.
It is not: an environment that doesn't recognize the value of case
management and support its optimal functioning. For instance, "Best
in Class" case management could not exist in a setting where
effective case management software programs were nonexistent, nor where
case managers spent more time attending to claims appeals and denials or
medical record coding and documentation than to patient care."Best
in Class" case management also is not case management that does not
encourage ongoing continuing education, professional development and
training. And, "Best in Class" case management is not case
management that is provided in a less than optimal patient setting - for
example - a patient's home instead of a continuation of a hospital or
healthcare facility stay interrupted because of errant cost
considerations.
"Best
in Class" case management is case management provided from
professionals who have the full support of their organization's C-level
executives, from the CEO and CFO to the COO and CIO. That support is
evident in the form of information technologies that streamline and
facilitate optimal case management administration. It presents itself in
the form of sufficient staffing - both in terms of number of case
managers and their levels of experience for best managing the current
case load. It is conveyed in the offering of regularly-scheduled
education and training programs that build better skills, reinforce basic
"Best in Class" skills and keep the passion alive in case
managers.
"Best
in Class" case management also is evident where case managers have a
real voice - when their recommendations relating to patient care,
discharge (or more appropriately, "transfer with continuous
management"), etc. are taken seriously and afforded the respect and
credence they warrant. Without case managers having a voice in the
process, "Best in Class" case management can never exist.
Finally,
case managers invest and risk a lot in their professional role. Their
higher education, professional licenses and credentials require
investments in time, finances and effort to learn and master many vital
subjects. They also assume legal and ethical responsibilities on behalf
of their patients, yet these duties are often ignored and certainly
subjugated in many cases, neither of which enables "Best in
Class" case management to exist. That has to change and case
managers must assume some of the responsibility for making change happen
and "Best in Class" case management go from being a popular
phrase to an accepted norm.
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 This just in:
Mullahy & Associates, LLC "Best in Class Case
Management"
Programs named Finalist
in Case in Point Platinum Awards. The Platinum Awards Recognize case management
excellence across the health care spectrum. To learn more,
click on the starburst.
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On
the Speakers' Circuit
Keynotes,
Meetings & Seminars
Upcoming Events
Mullahy & Associates'
President and Executive Vice President Catherine M. Mullahy, RN, BS,
CRRN, CCM and Jeanne H. Boling, RN, MSN, CCM, respectively will be
providing their popular "Best in Class Case
Management: Introduction to a Leading Edge Practice" and "Managing Case Management" seminars in upcoming Gannett Education programs. The
two-day, 14-contact hour "Best in Class Case
Management: Introduction to a Leading Edge Practice" seminar is being offered on the following dates and
locations:
March 14 -15th, Trump
Taj Majal, Atlantic City, NJ
April 4-5th, Harrah's,
Las Vegas, NV
July 18-19th, Pace
University, New York, NY November 3rd-4th;
Gannett Headquarters, McLean, VA.
Each program will start at 7:30
AM. The early bird rate is $449 (available up to 21 days before the
event) and the regular rate is $499. The seminar will guide attendees
of preparation for the CCM exam, teach them how to apply the process of
case management to actual cases, facilitate expanded career
opportunities and income, and earn them a copy of Mullahy's The Case Manager's Handbook,
Fourth Edition; an $82.95 value, which includes textbook and CD.
The "Managing Case
Management" seminar
is a one-day, 7-contact hour program being offered on July 20th
at Pace University, New York, NY. It will provide attendees with basic
management direction for hiring, mentoring, evaluating personnel, and
creating a department with credible outcomes, savvy business direction
and personal care management to patients. The early bird rate for this
program is $274 (available up to 21 days before the event) and the
regular rate is $299. To register: Call (800) 866-0919, email: ce@gannetthg.com or visit: www.nurse.com/events-Catherine
M. Mullahy, RN, BS, CRRN, CCM CMSA will be a keynote speaker at the CMSA's 21st Annual
Conference & Expo, June 14-17th, at the Henry B. Gonzalez
Convention Center in San Antonio, TX. Her topic will be: "Recommitting the Caring Heart of
the Case Manager for Better Patient Care and Advocacy." She will also be conducting
pre-conference workshop on Monday, June 13th from 8 am - 5
pm, titled, "Becoming
a Manager in Case Management - Gaining the Inside Track." Complete details on the
conference, these and other programs, visit: www.cmsa.org/conference/tabid/570/default.aspx Your complete
details on these seminars and to register online, visit:
www.nurse.com/eventsce@gannetthg.com
or call 800.866.0919 or email ce@gannetthg.com
For more information about
Mullahy & Associates and its complete line of educational
offerings, visit: www.mullahyassociates.com
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Did You Know... ?
One of the biggest challenges facing healthcare
providers today is curbing the high patient readmission rate.
The problem of patient
readmission is costing our nation a high price, both in lives and
dollars. Based on data from the Centers for Medicare & Medicaid
Services which started publicly reporting hospital readmission rates in
July 2009, 19.6% of Medicare beneficiaries were readmitted within 30
days of hospital discharge. The cost of readmissions nationwide is estimated
to be approximately $17.4 billion per year. Sadly, part of the problem
is that hospitals are actually rewarded for readmission and discouraged
from implementing sound case management and follow-up care coordination
for discharged patients. This problem has not gone unnoticed our
nation's legislators.
The proposed healthcare reform
legislation (i.e., "Patient Protection and Affordable Care
Act") has introduced a significant penalty for providers that do
not contain readmission - a reduction in Medicare payments. Case
management factors heavily in reducing readmissions which tend to
affect patients in certain categories more such as those
discharged post surgically, and/or those with congestive heart failure,
chronic obstructive pulmonary disease, and various cardiac conditions.
Throughout the field of nursing
and case management, professionals are advocating for specific patient
transition and case management programs to get control of the
increasing number of patients discharged from U.S. hospitals only to
return within 30 days. Structuring an effective care transition program
in which case, disease and utilization management are centrally
involved is paramount to controlling readmissions and the associated
losses...most notably, human lives.
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Thank you for your continued interest in Mullahy &
Associates. We value your feedback and look forward to bringing
innovative solutions to the case management community. We
sincerely appreciate your friendship and business and wish you the very
best for the remainder of the winter!
Happy
St. Patricks Day!
Catherine
M. Mullahy & Jeannie Boling
Mullahy
& Associates, LLC
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Best in Class Practice
Tips
"Support CMSA's Position on SSAP 85"
By
Jeanne H. Boling, RN, MSN, CCM
As we
all know, healthcare reform is at the center of a national debate. The
pro-Obama healthcare constituents feel there are more positive aspects
than negative in the legislation. The opposing side believes the
proposed "Patient Protection and  Affordable
Care Act" does not address the real problems with healthcare in
America and will result in more harm than good. Whichever side you are
on, legislative issues should be of concern to case managers. Right
now, in addition to healthcare reform, there are other regulatory
issues which will affect the role of case managers. One in particular
has the Case Management Society of America (CMSA) particularly adamant.
It relates to the classification of health plan expenses; in
particular, the calculation of the Medical Loss Ratio. At issue is how
case management, disease management and care coordination services are
classified.
Currently,
under the National Association of Insurance Commissioners' (NAIC)
Statement of Statutory Accounting Principles (SSAP) 85, case management
and disease management programs are identified as "cost
containment expenses" which are further defined by NAIC as
"expenses that actually serve to reduce the number of health
services provided or the cost of such services." With respect to
calculating a health plan's Medical Loss Ratio, the NAIC direct these
expenses to be allocated as "administrative expenses.
At
Mullahy & Associates, we support the CMSA's positions that case
management and disease management services should not be classified as "cost
containment expenses" nor "administrative expenses." We
agree that the NAIC should classify these programs as either
"medical expenses" or "quality improvement
expenses" which recognize the role of case management programs in
improving a patient's health and well-being and effectively management
their condition. This position stems from our belief that case
management and, in particular, "Best in Class" case
management which all case managers should aspire to provide, relies on
the case manager's performance of critical functions relating to
patient assessment, treatment planning, advocacy and collaboration with
other healthcare professionals. As such, case management and disease
management programs are critical components in the provision of physician-guided,
evidence-based clinical care. To category these programs as being of a
cost-containment or administrative nature is both short-sighted and
dangerous in that it further places the emphasis not on care, but on
costs - an orientation which has done nothing to improve America and
everything to continuing drive costs up.
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What's New at
Mullahy & Associates?
"Catherine M.
Mullahy, RN, BS, CRRN, CCM and Jeanne H. Boling, RN, MSN, CCM Named
Official Instructors for the Professional Patient Advocate Institute"
All of
us in the case management profession recognize the importance of
patient advocacy. Now, there is a new member organization dedicated to
providing advocacy for consumers relating to their healthcare needs -
the Professional Patient Advocate Institute (www.patientadvocatetraining.com).
The
institute is providing a wide range of services to assist professionals
in this role. Among the Institute's services are a Certificate in
Professional Patient Advocacy Program, premium educational content, and
toolkit and resource center.
Serving as official instructors for the Institute
are Mullahy & Associates principals, Catherine M. Mullahy, RN, BS,
CRRN, CCM and Jeanne H. Boling, RN, MSN, CCM. In a recent workshop
titled, "The Professional Patient Advocate," Mullahy and
Boling present an overview of the challenges and resources required of
Professional Patient Advocates when interacting with patients and their
families. They also presented a webinar on "Legal and Risk
Management Issues." Due to high demand, the workshop will be
repeated again on March 7th in Las Vegas, NV. Other upcoming
Institute programs include a "Care Coordination Summit" on
March 8th and a webinar on "Ethical Issues in
Professional Patient Advocacy" on March 22nd.
Complete details on upcoming events and training programs can be found
at: www.patientadvocatetraining.com/event_details.aspFor
more information on the Professional Patient Advocate Institute; its
mission, membership and services, visit: www.patientadvocatetraining.com
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Autographed
Copies Available!
The Case Manager's Handbook, Fourth Edition
authored
by
Catherine
M. Mullahy, RN, BS, CRRN, CCM
The
Case Manager's Handbook, Fourth Edition
Catherine Mullahy, RN, BS, CRRN, CCM
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