Happy Case Management Week 2019
National Case Management Week for 2019 is October 13th – 19th. The American Case Management Association (ACMA) and the Case Management Society of America (CMSA) both recognize this week as an opportunity to spotlight the great things about case managers and the case management industry.
American Case Management Association (ACMA)
This year’s ACMA theme is Case Management: Setting New Standards for Care. This theme was selected “to emphasize the impact professionals in case management make every day.”
In a prepared Press Release by the ACMA they advocate this week as “an opportunity to recognize the dedication, compassion and quality of patient care outcomes achieved by case managers across the health care continuum.” MMP couldn’t agree more and wishes all the Case Managers that we have the privilege to work with a Happy Case Management Week.
Case Management Society of America (CMSA)
This year’s CMSA theme is Transitioning Patients and Case Managers to Greatness. This theme reflects the CMSA definition of case management as being “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote safety, quality of care, and cost effective outcomes.”
The CMSA theme is also very timely as CMS has recently published the Discharge Planning Conditions of Participation Final Rule. You can read more about what was finalized in a related MMP article. As hospitals wait for the promised sub-regulatory guidance, here is a list of actions, considerations, and questions to answer as you work towards compliance with the new requirements by the November 29, 2019 effective date.
- Action: Pull a Team Together
- A Key Stakeholder should read the Final Rule and pull together a team to coordinate your efforts. Potential members of the team could include Case Management, Social Workers, IT representation, and Post-Acute Care Providers that you frequently work with.
- Action: Review Current Discharge Planning Policies
- Review your current discharge planning policies to identify needed changes based on the final rule. Example from the Final Rule: “The hospital must identify in its discharge planning policy the qualified personnel who will be involved in the discharge planning process and must execute their discharge planning process in accordance with their policies.”
- Action: Become Familiar with CMS Compare Websites
- Until CMS provides sub-regulatory guidance I would at a minimum recommend staff become familiar with quality and resource use measures available on the CMS Compare website as CMS expects “providers to make reasonable efforts to use the quality and resource use measure data that are currently available to them…providers should use these data sources to assist patients as they choose a PAC provider that aligns with the patient’s goals of care and treatment preferences.”
- Action: Developing Collaborative Relationships with Non-Health Care Services & Community Based Care Providers
- CMS finalized a requirement that a hospital include an evaluation of a patient’s likely need for appropriate non-health care services and community based care providers, and expects these efforts to collaborate will be documented in the medical record. Do you already have collaborative relationships with community-based services and community-based organizations (i.e., Area Agency on Aging)? If not, what is your plan to develop these relationships?
- Consideration: Compliance with Patient Choice
- Be mindful of the “patient choice” requirement when selecting post-acute care as CMS has indicated they believe hospitals “will be in compliance with this requirement if they present objective data on quality and resource use measures specifically applicable to the patient’s goals of care and treatment preferences, taking care to include data on all available PAC providers, and allowing patients and/or their caregivers the freedom to select a PAC provider of their choice…Providers will have to document all such interactions in the medical record.”
- Consideration: Expansion of PAC Provider Patient Choice List
- As of the November 29th effective date, hospitals will be expected to provide patient choice lists for Home Health, Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Long Term Care Hospitals.
- Question: Identifying Patients
- Do you currently have a process in place to “identify, at an early stage of hospitalization, those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning?”
- Question: Discharge Planning Re-Evaluation
- Do your current policies indicate your discharge planning process must require regular re-evaluation of the patient’s condition to identify changes that require modification of the discharge plan?
MMP will continue to watch for the promised sub-regulatory guidance from CMS. Until then, once again, MMP wishes all Case Manager’s a Happy Case Management Week.
Article by Beth Cobb
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.