By Marie Stinebuck MBA, MSN, ACM

During the past three years, case managers have remained in the hospital as integral members of the healthcare team. As bed shortages were discussed on the news, at all hours of the day, case managers were working to develop safe transitions of care for patients to alleviate the burden. Case management, at all levels, has been involved in hospital meetings and conversations related to bed management and throughput. We supported each other and worked together through the storm. Nursing and healthcare are a community, and we have the mentality to stick together through tough times. But now, almost three years out, we are seeing case managers leave the hospital setting. Where are they going? Well, one place that I have witnessed them moving to, in BIG numbers, is remote UR positions. My company offers UR classes and in our most recent class, we had a high percentage of nurses who have left CM and have moved into new UR positions. They come to learn the essentials of UR for this new role. The UR positions are typically remote and give individuals the flexibility to work from home whereas most case management positions are still required to work in the hospital setting.

What has UR lost being removed from the hospital setting?

I am going to be a little nostalgic and maybe date myself, but I miss the days of sitting in the case management office, near the nursing unit, with my UR specialist in the same office. Their input and expertise on the patients’ status and criteria for possible SNF placement were helpful in the care planning of the patients. Their presence at the daily rounds, at the table with PT, CM and the physicians added value to the conversation. They would call out patients who were in observation and discuss patients who were approaching their expected length of stay or approved and denied days and expand the conversation to ready each patient for discharge. With the loss of UR at the table and recently in the hospital setting, these conversations now need to be discussed and led by the case manager. With those changes, I don’t believe these conversations are occurring as regularly during rounds. The loss of UR interaction on a daily basis with all members of the healthcare team has become diluted and hospitals have lost aspects of these critical conversations that advance the patients’ progression of care.

One of the most impactful changes related to the removal of onsite UR specialists is the loss of personal relationships with staff and physicians. UR specialists who have moved into remote positions in the past three years have likely never met their CM counterpart and may not fully understand their role. Physicians also only know the UR nurse by a phone call or through epic chat with conversations on status conversions. That personal connection that used to exist has changed and we must ensure that we have guideposts in place to not lose sight of the importance of connection.

In many organizations, UR specialists have also been pulled from the ED, which decreases and may eliminate the possibility of discussing admission status and options to discharge an inappropriate admission from the ED. UR specialists are now waiting to look for an admission order to review a patient rather than be proactive prior to the admission. Without the proactive approach to reviewing patients prior to an admit order, inappropriate admissions will make their way into hospital beds.

Now how do we move forward in increasing communication with technology?

How do we move forward and maximize communication with our current reality? How can we use technology to our advantage in the growing remote environment? Let’s bring UR back into rounds to participate and be included in all advantageous meetings through virtual invites. Each meeting could be set up with remote access and inclusion. The use of the electronic medical record chat has expanded conversations between the multidisciplinary team and can bridge the gap and communication with physicians. Increased visibility of UR continues to increase the awareness of their value to the organization. The support of an onsite physician advisor increases education and conversations with hospitalists and other team members related to utilization review and denials prevention. UR leaders need to acknowledge that AI and outsourcing of UR continue to creep into our world. It needs to be our priority to demonstrate the UR specialists’ contributions to our organizations. Step up and be seen throughout your organizations, showing the value that we deliver!

Bio: Marie is the Chief Operating Officer of Phoenix Medical Management, Inc., the leading case management firm. Marie has practiced as a nurse for the past 25 years with 17 years in the field of case management. Marie has served in several roles in Senior Leadership roles in Case Management. She has had leadership oversight including case management, utilization review, denials prevention, clinical documentation improvement, and medical record integrity. Marie has authored articles for RACmonitor, CMSA, and Case Management monthly. She is also a weekly contributor on Finally Friday and is a Board Member for the Arizona ACMA. Marie holds an MBA from the University of Phoenix and an MSN in Leadership from Grand Canyon University. She received her Bachelor of Science in Nursing from Northern Arizona University.

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