By Laura Ostrowsky, RN, CCM, MUP and Joan Westgor, MSN, RN, CCM
Public policy and case management: What’s the connection? What does it mean to me as a case manager, a professional in healthcare, a citizen? Public policy affects all of us. As citizens in a democracy, we have choices, voices and votes. As professionals in healthcare, we have our unique knowledge and expertise. These help to shape our lives and our futures. We can participate or stand back and let others decide.
We have regulatory organizations that dictate standards, our profession from State Boards of Nursing, State law, credentialing agencies and, of course, our employers by way of job descriptions. Federal Public Laws are compelled to protect the public. Case managers are also protectors. We see and identify the pressing issues in client/patient/consumer relationships that suffer due to “social determinants of health.” So where do we start when change is needed? Look to public policy.
CMSA’s public policy committee seeks to make a difference in the future of healthcare. Access to healthcare has been growing since 1965 when Medicare and Medicaid were introduced. More recently in 2010, we witnessed the passage of the ACA exponentially increasing access to healthcare by providing coverage to millions of more Americans. Case managers are involved in coordinating care for and educating this increasing population of healthcare consumers on both a micro and macro level: Micro with individual patients and patient groups and macro from the viewpoint of population health.
As case managers, we are integral to the implementation of every change. Our participation is essential. Whether it is about access or advocacy, cost control or quality, fragmentation vs. coordination, education of users and providers, we are the linchpin.
Our first public policy initiative was the Nurse Licensure Compact. The NLC seeks to allow nurses to practice in other states without obtaining additional licenses and while maintaining public protection at the state level. We are up to 39 compact states with others pending enactment or implementation. There is still work to be done.
The Public Policy Committee of CMSA is currently focusing on 3 legislative areas:
- Workforce Development (includes compact licensure)
- Telehealth (includes video, telephonic, computer platforms
- Mental Health (private insurance to cover same in-person service in equal terms via telehealth).
Each month, we send out an email to the membership with the subject: Here’s What’s Happening on Capital Hill. It includes summaries of Health Policy Updates, Legislative Issues, Financial and Administrative news (click HERE to read January's update). If your chapter doesn’t have a public policy committee, review the current email at your next board meeting and consider forming a committee. If you need assistance, the national committee is ready to offer guidance.
There are no less than 89 bills in congress encompassing our three focused domains! At our February 2022 Virtual Hill Day, five selected bills were reviewed with our legislature’s staffers. Our intent was clear: Share our case management roles, our impact on outcomes, our importance as collaborative team members advocating for telehealth/mental health services, access expansion and reimbursement across diverse populations. (click HERE to read the article).
This year’s Virtual Hill Day is coming soon. Participation in Hill Day is a great introduction to public policy participation or a way to continue your current and past participation. Past participants are enthusiastic about the experience and eager to continue making their voices heard. To find out more and to sign up to participate, go to https://cmsa.org/public-policy/hill-day/
Join us on Hill Day, start a chapter public policy group or continue your current work on public policy. Remember, if we are not at the table, our voices won’t be heard.
Bio: Laura Ostrowsky, RN, CCM, MUP
Laura is the current president of the NYC chapter of CMSA and a director on the national CMSA board. She teaches a CCM prep course with the Case Management Institute, works with Athena Forum and writes and consults on all things case management. Laura has 40 years of healthcare experience, including time as a staff nurse, QA Coordinator, Director of UR and QA, followed by directorships in CM at New York Presbyterian (NYP) and Memorial Sloan Kettering Cancer Center.
Bio: Joan Westgor, MSN, RN, CCM
Joan’s commitment to case management began in her diploma of nursing education when the words of the instructor piqued her interest in “the patient’s discharge planning begins at admission.” Continuing with a BSN and MSN degree in Community Health, her career path revolved from Home Health, Acute Care clinical nursing and telephonic health educator into Utilization Management/Discharge Planner/Case Manager roles. Retired Lt Colonel Joan Westgor had a 23-year career in the USAF Active Duty and Reserve. As a civilian, she worked almost exclusively in San Antonio’s Air Force and Army hospitals, retiring on 12/31/2017. Joan has served on the Alamo Chapter board for many years and participated in two Capitol Hill Days, which was the impetus for leading the chapter’s Public Policy Committee and successful Grassroots Advocacy activities. She participated in CMSA’s 2022 Virtual Hill Day and looks forward to future “Hill Days.” Joan currently serves on CMSA’s National Public Policy Committee.