By Dr. Colleen Morley DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM
“Case managers are healthcare professionals who serve as patient advocates to support, guide and coordinate care for patients, families and caregivers as they navigate their health and wellness journeys”. This is the definition of who case managers are, posted on the new CMSA website (check it out!).
The role of advocate is one in which I take great pleasure — being the additional voice for the patient/family, serving as a bridge between patients, healthcare providers, and other stakeholders, and ensuring that patients receive the best possible care and support throughout their medical journey.
I had the great joy of watching this advocacy unfold just yesterday as a case manager on the team at my hospital reached out to me for some direction. She was very concerned about a patient she had been following and started to describe the issues. A very complex patient journey — multiple comorbidities, wound care, physical/occupational therapy needs, and multiple falls. The case manager had been a fierce advocate throughout the patient’s stay, making referrals for inpatient acute rehabilitation. This was initially denied by the payer, and she coordinated the appropriate peer-to-peer conversations which ultimately reversed the denial for the acute inpatient rehabilitation stay.
On the day of the transition to the inpatient acute rehab facility, the attending provider decided that since the focus of the patient’s care stay (vascular surgery) had resolved, the patient no longer required acute rehab level of care. The case manager spoke to the provider team and pointed out the other considerations (falls, recent PT/OT recommendations and nursing observations) and her concern that the patient would not be safe at home, even with home health care. She called me and we reviewed the case and the steps she had taken to this point.
I asked if the patient was amenable to going to the rehab facility; he was. Had she looped in PT/OT since this new decision to discharge home had been made? She had not. We planned to bring PT/OT into this conversation and reinforce the concerns for a safe discharge. The case manager coordinated the interdisciplinary conversation, bringing all concerns and perspectives together. End result? The provider team reviewed their discharge plan and agreed that inpatient acute rehabilitation was the best plan. The patient was able to transition to the rehab facility later that afternoon.
The case manager’s advocacy for this patient in coordinating care and ability to bring the whole picture together for the interdisciplinary care team was textbook advocacy for the right care setting, at the right time with a patient-centric approach. I was happy to play a small part in helping her refocus and support her efforts to ensure this patient had a safe discharge plan that set them up for long-term success.
So, be that fierce advocate for your patients/clients/members! You are their voice and the keeper of the “big picture”. And thank you, Gladys, for your exemplary advocacy. As always, you epitomize the true heart of case management.
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Bio: Dr. Colleen Morley DNP RN CCM CMAC CMCN ACM-RN FCM is the Associate Chief Clinical Operations Officer, Care Continuum for University of Illinois Health System and the current President of the Case Management Society of America National Board of Directors. She has held positions in acute care as Director of Case Management at several acute care facilities and managed care entities in Illinois, overseeing Utilization Review, Case Management and Social Services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management. Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her 1st book, “A Practical Guide to Acute Care Case Management”, published by Blue Bayou Press was released in February, 2022. Dr. Morley has over 20 years of nursing experience. Her clinical specialties include Med/Surg, Oncology and Pediatric Nursing. She received her ADN at South Suburban College in South Holland, IL; BSN at Jacksonville University in Jacksonville, FL, MSN from Norwich University in Northfield, VT and her DNP at Chamberlain College of Nursing.