The Commission – The Critical Role of the Case Manager for Health Care’s Future

Posted by on Dec 21, 2011 in Blog, Case Management

Case managers remain an integral part of the health care system. They oversee and interact with patient treatment plans, as well as offering assistance, guidance, and education. While their role holds great importance, confusion surrounds the profession for many and standards have appeared remarkably vague in the past. A new movement has begun in the healthcare system, pushing for case managers to become board certified.  Certification will help to remove the mystery surrounding the occupation and install a clearly defined standard of quality- an important and crucial step. Because certified case managers must meet such a high bar of excellence, the trust and confidence placed in them will naturally increase.  Especially in the midst of a changing health care system, it proves important for those in authoritative positions to clearly understand what case managers actually provide to the people in the health care system, and how board certification can help them do it better. For some groups more than others, such as those on Medicaid/Medicare, this awareness has become critical.  The confusion and difficulty encountered while navigating the health care system can leave underprivileged individuals or those on fixed incomes in a dangerous situation.  Board certified case managers will provide an indispensable resource for those in need of assistance while moving through the health care system. The enormous value of board certification for case managers has become obvious. As the need for these capable individuals’ increases, the number of case managers seeking certification will hopefully rise in response.  Awareness of the value board certification holds as well as encouragement by employers, policy makers, and healthcare providers will help make this goal a reality.  To read more about board certified case managers and their important role in the future of health care, check out Barbara Johannsen’s article here. low fee pay day loansresponsibility credit   Photo credit: eurasia-usa dot...

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5 Critical Aspects for Successful CAT Case Management

Posted by on Dec 14, 2011 in Blog, Case Management, Nursing, Workers Compensation

Acknowledging that each individual case is different within its specific merits, some critical commonalities exist regarding the successful management of any catastrophic case. These commonalities include the perspective of healthcare providers and their associated facilities, as well as the perspectives of the individual patient and his or her family. A catastrophic Nurse Case Manager is a key player in helping to successfully manage a catastrophic injured patient/worker. Costs  Cost represents the pinnacle concern and the top influencing factor in patient care — not just the costs incurred by the health care organization, the associated health care professionals and administrative staff, but also the costs for the patient as well (unless the injury is work related). While patients are obviously thankful for receiving quality healthcare, the doctors, nurses, staff members and other providers — and even any equipment present — all look like dollar signs when viewed through the eyes of the attorney, insurance adjustor, and patient, or their family. It is easier for the health care provider to see and understand the needed costs and long-term benefits of care. Patients, their advocates, and non-medical participants find seeing these benefits more difficult. Providers must manage costs carefully, keeping in mind the importance of the cost-benefit relationship. Communication  By communicating these benefits effectively with the patient and his or her advocates, the physician increases patient compliance with the long-term recommendations. This transparency also builds confidence among insurance adjustors, attorneys, and other patient advocates regarding the quality and appropriateness of the provided healthcare strategy. WWW.CIARAGERAGHTY.COM/WP-CONTENT/UPLOADS/2011/09/1/payday cash todaynon broker payday loans This communication must bear a tone and quality that the patient, and his or her advocates, can readily understand. Providers that lack proper bedside manner, or the ability to convey the relevance and appropriateness of care, almost guarantee that the patient and patient advocates will balk at the recommended long-term care strategy. This is especially true when high dollar strategies are requested for extended periods of time or for chronic problems/conditions. For successful management of the catastrophic case, the patient and all involved advocates must have full disclosure regarding all aspects of the case involving their health, treatment plans and recovery — from start to finish. Availability and Caring Patients and their representatives greatly benefit by participating in transparent communication between the attending staff and other caregivers. Transparent communication refers to the availability of staff to competently answer questions and address concerns in a suitable, satisfactory way and in a timely manner. This transparency and availability of staff to offer support that proves transparency of care, quells many fears, foments compliance, and creates an environment of caring. Patients know that they are being cared for, but do they know that anyone cares?...

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Obesity Responsible for 10 Percent of Direct Medical Costs in US

Posted by on Dec 7, 2011 in Blog, Health Care

Obesity continues to loom large as a major concern in the US health care arena.  Research shows obesity as responsible for almost 10 percent of direct medical costs in this country. In fact, over 100,000 Americans die each year from complications associated with obesity. With the potential to shorten Americans’ life expectancy for the first time since the Civil War, it represents a true health catastrophe that people swept under the rug for far too long. Obese individuals more likely to become injured  Not only does obesity increase the risk of illnesses, such as prostate cancer, diabetes, breast cancer, stroke, colon cancer, and heart disease; it increases the risk of injury and recovery time from injuries, occurring in car accidents, slips and falls, and others. Obese people are 73 percent more likely to have an accident, resulting in an injury requiring a hospital visit, according to a 2009 study conducted in Australia. The study, conducted by Samsung Life Insurance Lifecare Institute, also indicates that fatigue-inducing sleep disorders, such as sleep apnea and others, exacerbated by obesity, make obese adults more likely to have car accidents. Once injured, obese people spend longer in the hospital and have a higher incidence of complications, including death, than normal-weight individuals. Obesity – almost impossible to treat  Once a person becomes obese, the condition is almost impossible to treat effectively. The key lies in prevention of obesity. While numerous initiatives exist to stem the growth of serious diseases and conditions, such as heart disease and certain cancers, almost none exist that focus on truly preventing obesity. Congress has begun to implement things like junk food taxes and other initiatives, modeled after tobacco legislation that successfully decreased the number of American tobacco users. But these initiatives are problematic in that people don’t need tobacco to live. All people need food to live. Inexpensive, readily available food in urban areas has done much to decrease hunger and starvation among the poor. Promotion of healthy lifestyles – a call to action for all  In addition to the typical community interventions of educating people about healthy food choices, making healthy foods available, promoting exercise, and breast feeding, private industry must get involved as well. Companies should implement health and wellness programs to prevent illness and promote healthy living as part of their benefits package. They should execute a plan to help those who already suffer from obesity, or are clinically overweight, take steps to change the habits and tendencies that led to their condition in the first place. In the world of case management and legal nursing consulting, I see obesity and sedentary lifestyles effecting pre-operative workups, lack of ability to bounce back after a minor injury, increased...

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