A Case Manager’s Perspective
Successful collaboration between case managers and physicians is essential for optimum patient care. There are many factors that both parties are considering when taking care of a patient, and it’s crucial to ensure everyone is on the same page and aware of all factors in order to provide the highest level of patient care.
For example, sometimes physicians do not understand the utilization concept of meeting inpatient criteria that case managers look for when pulling together documentation for patient insurers. The physician may not be aware of the nuances required of various insurance payers, or of the documentation requirements that are crucial to each insurance company. Education regarding these particulars may be needed.
For Case Managers in these interactions, it is not what we say but how it is said. For example: “Please help me to understand why this patient remains in the hospital. I can then relay all relevant clinical documentation to the insurance company”. Case managers typically are strong, effective, well-versed clinicians. It is important to avoid coming across as arrogant or condescending. Case managers are there to assist in a process that is vital for all involved.
For caseworkers, getting to know each physician they work with is helpful for a working relationship. Some strategies to effectively engage M.D.s in the utilization review process are:
- Explain why
- Influence through negotiation
- Accept that anger is often the first step in the negotiation
- Avoid an emotional response
- Know when to disengage
This gives clinicians a way to focus attention and expectation on specific issues. Effective communication requires full engagement in conversation – make eye contact. Be curious, not judgmental. Respect what the other person is saying, and ensure reasoning is as transparent as possible.
Resolution of conflict regarding differences requires an understanding of the challenges and motivation of the other person. Physicians are small business owners not necessarily well versed in team collaboration, resolving conflict, and managing others. Their primary income source is their patients so any task that pulls them away results in decreased productivity.
Case managers also work with hospitalists, medical students, interns, and residents. In my experience, these students tend to be very open to learning. At the same time, they can be unrealistic in their expectations. Many times I have heard “work your magic” in cases where even magic could not accomplish the goal they have in mind.
Ensuring our patients receive the highest standard of care is a team effort — from case managers to physicians to the families, everyone is involved and on the same team — the patient’s team.
As always, Abundant Home Health Care is here for you. We can provide rides and assistance — please don’t hesitate to reach out or call us at 617-795-2171.