Presented By Laura Ostrowsky , RN, CCM, MUP

1. : • The Code of Professional Conduct: your GPS for navigating the care continuum, resolving conflicts and providing ethical care Presented By Laura Ostrowsky, RN, CCM, MUP

2. The Roles of a Case Manager • Advocate • Advisor • Coordinator • Clerical Support • Diplomat • Educator • Expediter • Expert • Facilitator • Hospital Employee • Mediator • Negotiator • Navigator • Surrogate Family Member • Therapist

3. Responsibilities of a Case Manager • Utilization Management • Cost Containment • Compliance • Patient Flow • Discharge Planning • Patient Education • Insurance Authorization • Denial Prevention • Denial and Appeal Management • And, so much more

4. Roles vs. Responsibilities • Inherent Conflicts • Confusion • Uncertainty • Ambivalence • Contradictions • Ethical conundrums

5. Navigating the care continuum What are our tools, our compass or GPS? • Code of Professional Conduct • Mission and Vision • Ethical principles

6. CCMC Code of Professional Conduct • Objective: to protect the public interest • The code provides a framework for ethical, high quality care • It consists of: • Principles • Rules of Conduct • Standards for professional Conduct

7. 8 Principles of the Code • Board certified CMs will • Place the public interest above their own at all times • Respect the rights and dignity of all their clients • Maintain objectivity in relationships with clients • Act with integrity and fidelity with clients and others • Maintain competency at a level that ensures clients receive highest quality service • Honor the integrity of the CCM designation and adhere to requirements for its use • Obey all laws and regulations • Maintain the integrity of the Code, by responding to requests for public comments to review and revise the code, thus helping ensure it’s consistence with current practice

8. CMSA’s Mission and Vision • Providing professional collaboration across the health care continuum to advocate for patients’ wellbeing and improved health outcomes. • Case managers are advocates who help patients understand their current health status. • Case managers are recognized experts and vital participants in the care coordination team who empower people to understand and access quality, efficient health care.

9. Ethical Principles Autonomy Beneficence Non-Maleficence Justice Veracity

10. Patient Advocate vs Employee • Coordinate a safe discharge • Decrease LOS • Maximize reimbursement (Prevent Denials) • Contain costs • Manage scarce resources (UM) • Expedite patient flow How do we reconcile these roles?

11. Dealing with disagreements within the team • Among the team members. • Between the patient and the clinical providers • Which side are you on? • Can you remain neutral? • Who can you call? • Strategies to achieve resolution….

12. Advocates or Adversaries • Hospital case manager and the insurance case manager • With the private advocate • Collaborating with payers

13. Patient Advocate or Fairy Godparent • Is there a “No” in advocacy? • Patient Rights vs. Patient Responsibilities • Non-compliant patients

14. The CM Department in the Hospital Hierarchy • Where does your department report? • Where should CM report? • Is report structure a reflection of perceived value of CM?

15. Coping with Conflict • Meditate • Eat Chocolate • Ruminate • Lose Sleep • Exercise • Scream • How do we take care of ourselves and move on?

17. Resources/suggested reading • Article about patients leaving AMA https://www.nytimes.com/2017/01/12/well/live/when-patients-leave-against-medical-advice.html?_r=0 • Fadiman, Anne The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors and the Collision of Two Cultures. New York: Farrar, Straus and Giroux, 1997

18. Contact Information Laura Ostrowsky, RN, CCM, MUP lrostrowsky@gmail.com