Self-management. We expect it for ourselves; we expect our patients to take care of their chronic issues. It resides as a national issue, front and center. But have we, case managers, ever walked in the shoes of the truly chronically ill? Even seasoned case managers are challenged by self-management issues and this issue's poignant HeartBeat of Case Management is certainly from the heart of a case manager. But Karen Zander is not just any case manager; she is a case management Pioneer, whose models and books have a place in case management history.
In the HeartBeat column, Ms. Zander discusses a very personal journey, with realism and candor. I would like you, the reader, to digest her message; then read this "Letter to the Editor" submission about holding the patients accountable for their care and some of their readmissions.
Dear PCM Journal,
After reading the article "Case Managers: A Key to Reducing Readmissions" (Ellsworth, 2015), I felt compelled to provide another perspective. In my 18 years of nursing, I have held the title of a case manager for at least 10 years or more. I have been a certified case manager (CCM) since 2005, and I actively participate in the discharge planning process while overseeing the medical necessity for hospital admissions.
Hospitals are penalized financially for readmissions, but I believe the noncompliant patient who fails to follow the prescribed health care regimen must also be accountable for his or her readmission. According to "Hospital Perspectives" (2015), "a hospital has limited ability to control what takes place after the patient is initially discharged" (p. 3). Most hospitals lack methods to track and follow what patients do after they are discharged ("Hospital Perspectives," 2015).
Hospital leadership needs to work with the insurance plans, physicians, and other care providers to hold patients accountable for complying with the prescribed discharge regimen. Patients should receive incentives for complying and penalties for not complying with the prescribed treatment regimen. Hospital leaders are at the forefront of changing health care and need to challenge the system to avoid the financial burdens that arise from noncompliant patients.
Sincerely,
Kimberly Wyers, BSN, RN, CCM
Memorial Hermann The Woodlands
Case Management Department
[email protected]
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