1. Powell, Suzanne K. RN, MBA, CCM, CPHQ


The health care changes are coming at the fastest pace in recent history. Case management is often at the heart of those changes. It is more imperative than ever that we recognize the stress and its consequences, promote mutual respect, and know when to proudly accept the applause.


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Before you read this issue's Editorial, may I direct you to the HeartBeat of Case Management, written by some of the pioneers in case management. This column gives hints of the early evolution of the Case Management Society of America. And most interesting to me were the common questions this "birthing" group of 13 were asking about case management, because they are still questions echoed today:


* Do we all define case management the same way?


* Do we all play the same role as case managers?


* Do we all practice in the same practice settings?


* What do we do the same and what do we do different?


* What is our value to the patients and families we serve, as well as our value to the health care team?



There is only one certainty in case management and that is "change"-that the health care environment will continue to change, and therefore, so will the work and privileges of case managers. The game rules are rapidly changing. Late in 2013 the Centers for Medicare & Medicaid Services rolled out the "two-midnight rule" for hospitalized Medicare patients. That initiative-although clearer as of this writing-has affected hospitals throughout the land and turned some case management processes on their heads. For example, whereas some hospitals serenely utilized the "case management protocol (CMAP)" and had excellent results, the regulation eliminates that process. In all venues of health care, the regulations are changing, and with it, case management processes and roles must also change.


Recently, another rather hidden facet of the Affordable Care Act is coming to light. Out-of-pocket expenses for you, your family, and your patients/clients may soon be affected by "reference pricing." This was spun as "transparency" (ie, show the cost comparisons online between hospital procedures across the country). Reference pricing may be just that-or it may equal tremendous out-of-pocket expenses if the consumer chooses the more expensive options. One small detail-but one likely that the case managers may be tasked with explaining to patients.

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Without a doubt, we are seeing the fast-paced changes leading to some of the stressful distrust noted in the HeartBeat column, but it also demonstrates the importance of "learn(ing) how to intentionally work together in a manner that denotes mutual respect and valuing of expertise across all care team stakeholders" (this issue HeartBeat Column, Time to Reflect and Celebrate Professional Case Management: You Deserve It! on page 235). If we are going to survive in these tumultuous times, we must value, respect, and celebrate one another.


I will end this Editorial with a little horse story. Reining is a riding competition that has been described as a Western form of dressage riding. For good competition scores and in a great "ride," the horse and the rider are in a wonderful partnership. These forms of riding require the horse to be willing, with little or no apparent resistance; meanwhile, the rider uses a light touch in the hands and- although the movements are controlled by the legs-neither hand or leg commands are obvious. While watching these competitions, my rather untrained eye could not tell who-was-leading-who, and conversely, who-was-following-who. It gets more fun with "free style" reining where the horse and the rider really must work as a partnership, because often, there is no bridle, or saddle, and the "dance" is to music. Here, the "applause meter" is often part of the score. Matt Mills, an expert reiner, would say that after a ride, he would stop the horse and "absorb the applause."


This reminds me of some of the best teams in case management, where the partnership between the nurse and the social worker are so well-done (often through crucial handoffs and huddles), that the "dance" is invisible to the patients. So, on this National Case Management Week, which began more than 15 years ago, PCM Journal asks you to take a big bow, and "absorb the applause"; you are the rock stars of health care.


case management week; reference pricing; two-midnight rule