1. Powell, Suzanne K. RN, MBA, CCM, CPHQ
  2. Kimberly, Wyers BSN, RN, CCM


The national agenda for health care includes working with patients to move them to self-efficacy, also known as self-management. Without self-management, patients with chronic conditions will certainly have more emergency department visits and readmissions. Is self-management a realistic and achievable goal? For some, yes; and we must hold them accountable. For others, it is not certain.


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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.




Kimberly Wyers, BSN, RN, CCM


Memorial Hermann The Woodlands


Case Management Department


[email protected]




Ellsworth J. (2015). The heartbeat of case management. Professional Case Management, 20(3), 147-149. [Context Link]


"Hospital perspectives on reducing and preventing readmissions." (2011). Healthcare Financial Management, 65(12), 1-7. [Context Link]


Noncompliance is a charged word. The knee-jerk response is that this patient refuses to follow medical direction, does not take her or his medications as directed, eats food that exacerbates the disease, and "causes" all the dow nstream medical problems. However, as in any "story," there is more than meets the eye.


Two perspectives are outlined in this issue, and both are absolutely correct.


As case managers celebrate their "National Case Management Week" on October 11-17, 2015, remember that it is because of the building blocks of the early ones-and because of YOU. As you read this Editorial and the HeartBeat Department, let us never lose sight of the person behind our work, or of the "journey" that is our patients' life. As I read this, I am honored that Ms. Zander is willing to share the picture for us of "what is it really like." It is not just our case management responsibility to look at the whole picture and include the whole story; it is our duty, privilege, and legacy.


case management; national agenda; self-management