1. Sminkey, Patrice V. RN

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In the 6 years since the Patient Protection and Affordable Care Act was signed into law, and in the 2 years since the major provisions became effective, health care has undergone tremendous change. Millions of previously uninsured people, many of them with complex medical conditions, have gained access to the health care system. The "Triple Aim" of health care-improving the experience of care, achieving better health for individuals and populations, and reducing the per capita cost of care (Berwick, Nolan, & Whittington, 2008)-has become an imperative. New care models, such as accountable care organizations and patient-centered medical homes, have emerged. Within these models, interdisciplinary teams must work together to pursue the desired outcomes of safe, quality, and cost-effective care (Tahan, Watson, & Sminkey, 2015).


Against this backdrop of higher expectations for care delivery, the board-certified case manager is a constant and unifying presence within a complex health care system. The demands being placed on the professional case manager, especially in the crucial care coordination role, point to the importance of a rigorous certification process to protect the interests of consumers and the public at large. Certified case managers (CCMs), in particular, are held to the highest standards for professional and ethical practice, including the Code of Professional Conduct for Case Managers, as put forth by the Commission for Case Manager Certification (CCMC). Accepted throughout the industry, the code provides a framework for all case managers. For CCMs, adherence to the code is foundational to the ethical practice of putting client's safety, privacy, and autonomy first (CCMC, 2015a).


Given the increased emphasis on ethics today, the CCMC now requires CCMs to obtain ethics-related continuing education (CE) credits for recertification. Overall, 80 CEs are required every 5 years to renew the CCM credential. Specific ethics requirements for certification renewal are as follows: for CCMs expiring in 2016, a total of two ethics CEs; for CCMs expiring in 2017, a total of four ethics CEs; and for CCMs expiring in 2018 and thereafter, a total of eight ethics CEs (or 10% of the total CEs required).


Ethics, as every professional case manager knows, are far more than rules of what to do or not to do. Ethics are a way of thinking, behaving, and interacting across the spectrum of health and human services-especially as an advocate for clients (individuals receiving case management services). Advocacy is the primary function of case managers, who must understand the importance of achieving quality outcomes for clients, while also committing to the appropriate use of resources and empowering clients in a manner that is supportive and objective. As the code states: "Board-certified case managers (CCMs) will place the public interest above their own at all times ... (and) will respect the rights and inherent dignity of all their clients" (CCMC, 2015b, p. 3). For individuals with serious health issues, multiple comorbidities, and/or psychosocial issues that add to their health-related stress, case management services are key to becoming informed, educated, and empowered in their decision making around health care.


The article, "Case Management Ethics: High Professional Standards for Healthcare's Interconnected Worlds," which also appears in this issue, describes board-certified case managers as having a foot in two worlds. In one, they are advocates, with the ethical mandate to provide the right care and treatment at the right time in support of the individual's health goals. In the other, they are good stewards of health care and financial resources, as well as accountable to multiple stakeholders. At the same time, case managers must remain aware and up to date on the latest health care policies and regulations while putting that knowledge into practice for the good of the client.


The multifaceted demands on case managers today were a topic of recent discussion when I was invited to address a regional chapter of the Case Management Society of America (CMSA) on ethics-and more specifically, recent revisions to the code, as adopted in 2015. In the midst of our discussion about such issues as electronic health records and informed consent, I held up a document. It was little dog-eared from frequent use, with Post-it notes protruding from the margins. The document was a printout of the code (available on the CCMC website; see Although the code can be accessed electronically, my personal preference is a physical copy, which for me is like carrying a touchstone to guide and inform actions, interactions, and decisions. Even though I no longer provide direct care to patients, as I did earlier in my career, the code still speaks to me. When I face a challenging question or must make a decision that requires me to look at things from multiple perspectives, I refer to the code. I know many board-certified case managers who do the same thing, whether they have an electronic copy on their computer desktop, downloaded on their tablet, or, like me, printed out on paper.


The code is a living document that keeps pace with the changing times in health care; for example, it addresses security of transmission and use of electronic health information. And, the code remains timeless; always, case management is guided by the ethical principles of autonomy, beneficence, nonmaleficence, justice, and fidelity. The code, its principles, and its standards function much like guardrails for ethical practice, always bringing us back to the path of advocacy, ensuring that our behaviors and actions are in the best interest of those we serve.




Berwick D., Nolan T., Whittington J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759-769. Retrieved from[Context Link]


Commission for Case Manager Certification. (2015a). Foundational principles: Newly revised Code of Professional Conduct provides a framework for ethical, high-quality care [Issue Brief]. Retrieved March 1, 2016, from[Context Link]


Commission for Case Manager Certification. (2015b). Code of professional conduct for case managers. Retrieved March 1, 2016, from[Context Link]


Tahan H. A., Watson A. C., Sminkey P. V. (2015). What case managers should know about their roles and functions: A national study from the Commission for Case Manager Certification-Part I. Professional Case Management, 20(6), 271-296. [Context Link]