Case Management

As hospitals across the country scramble to keep up with an influx of COVID-19 patients, while simultaneously experiencing critical shortages of personal protective equipment (PPE), staff, and testing supplies, case managers are being increasingly pulled into the fray.

COVID-19 was officially classified as a global pandemic on March 11 by the World Health Organization (WHO). The rate of fatality varies by age group, with the elderly being more at risk. The statistical projections by the Society of Critical Care Medicine anticipate that approximately 4.8 million people will be hospitalized for COVID-19 in the United States. Some mathematical models predict that this new virus will infect over half the U.S. population.

Q: What changes brought about by the 1135 waiver will most affect case managers, and what should they know about these modifications?

CMS issued a waiver on March 13 designed to help hospitals and other healthcare facilities better respond to the surge in demand placed on them by the COVID-19 pandemic. The waiver allows CMS to bypass traditional rules, including Conditions of Participation when necessary, and aims to help organizations move patients through levels of care more quickly to free up needed hospital beds for critically ill COVID-19 patients.

Q: The use of telemedicine and telehealth has expanded dramatically during the COVID-19 pandemic. What should case managers be aware of when determining the most viable telemedicine options for patients?

As organizations respond to the COVID-19 pandemic, a growing number are turning to telemedicine to safely meet patient demand. “The current crisis is expanding people’s willingness to shift the paradigm both on the provider and patient side,” says Diane Iverson, RN, BSN, BS, ACM, CCM, a Baltimore-area case manager. “Systems are gearing up to expand services rapidly.”

Q: What are the essential steps to addressing some of the communication gaps that exist among primary care physicians, hospitals, and other providers?

Are you having trouble communicating with your patients’ primary care physicians? It’s a problem in the U.S., according to a 2019 Commonwealth Fund International Health Policy Survey published by Health Affairs.

Q: Our facility sees a lot of patients dealing with diabetes and diabetic complications. Do you have any advice for helping these patients during their stay or after discharge?

In a 26-page document published on April 9, CMS outlined dozens of blanket waivers that are retroactively effective March 1. The entire utilization review (UR) condition of participation will be waived, according to CMS.