One of the most challenging barriers to patient health is often patients’ own behavior. Case managers encounter them daily: the patient who won’t follow the treatment plan, the patient who persists with unhealthy habits, or the patient who opts against making lifestyle changes that can improve his or her condition.
Case managers in today’s healthcare world face a challenge in confronting growing opioid abuse while also managing the use of opioids in certain circumstances as an effective treatment option for acute and chronic pain.
Inpatient rehabilitation facilities are a valuable postacute option for patients with complex medical and rehabilitative needs. But if you’re planning on referring a patient to one of these facilities, it’s becoming more important to make sure he or she meets medical criteria for the placement before making a recommendation.
A PICC line allows the medications to quickly reach the source of infection—but unfortunately, it also provides an easy route for the patient to use illegal drugs to get high. And sending an active or recent substance abuser home with a central line of any kind presents legal and ethical risks.
Mr. A suffered a cerebrovascular accident, which has affected his ability to comprehend and communicate. Mr. A needs someone to consent for percutaneous endoscopic gastrostomy placement, but he lacks the capacity for decision-making, as certified by two physicians.
Does case management need to be a seven-day-a-week service, or can the service succeed with coverage five days per week? As a case manager, I need to retain staff but also provide some consistency to the patients.
CMS’ Chronic Care Management service is aimed at strengthening access to chronic care management services in primary care settings while reducing costs, and a report on the program prepared by Mathematica Policy Research for CMS indicates its doing just that.
