Revised CMSA standards reflect new CM issues

Organization issues first revisions since 1995

The 2002 version of the Case Management Society of America’s (CMSA) Standards of Practice are designed to reflect the role of the case manager in the changing health care system.

"The development of the CMSA standards went from infancy in the first 1995 edition to adolescence in the 2002 updated edition. The new standards reflect a maturing of case management as we figure out who we are, and what we can be," says Kathleen Moreo, RN, Cm, BSN, BPSHSA, CCM, CDMS, CEAC, who co-chaired the Standards of Practice Task Force with Gerri Lamb, PhD, RN, FAAN.

The Task Force that developed the original standards never could have predicted the breadth and extent to which the standards have been utilized, Moreo says.

"The CMSA Standards of Practice are the most important source of standards of care for case managers. They have a huge impact," she adds.

For instance, some accrediting bodies include the Standards of Practice within their measurement criteria. Health care organizations in other countries use the CMSA Standards of Practice as benchmarks for their standards and have asked for the CMSA Standards of Practice to be published in their languages.

Many companies on the payer and the provider side utilize the Standards of Practice in their job descriptions.

In revising the standards, the Task Force looked at the growth of managed care and demographic trends, along with other current issues such patient rights, quality initiatives, technology, and cultural competency and how they affect the practice of case management.

"Instead of the case manager in the center, we put the patient in the center. We have changed our focus from identifying resource utilization to identifying resource management and stewardship," Moreo says.

Although there were many minor changes in the standards, major changes included:

Legal issues of consent for case management services and health care services and products.

The first standards included information on informed consent but focused on the independent case manager. The new standards include language on informed consent in the current health care environment, Moreo says.

Cultural competency for case managers.

"From a personal standpoint, when I look at my caseloads, they are so different from a cultural standpoint than they were five years ago. Our country and our health care system have so much more diversity in cultural aspects than we did five years ago," Moreo says.

The standards have guidelines on what cultural competency is and how case managers can become culturally competent.

Patient confidentiality issues for case managers.

"We are privy to a lot of confidential knowledge. Confidentiality has been on the forefront," Moreo says

The patient confidentiality portions were partially driven by the Healthcare Portability and Accountability Act (HIPAA) requirements but do not specifically mention HIPAA, she says.

"It is not our role and responsibility to speak to the specifics of any federal legislation," Moreo adds.

A shift in focus from resource utilization and cost of care to resource management and care management.

"Resource utilization was a huge part of case management, but now we are doing resource management and stewardship in our plan of care," Moreo says.

Other major trends that are addressed in the new standards include population-based care and use of evidence-based guidelines.

"The model of case management has changed considerably since the standards were developed in 1994. In the old model, we defined the case manager as being in the center of activity. In our current client-centered environment, we placed the client in the middle," Moreo says.

The model was changed to reflect four key processes: assessment, planning, facilitation, and advocacy.

"Within those four processes are the steps we believe we all do, and all we do will fit into those four key areas," Moreo says.

As they reviewed the standards, the task force looked at issues and trends in case management today.

"We looked at emerging trends and maturing trends. We realized that the Standards of Practice couldn’t embrace everything. We were trying to be as reflective of current practice as possible," Moreo says.

For instance, the old standards recommended achievements in education and certification. The language was changed in the new standards to acknowledge the education and certification, rather than recommending it.

"The consensus among us was that these are voluntary guidelines and we shouldn’t recommend certain achievements in education and certification," Moreo says.

The old standards said that case managers conduct research. The new standards say that case managers read, use, and disseminate research.

A task force of industry representatives with a wide range of experiences undertook the initial revision of the Standards of Practice. Their first draft was reviewed by a reference group of 25 industry leaders.

The task force and the reference group include representatives of multiple practice settings, all disciplines, and people from administration, education, and research, as well as practitioners.

"Even though nursing dominates a large portion of case management, we believe that will change, particularly with the nursing shortage, and we will see other disciplines coming into case management," Moreo says.

The revisions went through a public comment period in the spring. The task force reviewed the comments and presented another revision for extensive legal review. The board of directors received the final draft in the fall of 2002.

Information on the Standards of Practice for Case Management is available at the CMSA web site, www.cmsa.org, or by calling the CMSA at (501) 225-2229.