Economy still affecting CM salaries, work increases

Reform should bring more money, options for CMs

As health care organizations tighten their belts to deal with today's health care environment, case managers report working harder with fewer raises and benefits. But, there is hope on the horizon as new opportunities open up for case managers under health care reform, experts say.

As she works with case managers in a variety of settings across the country, Catherine M. Mullahy, RN, BS, CRRN, CCM, has observed that for most case managers salaries are remaining the same, with few case managers, if any, receiving raises.

"I think the economy has a lot to do with this, as many hospitals and other practice settings have to do more with less. We continue to see RNs and case managers being laid off — a sign of the times as well," says Mullahy, president of Mullahy & Associates, LLC, a Huntington, NY, case management consulting firm.

The work day for case managers in all settings is being expanded, and night, weekend, and holiday shifts are becoming more common.

The opportunity to have nights, weekends, and holidays free initially was one of the attractions for case managers "in the early days," Mullahy says.

However, the practice of requiring case management coverage for longer hours during the week, weekends, and holidays does create employment opportunities for case managers who need to work a flexible schedule, she points out.

"But if we're really trying to 'walk the walk' instead of 'talk the talk,' isn't this a positive initiative to creating patient-centered care? Patients don't get sick only from 9 to 5 Monday through Friday," she adds.

The good news on the horizon is that the demand for qualified case managers will increase under health care reform and is likely to drive increases in salaries and benefits, predicts Teri Treiger, RN-C, MA, CCM, CCP, a case management consultant based in Holbrook, MA, and president of the Case Management Society of America.

"The need for qualified case managers is going to gradually increase, and with the increased demand, the options for case management careers will expand, creating a scarcity. Employers could be in a bidding war of sorts as they do their best to attract qualified case managers," she adds.

Achieving certification is a way that case managers distinguish themselves as someone who has a knowledge base within their profession, Treiger adds.

"Credentials are widely recognized in health care across all professions," she adds.

The movement in many acute care settings is toward achieving nursing magnet status, and as a result, many organizations are hiring certified case managers or encouraging their staff to pursue certification, points out Margaret Leonard, MS, RN-BC, FNP, senior vice president for clinical services for Hudson Health Plan.

Some institutions are paying for case managers to take the review courses and the exam, and a few are giving salary bumps, she adds.

Hudson Health Plan pays for the review manual, the course, and gives staff time off to take the exam. Case manager receive a $3,000 bump in salary for certification, she adds.

In the future, case managers will have new opportunities in a variety of settings, Treiger predicts.

As examples, she cites patient-centered primary care homes and accountable care organizations that are being created as a way to improve patient care and cut health care costs.

"With hospitals getting penalized for avoidable readmissions, more people coming into the system, a growing scarcity of resources along with more complex treatments, there will be an increased demand for case management. The big question will be, will payers (private and public) eventually specifically reimburse for these services," Mullahy says.

The changes in health care are bringing an overdue recognition of the services case managers can provide, Treiger says.

"However, if reimbursement remains at the current level or is reduced, the expectation of expanded care coordination may not be fulfilled," she says.

The Case Management Society of America is actively working to have case management recognized as a separate reimbursable activity, she says.

"As with most things within the current paradigm of health care, it is not an easy goal to attain," she says.