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A good working relationship between a knowledgeable and effective case manager and a cooperative, clinically up-to-date physician can result in excellent, cost-effective patient care with superior outcomes and high levels of patient satisfaction.
But it doesn’t always happen that way.
That’s why Frank L. Urbano, MD, FACP, and Pat Orchard, CCM, CHE, set out to improve relationships between case managers and physicians at their hospital and put together a presentation: "Can’t We All Just Get Along: Strategies for Developing an Effective Case Manager/Physician Relationship."
Urbano and Orchard met several years ago when Orchard became assistant vice president for case management at the Virtua Memorial Hospital Burlington County in Mount Holly, NJ, where Urbano practices and now is physician advisor to case management.
"Prior to that, I had no knowledge of what true case management was about. After research and with my own experiences working with the case managers at our hospital, I discovered that the major problem I saw was that there was a poor relationship between case managers and physicians," Urbano recalls.
The reasons for the poor relationship were twofold, he adds: Physicians felt that case managers were intruding on their time, and case managers didn’t want to bother the physicians when they were so busy.
"In our hospital, I think that the physicians specifically work well with the case managers, but there still is that barrier to overcome. Physicians feel as though their way of practicing is being intruded upon and that what the case managers are trying to do is just one more thing they don’t have time to handle," Urbano says.
Case managers need to take the lead in changing the perceptions that physicians have about the case management process, Orchard notes.
"There are very great opportunities for case managers to be a patient advocate if they are on the same page as the physician. There needs to be a change in the attitude of both parties. The person who is in the position to best change the attitude is the case manager," she says.
Good relationships are based on good working attitudes, respect, and trust, Orchard says.
"In order for case managers and physicians to get along, each must value what the other is doing, trust that what the other is doing is in the best interest of the patient, and understand what their respective role is in the diagnosis, treatment, and recovery of the patient," Urbano adds.
Case managers should approach physicians by telling them what they do, how they can help, and how their presence can benefit the patients and the physician, Urbano advises.
"Physicians are very much interested in what is best for the patient. Everyone should focus on what is best for the patient and not let ego and power get in the way," Orchard adds.
Respect the fact that physicians have multiple priorities and limits on their time and don’t expect them to respond to you and you alone," she says.
When you approach physicians, concentrate on what is best for the patient, Orchard suggests.
"Physicians can identify more with doing the best for the patient than they can with insurance or workers’ compensation mandates," she adds.
The best way to approach a physician is with evidence-based criteria and not just telling him or her that it is criteria set forth by a health plan, Urbano adds.
"The various criteria we hear about, such as Milliman [USA], are excellent, best-practice criteria, but when a physician hears that the insurance companies are using it, it automatically is suspect," he says.
Sometimes case managers carry the reputation of having a utilization review mentality, and they have to work to overcome that perception, Orchard adds.
"I find it offensive when case managers forget that they are clinicians and not technicians and they simply count days and justify stays. There’s a lot more to case management than this," Urbano points out.
Case managers need to be aware of their skill limitations and know where they can get the information they need. If case managers delve into areas in which they don’t have expertise, the physician can tell if they don’t know the subject, Orchard points out.
For instance, case managers should be knowledgeable about the medication the patient has been prescribed before calling the physician about it, and if they don’t know, they should have resources available to help them find out.
"Physicians don’t expect case managers to be pharmacy experts, but they should understand drug side effects and other things that can help move the patient through the level of care," she says.
The worst thing a case manager can do is to be argumentative and confrontational, Urbano notes.