The value of CM is being recognized — but where is the pay?
2013 Salary Survey Results
The value of CM is being recognized — but where is the pay?
Compensation often doesn't reflect the workload
Case managers are working long hours and most get only cost-of-living raises, readers of Hospital Case Management reported in the annual salary survey.
However, thanks to the Patient Protection and Affordable Care Act and other initiatives from the Centers for Medicare & Medicaid Services (CMS) and commercial payers, case managers are getting greater recognition for the value they bring to the healthcare system, experts say.
"The value of the case management profession is being recognized, and the changes in the healthcare system are making case managers essential, but case managers still aren't being appreciated and incentivized from a financial perspective," says Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK, healthcare consulting firm.
A few respondents to the survey reported no change in salary or a salary decrease, but most who replied reported a 1% to 3% raise last year.
The majority of respondents to the 2013 salary survey report that they got a raise last year, but a few case managers reported no raise or a decrease in salary. The majority of raises were in the 1% to 3% range. The majority of respondents to the 2011 and 2012 surveys also reported raises of 1% to 3%.
According to Patrice Sminkey, chief executive officer of the Commission for Case Manager Certification, more than 5,000 case managers who responded to the organization's recent trends surveys reported that salaries are rising. The commission includes case managers from all settings, not just hospital-based case managers.
"We see a positive trend in recognizing the value of case managers and the need to compensate them, particularly if they have demonstrated their knowledge and proficiency by becoming certified," she adds.
Hospital Case Management readers are older and experienced case managers, with the vast majority of respondents reporting being over 50. Almost all respondents reported healthcare careers that span 25 years or longer. Many have been case managers for 13 years or longer.
Today's case managers are well educated. The majority of respondents to the salary survey have a bachelor's degree or higher, and many have completed a post-graduate degree.
Years ago, hospital case managers were willing to accept lower salaries than their counterparts who were bedside nurses in exchange for evenings, weekends, and holidays off, says Toni Cesta, RN, PhD, FAAN, partner and consultant, Case Management Concepts, LLC, in North Bellmore, NY. Now that case managers are rotating weekends and holidays and often work beyond the 9 to 5 time slot, salaries have to be commensurate with nursing salaries, she adds.
In the past, case management was attractive because the hours typically were 9 to 5, Monday through Friday, Keeling points out. "Case management has become a seven day a week job. Now a lot of hospitals have case managers in the emergency department and admissions 24-7. The problem is that hospitals are having problems staffing these positions, and many case managers end up working extra to take care of all shifts," she says.
For instance, Beverly Cunningham, RN, MS, vice president of resource management at Medical City Dallas Hospital, reports that attracting staff who will make good case managers has become more difficult as providers and payers across the healthcare spectrum recognize the value of case managers. "Our challenge is how many other entities we are in competition with — skilled nursing facilities, rehabilitation providers, home care, long-term acute care hospitals and now the payers, accountable care organizations, and medical homes. They all want a case manager," she says.
Some case managers are leaving the hospital setting for positions with the insurance industry, Keeling points out. "The third-party payer duties are usually 9-to-5, the pay generally is better than what hospitals offer, and often case managers can work at home and contact their clients telephonically," she says.
Case management caseloads have definitely gotten better, but they haven't decreased to the extent they should, Cesta says. In some hospitals, the case management department is not adequately staffed, she adds.
"When I speak at conferences, there still are case managers who raise their hands and say they have a caseload of 30 or more patients. Case managers are taking on more jobs now that CMS is penalizing hospitals for excess readmissions and has launched other programs that affect reimbursement. But in most cases, they aren't being paid for the new work," Cesta says.
"Case managers are very busy, have a hectic schedule, and often feel pressured. Universally, I hear from new case managers that they didn't realize how difficult the job was when they looked at it from outside," Cesta say.
Case management software and the addition of clerical support have increased efficiency and made it possible for case managers to take on more, she says. "Back in the day, case managers spent a lot of time at the fax machine. A lot of the busy-work has shifted to electronic tools and in some cases clerical staff, and that makes it possible for case managers to tread water with high caseloads," she says.
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