CMs being recognized but not compensated
Learn how to sell your value
While new regulatory mandates and payer requirements are making case management essential, case managers are still not getting the recognition they deserve in the form of increased compensation, says Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK, healthcare consulting firm.
The industry is beginning to recognize the value of case management; however, in some hospitals, case managers still aren't being paid as much as floor nurses, she says. "In rural hospitals, it's a fight to get case management positions and to pay them what they are worth," she says.
Marcia Diane Ward, RN, CCM, PMP, a case management consultant based in Columbus, OH, reports that her friends who are case managers are getting cost-of-living raises of 2% to 3% a year. "But whether they work in the insurance industry or the healthcare delivery industry, case managers often comment that most of what they do is paperwork and they don't have the advocacy role they once had," Ward says.
Achieving certification may be one way for case managers to get a bonus or an increase in salary, adds Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.
"Many organizations will recognize and offer a slight salary increase for case managers who are certified. Even if organizations do not support certification, I strongly believe and encourage individuals to pursue this as a goal for themselves," she says.
Case managers who responded to the Commission for Case Management Certification's annual trend survey, sent to 5,000 certified case managers, report that their salaries are rising, says Patrice Sminkey, chief executive officer.
Many organizations are either requiring that case managers be certified when they are hired or that they become certified within two or three years, Sminkey says.
"Our certificants tell us that they have experienced an increase in pay once they get their CCM and that they have greater opportunities for advancement," she says.
But some case managers are leaving the profession because of low salaries and huge workloads, Ward points out. "One friend, who had been a case manager for eight years, took a job as a hospice nurse and has a much larger salary. In addition, she feels that now she is making a difference to her patients," she says.
Another of Ward's friends started her own business as an independent case manager and found a niche with money management companies who are looking for services to benefit their older clients. "They hire her to set up services for their clients and for life care planning," Ward says.
As case managers are being asked to do more for less, they are getting frustrated and have a high burnout rate, Keeling adds. "Everyone tends to forget that nurses get into the profession because they have a passion for caring and nurturing. When they feel like they are just pushing papers and not affecting patient care, they lose their effectiveness," she adds.
"Case managers are going to have to beef up the way we explain our role. We can't blame the salaries and workload on the industry and economics. We have not done a good job of educating people about case management and selling our role," Keeling says.
In the past, there has been a major focus on the utilization review side of case management, which has lead people to think of case managers as the chart police, she says.
"Case management isn't the kind of profession that has lobbyists who can promote our value. Organizations have got to see the return-on-investment and the data isn't easily available to show the value that case managers bring to the table," Ward says.
In fact, many case managers may not recognize the value they add to their individual setting, or they lack the skills to communicate their value effectively, Mullahy says. But because case managers create additional overhead for the organizations that hire them, they need to obtain baseline financial data to demonstrate what savings case management interventions attain, she adds.
"We need to understand what the outcome could be [e.g. clinical, patient satisfaction, decreased hospital readmissions, financial impact, etc.] for the specific practice setting we are in, define just how we can achieve those outcomes, know what success will look like in that practice setting, and then communicate those results to those who need to know in a manner that is relevant and understandable to them," she adds.