Breaking down barriers to CM by telephone
Take these steps to reduce your liability
Does the following scenario sound a little too familiar? "Thank-you for calling ABC Health Care. If you are calling to check the status of a filed claim, press 1. If you are calling to speak to our customer service department, press 2. To file a complaint, press 3. To speak with the case management department, press 4. To repeat this message, press 5."
If your client has been on the phone for more than five minutes and still has not reached a person, you already have begun to increase your liability risk, says Carol Stock, JD, MN, RN, principal of Carol M. Stock & Associates and adjunct professor of nursing at Seattle Pacific University Department of Graduate Nursing. "Telephone technology is wonderful, but it also creates a lot of barriers. When you do telephonic work, you have disadvantages. You can’t see the patient or client, and you may or may not have a chart available."
In addition, some callers may not be very sophisticated, she says. "There are areas of the country that still don’t have touchtone phones. In these cases, you may be cutting off service because these people can’t access your system."
Several developing trends in practice litigation suggest some rules for avoiding legal pitfalls in telephonic case management, Stock says. Here are some steps she suggests you take to reduce your liability when you work with clients on the telephone:
• Never leave a client on hold for more than two or three minutes. "If a client is left on hold for more than a few minutes, there is a liability that begins to evolve," she says. "Remember that angry people bring lawsuits."
• Prepare for accidental disconnection. "Make sure that you get the name and phone number of the client so that if you are disconnected, you can call back. And you must call back right away. If you put it off, you run the risk of getting caught up in other work and letting it go."
• Always follow written protocols. "You must have guidelines written by medical directors to follow and not deviate from them," Stock says. "Of course, there may be situations where it is necessary to deviate from guidelines, but you must document clearly why you did deviate."
Your written protocols also should cover your responses to situations such as suspected elder or child abuse, she says. "Both child and elder abuse are on the rise around the country. You should train your staff on how to contact protective agencies. In some states, notification is mandatory. Your staff training should cover issues such as the necessary reporting forms and any exceptions to mandatory reporting of suspected abuse."
• Comply with the Americans with Disability Act. "If you work with hearing-impaired clients, make sure you have TDD lines. And if there is a language barrier, make sure you have access to an interpretive service. If the client can’t understand your language, you can’t provide similar service, and that may be cause for a discrimination suit."
• Keep telephonic communication confidential. "Don’t give telephonic advice where it can be overheard by inappropriate personnel," she says.
• Always follow up on client progress. "You must call back. If you’ve given advice, you have to check back to see how the client is progressing. This is an obligation under your nurse practice act."
• Avoid allowing inappropriate personnel to give advice on the telephone. "You must be aware who is giving advice over the phone. You must monitor who is doing what in your setting. The receptionist shouldn’t be giving advice."
In addition, Stock says the American Medical Association in Chicago has developed standards for giving medical advice by telephone, and the American Nurses Association in Washington, DC, also is working on guidelines.
Case managers also can take these steps to reduce the legal risks of telephone communication, Stock says:
• Keep hard copy manuals and records on hand. "If your computer goes down and with it all your protocols, guidelines, and patient data, you can’t ask callers to call back later because your computer is down," she says. "You still have to keep hard copy backups and hard copy manuals and documentation forms close by and don’t forget how to document longhand."
• Negotiate 24-hour maintenance contracts. "If you depend on a computer system, make sure that you have 24-hour support when problems occur."
• Be prepared for emergencies. "You should have written procedures for difficult situations. If a client threatens suicide, can the case manager trace the calls? How should the call be traced? Procedures must be in place for handling these kinds of callers. (For more on handling difficult calls, see box, above. Also, see Case Management Advisor, Sept. 1996, pp. 117-122.)