Success means doing the right thing

Know the rules and follow them

To make a go of it as an independent practitioner, case managers must have a strong desire to do the job, know the rules and regulations involved in their profession, stand firm and resist the pressure to veer from doing things the right way, says Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK, healthcare consulting firm specializing in regulations and compliance.

It’s not a matter of keeping people happy. It’s a matter of doing the right thing for the patient, following the rules, and ensuring that your clients do the same. “A lot of times, hospital administrators don’t like what I tell them, but when I show them the regulations and the numbers, they know I am right,” she says.

For instance, hospital finance people point out that if only people who meet admissions criteria are admitted, the census will drop. In those cases, Keeling tells them of a young patient who was admitted for treatment for asthma after having only one breathing treatment in the emergency department. Evidence-based medicine recommends three treatments, and that is a standard requirement of payers. “The stay was denied, the hospital billed the family $40,000, and they ended up in bankruptcy court. Ignoring admissions criteria was financially devastating for the patient’s family and the facility didn’t get paid,” she says.

When case managers care about doing the right thing for the patients, referrals will follow, she says.

If you consistently demonstrate a quality, ethical work product and are committed and passionate about the best outcomes, people will trust you and recommend you, says LuRae Ahrendt, RN, CRRN, CCM, nurse consultant at Ahrendt Rehabilitation in Norcross, GA.

“The world of case management is pretty small, and individuals can’t afford not to act in a high quality, ethical manner because people will know. You’ve got to be committed to your client’s best outcome every time,” she says.