Going solo has challenges, but many rewards

Opportunities abound for independent CMs

If you’re tired of the same routine, dealing with your organization’s bureaucracy and policies and procedures, and being just another employee who has to take the cases your supervisor gives you, it might be time to look into starting your own case management business as a solo practitioner.

It’s not an easy decision to move from working for someone else to working for yourself, but it’s incredibly rewarding, says LuRae Ahrendt, RN, CRRN, CCM, nurse consultant at Ahrendt Rehabilitation in Norcross, GA. Ahrendt specializes in life care planning and case management.

The real advantage is that you can choose the cases you take, rather than having someone assign them, she says. “As case managers become more successful, they can turn down clients if they don’t think they will be a fit,” she says.

Independent case managers can focus on what they like to do and create their own schedule, fitting it in with their other commitments, adds BK Kizziar, RN, CCM, CLCP, owner of BK & Associates, a case management consulting firm based in Southlake, TX.

The time has come for independent case managers, says Brenda Keeling, RN, CPHQ, CCM, president of Patient Response, Inc., a Durant, OK, healthcare consulting firm specializing in regulations and compliance.

“When I started my business in 1995, people really didn’t know what case management was. Now independent case managers have a world of opportunities. The healthcare industry realizes what case managers do and they clearly understand that it’s an important role,” she says.

Today’s healthcare environment creates extraordinary opportunities for case managers who want to become independent case managers or direct-to-consumer case managers,” adds Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.

Independent case managers contract their services to organizations and individuals seeking them, Mullahy explains. Their services might include working directly with injured employees or claimants, acting as a consultant to a physician practice group or an employer organization, contracting with healthcare providers to design programs, or providing private case management directly to patients and therefore contracting with the patient or family members.

Case managers who restrict themselves to direct-to-consumer case management market their services directly to the community and are paid by the patient or family, rather than a third-party payer. Services may include coordinating care for a child, an aging parent, or a spouse with a complex medical condition.

After years of urging by the Case Management Society of America (CMSA), the Centers for Medicare & Medicaid Services (CMS) has created CPT codes for physicians to provide transitions of care, including contacting patients after they are discharged from the hospital, Kizziar points out. “The hospital case managers will alert physicians when their patients are discharged from the hospital and physicians are going to be responsible for contacting patients and working to ensure that the discharge plan is successful,” she says.

The CMS regulations don’t specify that a nurse should make the calls, but it still represents a tremendous opportunity for case managers to develop agreements with physician practices to track patients in the hospital and follow up after discharge, Kizziar says.

Families are beginning to understand the value of case management when they need help navigating the healthcare system and identifying resources and funding for loved ones with complex care needs, Ahrendt adds. “There’s an increasing need for geriatric case management with the graying of the population, especially in the area of aging with disabilities,” she adds.

Some case managers who become independent are outsourcing to hospitals to provide case management services on an as-needed basis, Keeling says. “They sign up independently or with an agency that handles PRN nurses,” she says. Hospitals call a PRN (per diem nurse) to work as needed to fill in when the nurse employed by the hospital is sick or on vacation.

Case managers have the opportunity to provide services to individuals, companies, physician practices, or even contract with hospitals to perform their post-discharge follow up, Kizziar says. One possibility is to contract with employers to guide employees through the process of choosing insurance coverage.

Ahrendt points out that case managers also have opportunities in long-term care, disability, Medicaid, and other roles created from healthcare reform.

While there are opportunities, don’t expect to find one single stream of referral sources that is sufficient for a comprehensive practice, Ahrendt advises. Develop a vision for your business in one year, five years, and ten years and proceed that way. Develop a good referral network.

“In these economic times, case managers are well advised to look at a broad area of practice and expand their opportunities by matching their skills with the products the market desires,” Ahrendt says. For instance, in addition to case management, consider file review or legal nurse work.

Do a lot of research into what the market is in your area to make sure there is a need for the kind of services you want to offer, Kizziar says.

Be willing to do many different things, she says. In the beginning of her practice, she became a certified Life Care Planner because there was work available in that area.

She did a lot of work with workers compensation and insurance companies as well. For instance, she was hired by a liability insurer for a restaurant chain to manage the care of a woman who slipped on a green bean at a salad bar and broke her hip. “The insurer wanted to make sure the woman got the care she needed and was so pleased with the company’s response that she didn’t file a lawsuit,” she says.

Today, case managers have numerous opportunities to work as independent contractors, Kizziar says.

She now speaks at conferences, contracts with other independent case managers to cover their practices when they are sick or on vacation, and sometimes takes an interim position as a case management director for a hospital while the administration searches for a permanent director.

It took three tries for Brenda Keeling to find a market for her services that would pay the bills. She started out providing case management to individuals and families.

“I wanted to be able to work out of my home and choose my own schedule. I live in rural Oklahoma and wanted to provide a service for people who didn’t have the option of having someone to help them navigate the healthcare system and identify resources,” Keeling says.

The only problem was that while she had no shortage of people who wanted her services, she didn’t have a way to get paid. “There was no payer source at the time and many people needed help with paying their bills, so they couldn’t pay me,” she says.

For a while, Keeling reviewed legal cases but found that many law firms had full-time staff to review medical cases and she wasn’t making enough money to cover her living expenses.

Option three was a success. Keeling had experience in regulations and compliance as an employee of Oklahoma’s Quality Improvement Organization. At the same time, hospitals were beginning to need help with compliance issues.

Keeling contracts with hospitals who are facing a Joint Commission survey or who need help avoiding denials from the Recovery Auditors or through CMS’ readmission reduction and value-based purchasing programs.

“Now with value-based purchasing, the readmission reduction program, core measures, and other CMS initiatives, there’s a demand for my case management experience as well as my regulatory experience,” she says.

Keeling speaks on the national circuit and advises other case managers to persevere and stay the course through the rough times.

“It took a while to find my niche. It was always there but I didn’t appreciate the expertise I had to share,” she says.