Certification helps CMs meet today’s challenges

Skills, knowledge, competency enhanced

By Hussein A. Tahan, DNSc, RN, CNA
Chair, Commission for Case Manager Certification
Rolling Meadows, IL

Hospital-based case managers are facing mounting challenges today, from the aging of the population and the rise in chronic health conditions to the escalating cost of health care services and advancements in medical technologies. They are especially pressured to ensure that clients have access to cost-effective, appropriate, timely, safe, and efficient health care services. These demands are further compounded by the responsibilities placed upon them to be both advocates for patients and their families as well as stewards of health care resources.

In this complex and challenging environment, hospital-based case managers have at their disposal a powerful and effective means to distinguish themselves: certification. Certification allows case managers to demonstrate their educational background, experience, skills, knowledge, and competencies while executing their complex job responsibilities. As these pressures continue to exist in the future, certified hospital-based CMs will be even more valuable in the health care system for their ability to oversee patient care plans and assure they meet the desired patient and organizational goals.

The number of hospital-based case managers managers has been on the rise, a trend that is expected to continue, according to the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies case managers. According to the 2004 CCMC Role & Function study, of the 6,300 case managers who responded to the survey, the largest percentage (18.8%) indicated they worked in a hospital setting. This was followed by 16.57% in independent case management companies, 14.55% in health insurance companies, and 14.5% in managed care companies.

As part of the 2004 study, the essential activities of case managers across all venues of practice were examined. These included assessment, planning, implementation, coordination, monitoring, evaluating, and outcomes, in addition to a general category related to functions applicable across all steps of the case management process, such as advocacy. The study also assessed knowledge areas necessary for effective and competent CM practice. These included case management principles and concepts, health care management and delivery, health care reimbursement, community resources and support, psychosocial/spiritual issues, and outcomes, as they relate to case management practice.

The study also showed evidence of increased recognition of certification in case management by employers. Specifically, 26% (1,585) of the case managers who participated in this study noted that the CCM credential was required at their facilities. In addition, 20% (1,268) of those who responded indicated there was a financial incentive given to those who attain CCM certification.

Certification allows case managers to access better job opportunities. Being certified indicates the achievement of an advanced level of competence in the practice of case management. That kind of competent practice is desired by all interested parties: patients, providers, health care executives, and payers. Furthermore, there are indications in the market of a rising number of employers who value case management certification.

This is evidenced by the current trend of advertisements for case management jobs that ask for certification in case management as either a required or preferred condition for employment in addition to experience.

Case managers, including those in hospitals and acute-care settings, prefer to work in environments in which their competence, educational degree, type of certification, and contributions to patient care and organizational outcomes are valued, recognized, and rewarded through financial compensation or career advancement. There is evidence in the recruitment market that employers are willing to provide more financial compensation to case managers who are certified.

In addition, many hospitals have career ladders that underscore the value of certification as part of professional development and career advancement.

The CCMC is the largest and oldest case management certifying body accredited by the National Commission for Certifying Agencies (NCCA). Of the 100,000 U.S. case managers, approximately 26,000 hold the CCMC’s Certified Case Manager (CCM) credential. Recognizing changes in the case management field, the CCMC has broadened its certification eligibility criteria to include case managers working in a variety of venues, especially those in hospitals and acute-care settings.

The new criteria, made effective with the 2002 exam, include those listed below:

1. Eliminate the requirement that case managers apply the core components of case management in "multiple environments." The new standard defines the continuum of care as matching the needs of the individuals being served with the appropriate level and type of health, medical, financial, legal, and psychosocial care and services within a setting or across multiple settings.

2. The case manager’s primary focus is on case management practice. CCMC recognizes that although case managers focus primarily on the provision of case management services, they may be involved in direct care activities such as "complex patient education regarding health regimen."

3. Waive the requirement that applicants for the CCMC exam have an approved license awarded on the basis of an examination. This allows social workers and other allied health care professionals, whose states do not require an exam for licensure, to sit for the CCM exam.

Clearly, under the new criteria, hospital-based case managers are eligible to sit for the CCM certification exam. More information about the case management certification is available at the CCMC web site at www.ccmcertification.org.

Along with a growing demand for and recognition of certification for individual case managers, there also is an increased trend in the certification of organizations, such as acute-care hospitals.

Lately, confusion has arisen regarding individual and institutional certification in case management.

There are distinct differences, however, between a certification of an individual vs. an organization.

Certification for an individual takes place in the form of a credential usually based on passing an exam. However, certification for an organization or program within an organization is offered in the form of an accreditation based on demonstrating compliance with specific national standards.

Health care professionals, and in particular hospital-based case managers, must be aware of these important differences and communicate them carefully with members of the public and others.

Perhaps the most important difference, particularly for patients and other members of the public, is that the certified individual is a professional who has achieved an advanced level of competence in an area of specialty or practice such as case management. The certification of a program, service, or specialty at an institution shows that it is recognized as a "center of excellence" in this particular area.

When a facility, such as a hospital, is accredited, the certification does not automatically extend to the individual professionals working there.

Similarly, having certified professionals on staff does not allow a facility to claim certification. If a hospital is accredited by an appropriate agency and employs certified case managers, it demonstrates a meaningful commitment to excellence in care.

The field of case management already has undergone tremendous change and will continue to evolve and mature. As the CCMC evaluates the results of its 2004 Role and Function study, it will be closely monitoring changes in the field, especially as they occur. For example, the job of a case manager likely will include demands to decrease costs, allocate resources, utilize techniques such as disease management, and emphasize patient and organizational outcomes.

The CCMC’s study of the field also enables itself to ensure its certification exam remains evidence-based, backed by scientifically conducted research, and reflective of the current demands and practices of the field.

Keeping the certification exam up-to-date and relevant is essential to assure certified professionals can demonstrate their knowledge, expertise, and competence in case management.

Moreover, through certification, case management professionals will be distinguished in the field. Certification is vital for hospital-based case managers who face the dual pressures of advocating for patients and their families while allocating resources in an acute-care setting.

(Hussein A. Tahan, DNSc, RN, CNA, is the chair of the CCMC, the first and largest case management certifying organization to be accredited by the NCCA. He also is the director of nursing for Cardiovascular Services and Care Coordination at Columbia University Medical Center, New York-Presbyterian Hospital in New York City. Additionally, Tahan is the co-author of The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice.)