5 Goals to Tackle in the War on Obesity

May 18th, 2012 by Cheryl Miller

It’s not new that obesity numbers are going up. Hardly a week goes by that we don’t report an alarming new statistic on this problem; the latest, from Duke University, states that nearly half of the U.S. population could be obese by 2030; and 11 percent of this group will be severely obese, or roughly 100 pounds or more overweight.

It’s hardly new that obesity endangers not just its victims, but our healthcare infrastructure as well; a recent study from Duke and the AHRQ reported that obesity costs states $15 billion a year in medical expenses, and the Institute of Medicine (IOM) estimates that obesity costs the United States $190.2 billion a year in health-related costs. And the costs of obesity aren’t limited to our country; according to new data from the World Health Organization (WHO), “In every region of the world, obesity doubled between 1980 and 2008,” says Dr Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. “Today, half a billion people (12% of the world’s population) are considered obese.” The report goes on to say:

The highest obesity levels are in the WHO Region of the Americas (26% of adults) and the lowest in the WHO South-East Asia Region (3% obese). In all parts of the world, women are more likely to be obese than men, and thus at greater risk of diabetes, cardiovascular disease and some cancers.

So it’s by no means new that efforts are once again underway to control this epidemic, with the IOM’s new report on “Accelerating Progress in Obesity Prevention.” But what is new is the scope of the conversation on obesity this time. Just this month, Kaiser Permanente, HBO, the National Institutes of Health, the Michael & Susan Dell Foundation, the CDC and the IOM launched a major public-health campaign aimed at obesity, excess weight and their effects on the nation’s health. A new four-part documentary series from HBO, called the Weight of the Nation, is currently available to all cable subscribers, not just HBO subscribers. And the CDC held a Weight of the Nation conference in Washington, D.C. on May 7th, where speakers stressed that while knowledge of healthy eating and lifestyle strategies were widely known, access to these strategies weren’t always easily accessible.

And just about every media outlet has made the issue a pivotal part of their program. Because according to the IOM’s report, it will take a concerted effort from all to make any progress.

In its comprehensive review of obesity prevention-related recommendations, strategies and action steps that have the greatest potential to speed up progress in combating the obesity crisis, the agency presents five goals:

  • Make physical activity an integral and routine part of life.
  • Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice.
  • Transform messages about physical activity and nutrition.
  • Expand the roles of healthcare providers, insurers, employers.
  • Make schools a national focal point.

    • There must be consensus among all relevant parties to help make these goals attainable, the report stresses. To make physical activity more accessible, one example encourages civic leaders to convert unused spaces, like railroad beds, into walking/running/biking trails. To make healthy food and beverage options available, the report recommends the following steps:

    reducing unhealthy food and beverage options while substantially increasing access to healhier food and beverages at competitive prices. The overconsumption of sugar-sweetened beverages must be reduced; calories substantially slashed in meals served to children while the number of affordable, healthier menu options is boosted significantly; and governments need to provide incentives to encourage supermarkets and other food retailers to place stores in underserved areas.

    Congress, the White House, federal policy makers and foundations have to dedicate funds to develop and implement sutstained social marketing campaigns aimed at physical activity and nutrition. Employers and doctors need to encourage and uphold better health. And schools need to be a major advocate of healthy eating for children, because most children spend nearly half their days there, and according to the IOM, consume between one-third to one-half of their daily calories there.

    Maybe this is just what we need, an APB, of sorts, or a call to action to everyone from individuals to families to schools to doctors to employers to civic leaders to the White House to get on board with this issue. Because none of this is new information. But just maybe, we could make it old news.

    Posted in Uncategorized | No Comments »

    New Rule Would Bring Medicaid Payments for Primary Care in Line with Medicare’s

    May 14th, 2012 by Cheryl Miller

    Under a proposed rule, Medicaid will reimburse primary care services for family medicine, general internal medicine, pediatric medicine and related sub-specialists at Medicare levels in 2013 and 2014. Such a ruling could help encourage primary care physicians to continue and expand their services to Medicaid beneficiaries, including providing checkups, preventive screenings, vaccines and other care, CMS officials say.

    CMS follows the AMA’s recommendations when calculating physicians’ fees under Medicare nearly 90 percent of the time, a report from Columbia University finds. The fees, which are based on assessments of time and effort associated with various physician services, often influence how some state and private payors pay doctors. In recent years there have been increasing pay gaps between PCPs and specialists, and PCPS have expressed concerns that the AMA committee is partly responsible for this. More in this issue.

    The problem of obesity continues to grow, with the latest findings estimating that nearly half of the U.S. population could be obese by 2030, which means the healthcare system could be burdened with 32 million more obese people by that time, according to research from Duke University, RTI International, and the CDC. Keeping obesity rates level could save nearly $550 billion in medical expenditures over the next two decades, researchers state.

    And the age of claimants for critical illness insurance policies decreased in the past year, according to a study from the American Association for Critical Illness Insurance. The majority of claimants were younger than 55, marking a significant increase in claims by younger policyholders compared to those filed in 2010.

    Don’t forget to participate in our second annual survey on ACOs. If you contribute by May 16th, you will get a FREE executive summary of the compiled results and year-over-year ACO trends.

    These stories and more in this week’s issue of the Healthcare Business Weekly Update.

    Posted in Uncategorized | No Comments »

    Meet Case Management Manager Hillary Calderon: Care Coordination Crucial to Achieving Better Outcomes, Costs

    May 10th, 2012 by Cheryl Miller

    This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

    Hillary Calderon, RN, Senior Manager of Corporate Case Management for HCA

    HIN: Tell us a little about yourself and your credentials.

    Hillary Calderon: I have been a director of case management for over 16 years. I worked for (now Vanguard-owned) Baptist Hospital in San Antonio for nine years, and then transitioned to an HCA-owned facility in San Antonio, Northeast Methodist Hospital. I am an RN, working on my master’s degree.

    What was your first job out of college and how did you get into case management?

    I actually was working as a unit secretary (as my degree was in home economics). I then went to nursing school and worked as a telenurse for five years. The case management department was in its infancy and I helped bring it to fruition. We went through many changes; it was a good opportunity and I wanted to be challenged to start a new restructuring in the field.

    Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

    Well, many. Making a difference for patients and now making a difference with case managers that are making a difference. I am thankful that I have the opportunity to assist case management departments in creating a process that will meet corporate and CMS requirements. It seems like when I question my way, it comes back as the correct road for me to be on. I love this, so it is not work for me!

    In brief, describe your organization.

    HCA- Hospital Corporation of America. We currently have over 170 hospitals (and growing) across the nation. Great company to work for!

    What are two or three important concepts or rules that you follow in case management?

  • Keep focused on your goals. The goals should be patient and family first. Right plan for the patient/family.
  • Remember what is in scope for you to do. Do what you can, concentrate on that. Don’t get caught up in “extra” duties as assigned, unless it pertains to your goal (see first item)

    • What is the single most successful thing that your organization is doing now?

    Focusing on initiatives, quality driven and clinical excellence.

    Do you see a trend or path that you have to lock onto for 2012?

    Care coordination. A must for healthcare to achieve better outcomes and cost containments.

    What is the most satisfying thing about being a case manager?

    The knowledge base, the liaison role that a case manager has in communicating with the patient, family, administration, payors and post-acute providers. Problem solving, it’s like a puzzle!

    Where did you grow up?

    Grew up in Dallas (early years), then San Antonio the rest of my years.

    What college did you attend? Is there a moment from that time that stands out?

    East Texas State University… no not really a moment in time. I was a member of the Gamma Phi Beta Sorority. Loved that!

    Are you married? Do you have children?

    Married, three daughters… 21, 25, and 28. No grandkids, and they are all three single!

    What is your favorite hobby and how did it develop in your life?

    I love, love, love gardening. I have always loved the outdoors and creating landscapes. I also love to paint (watercolor and acrylic).

    Is there a book you recently read or movie you saw that you would recommend?

    Last book I read was “The Help.” I am last at reading the trends. I am in the process of reading “The Hunger Games.” Last movie I saw was “The Artist,” this year’s Oscar winner. Loved it!

    Posted in Case Management, Case Manager Profile | No Comments »

    United States Rates Higher Than Most Nations in Diabetes-Related Deaths

    May 7th, 2012 by Cheryl Miller

    Obesity and diabetes continue to make headlines, and are the subjects of two of our stories this week. The first: the United States has among the highest rates of obesity and diabetes-related deaths than most nations, according to researchers contributing to a new Commonwealth Fund report. This, among other factors, accounts for the United States’ spending more on healthcare than most nations, but getting just fair marks when it comes to quality. More on this, including the nation with the lowest per capita healthcare costs, in this issue.

    Kaiser Permanente, HBO, and four major organizations are hoping to raise the country’s rating with a new public health campaign aimed at obesity, excess weight and their effects on the nation’s health. Integral to the campaign is the launch of The Weight of the Nation, a four-part documentary series that will be available to all cable subscribers, not just HBO subscribers, on May 14th and 15th. There will also be an option to view the series with Spanish subtitles. Along with HBO, Kaiser is working with National Institutes of Health, the Institute of Medicine, the Michael & Susan Dell Foundation and the CDC on this month-long campaign.

    A campaign of a different sort takes aim at underserved communities, with the government’s continued effort to ensure their access to primary healthcare services. HHS has dedicated nearly $730 million to build, expand or improve community health centers. Currently, more than 8,500 service delivery sites around the country deliver care to more than 20 million patients regardless of their ability to pay.

    And there are no likely measures on tap to rein in specialty drug spending, which is expected to soar over the next decade, according to a new study from the Center for Studying Health System Change (HSC). Unlike conventional prescription drugs, whose spending has been limited by patent expiration, generic substitution and other factors, health insurers and employers have few tools to control rapidly rising spending on specialty drugs, which are typically high-cost biologic medications used to treat complex medical conditions. Studies show that specialty drug spending has increased by 14 to 20 percent annually in recent years.

    Are you a follower, director or guide? Check out our story on these three types of communication styles within motivational interviewing to find out.

    These stories and more in this week’s issue of Healthcare Business Weekly Update.

    Posted in Uncategorized | No Comments »

    Self-Examination: Industry Questioning Necessity, Cost Irregularities of Healthcare Services

    May 2nd, 2012 by Cheryl Miller

    Regardless of whether the Supreme Court overhauls health reform, the industry is seriously thinking about ways to cut healthcare spending, either by reexamining the need for commonly administered services or unraveling the mysteries of medical bills.

    As we reported in a recent news story here, a coalition of nine leading physician specialty societies representing nearly 375,000 physicians have identified specific tests or procedures that they say are commonly used but not always necessary in their respective fields.

    Coordinated by ABIM Foundation’s Choosing Wisely campaign, the lists of “Five Things Physicians and Patients Should Question” provide specific, evidence-based recommendations physicians and patients should discuss when making healthcare decisions. Among the tests that patients might not necessarily need are stress imaging tests for annual checkups if the patient is an otherwise healthy adult without cardiac symptoms, according to the American College of Cardiology, and chest X-rays for patients going into outpatient surgery, according to the American College of Radiology. Most of the time, the x-ray images will not result in a change in management and have not been shown to improve patient outcomes, college officials say.

    A recent opinion piece from the New York Times echoes the feeling that more evaluation of health services and costs is necessary, and sheds some light on the abundance of medical tests. The article, Why Medical Bills are a Mystery, written by Robert S. Kaplan and Michael E. Porter, professors of accounting and strategy, respectively, at Harvard Business School, states that:

    The lack of cost and outcome information also prevents the forces of competition from working: Hospitals and doctors are reimbursed for performing lots of procedures and tests regardless of whether they are necessary to make their patients get better. Providers who excel and achieve better outcomes with fewer visits, procedures and complications are penalized by being paid less.

    The article goes on to cite a lack of uniformity for healthcare costs and reimbursements, and suggests that by analyzing costs, hospitals can save money and improve care:

    Because health care charges and reimbursements have become disconnected from actual costs, some procedures are reimbursed very generously, while others are priced below their actual cost or not reimbursed at all. This leads many providers to expand into well-reimbursed procedures, like knee and hip replacements or high-end imaging, producing huge excess capacity for these at the same time that shortages persist in poorly reimbursed but critical services like primary and preventive care.

    A new University of California San Francisco (UCSF) study published online this week in Archives of Internal Medicine underscores the concerns voiced by Kaplan and Porter:

    The study looked at nearly 20,000 cases of routine appendicitis at 289 hospitals and medical centers throughout California. The patients – all adults – were admitted for three or fewer days. The researchers uncovered an enormous discrepancy in what different hospitals charge, ranging from a low of $1,529 to a high of nearly $183,000. The median hospital charge was $33,611. The startling cost variation reveals a “broken system,” the authors said.

    “Consumers should have a reasonable idea of how much their medical care will cost, but both they and their healthcare providers are often unaware of the costs,” said lead author Renee Y. Hsia, MD, an assistant professor of emergency medicine at UCSF.

    What to do? The Journal of the American Medical Association (JAMA) weighed in on ways to cut waste and improve quality in U.S. healthcare. In a recent article researchers identified six categories where cuts could result in a significant reduction in healthcare costs. In these six categories: overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse, the sum of the lowest available estimates exceed 20 percent of total healthcare expenditures.

    Posted in Avoidable ER Use, Behavioral Health, Healthcare Costs, Transitions in Care, Uncategorized | No Comments »

    Organ Donation and 5 More Reasons Healthcare Should Follow Consumers to Social Media

    May 1st, 2012 by Patricia Donovan

    Now that Facebook users can post their organ donor status as easily as photos of last night’s dinner, it might be time for healthcare to “like” social media a little more.

    Starting today, Facebook users can indicate in their timeline that they’re an organ donor. They can also share stories about their decision to become a donor and register for state and national organ donor registries.

    Facebook’s move reflects the increasing integration of social media and health behaviors. Consumers, especially 18- to 24-year-olds, are heavily invested in social media use for health-related matters — for education, provider and treatment reviews, physician interactions, and decision-making, according to new research by the Health Research Institute (HRI) at PricewaterhouseCoopers (PwC).

    Healthcare organizations that ignore these trends may miss a chance to engage and do business with these consumers, say authors of the new report, Social media likes healthcare: From marketing to social business.

    The report found that social media activity by hospitals, health insurers and pharmaceutical companies is miniscule compared to the activity on community sites such as patientslikeme®, where 146,438 members (today’s count at 1:56 pm EDT) share thoughts on more than 1,000 medical conditions.

    For example, the report notes that while eight in 10 healthcare companies (as tracked by HRI during a sample one-week period) had a presence on various social media sites, community sites had 24 times more social media activity than corporate sites.

    For the uninitiated, the idea of social media can be intimidating. There are also legitimate concerns related to patient confidentiality and privacy. To this end, the General Medical Council (GMC) has drafted guidance for doctors on managing the risks of using social media Web sites such as Twitter and Facebook to connect with patients. Rule number 1: maintain a professional boundary between doctor and patient.

    Still not convinced? If Facebook’s organ donation tool doesn’t motivate, here are five more trends in health-related use of social media identified in the HRI research:

    • One-third of consumers now use social media sites such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical information, tracking and sharing symptoms, and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans.

    • Four in 10 consumers say they have used social media to find health-related consumer reviews (e.g. of treatments or physicians); one in three have sought information related to other patients’ experiences with their disease; one in four have “posted” about their health experience; and one in five have joined a health forum or community.

    • When asked how information found through social media would affect their health decisions, 45 percent of consumers said it would affect their decision to get a second opinion; 41 percent said it would affect their choice of a specific doctor, hospital or medical facility; 34 percent said it would affect their decision about taking a certain medication; and 32 percent said it would affect their choice of a health insurance plan.

    • While 72 percent of consumers said they would appreciate assistance in scheduling doctor appointments through social media channels, nearly half said they would expect a response within a few hours.

    • Young adults are leading the social media healthcare charge. More than 80 percent of individuals between the ages of 18 and 24 said they were likely to share health information through social media channels and nearly 90 percent said they would trust information they found there. By comparison, less than half (45 percent) of individuals between the ages of 45 and 64 said they were likely to share health information via social media.

    Posted in Disease Management, Healthcare Trends, Wellness/Prevention, e-Health | No Comments »

    CMS Proposes Increased Hospital Fees for Improved Patient Care

    April 30th, 2012 by Cheryl Miller

    Hospitals are getting a raise, of sorts. CMS has proposed a rule that would update Medicare payment policies and increase rates for inpatient stays at general acute care and long term care hospitals. The ruling, if finalized, is designed to strengthen patient care and promote quality over volume, CMS officials say. Included are quality measures regarding hospital-acquired infections, and a new HCAHPS survey measure regarding care transitions. Public input will be accepted until June 25th.

    Care transitions is the subject of a new report from Avalere Health for the Alliance of Community Health Plans. It proposes five ways to enhance the transition from hospital to home. Among them: engaging patients early on in their transition period, prior to discharge, and encouraging providers to become program partners. Health systems whose transition programs are perceived favorably are also mentioned in the report; details in this issue.

    The chronically ill are the target of a new Commonwealth Fund report, which seeks to launch a care plan over the next 12 months in 50 to 100 communities around the country that have significant concentrations of patients with multiple chronic conditions and high medical costs. Such a plan could save $184 billion in health spending over the next 10 years, commission officials say.

    Text message reminders to parents about flu vaccinations may help boost the number of children vaccinated, according to a recent report from Columbia University Medical Center and New York-Presbyterian Hospital. Texting is considered an effective tool given its ability to reach large numbers of people, researchers say. The study focused on hard-to-reach, low-income, urban children and adolescents, because they are more at risk for acquiring influenza due to their crowded living conditions. And while a higher percentage of families receiving the message did vaccinate their children, overall, vaccination rates remain low.

    This might be good news to a group of Vermont-based residents advocating against a law that would make vaccinations in their state mandatory. According to a recent story from ABC World News the debate over the bill has divided Vermont’s families over the benefits and risks of vaccines. It has also pitted the state House — whose majority voted down the bill — against the state Senate, which voted to approve it. The debate will most likely continue, lawmakers say.

    And lastly, if you haven’t already, please take part in our second annual Accountable Care Organizations survey. The last 12 months have been a hotbed of ACO activity. In addition to the many private pilots of this collaborative care model, CMS kicked off its Medicare Shared Savings Program on April 1st. Participants get a FREE executive summary of the compiled results and year-over-year ACO trends.

    These stories and more in this week’s issue of Healthcare Business Weekly Update.

    Posted in Affordable Care Act, Avoidable ER Use, Behavioral Health | No Comments »

    New HCAHPS Measure Would Evaluate Quality of Care Transitions

    April 27th, 2012 by Patricia Donovan

    Beginning in January, patients discharged from the hospital could be asked three key questions to assess the quality of their care transitions, as part of a proposed new measure in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey.

    As part of a proposed rule issued April 24, CMS wants patients about to be discharged to respond to the following three statements about the care transition:

    • During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left.

    • When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

    • When I left the hospital, I clearly understood the purpose for taking each of my medications.

    For the last question, patients would be able to indicate that they were not given any medication at discharge.

    The proposed questions are based on the three-Item Care Transition Measure developed by the University of Colorado Health Sciences Center for the NQF Endorsement Project entitled “National Voluntary Consensus Standards for Quality of Cancer Care.” Detailed information on scoring methodology can be found on the Care Transition Measure Web site.

    CMS also wants to add two “About You” items to the survey that would not be included in public reporting of the HCAHPS survey but would be employed in the patient-mix adjustment:

    • During this hospital stay, were you admitted to this hospital through the Emergency Room?

    • In general, how would you rate your overall mental or emotional health?

    CMS said it has received numerous inquiries and requests from hospitals and researchers to add a survey item concerning patients’ overall mental health. Some researchers claim that mental health status is an important factor in how patients respond to HCAHPS survey items.

    The HCAHPS Hospital Survey is a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care. In its current form, the HCAHPS survey contains 18 patient perspectives on care and patient rating items that encompass eight key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.

    The survey also includes four screener questions and five demographic items, which are used for adjusting the mix of patients across hospitals and for analytical purposes. The current survey is 27 questions in length.

    Posted in Uncategorized | No Comments »

    27 Questions to Ask to Prevent Heart Failure Readmissions

    April 27th, 2012 by Jessica Papay

    Was aspirin prescribed for the patient?

    Asking this simple question and 26 others on a one-page checklist can help to prevent heart failure readmissions and in the long run reduce billions in Medicare healthcare spend each year, according to new research presented by the American College of Cardiology (ACC).

    The ACC determined that the checklist made it possible for clinicians to cut the percentage of patients who were readmitted to the hospital within one month of a cardiac event from 20 to just 2 percent.

    The readmission rate continued to be lower six months after discharge.

    This checklist, developed by Dr. Abhijeet Basoor at St. Joseph Mercy Oakland Hospital in Pontiac, Mich., where he practices internal medicine and cardiology, was instituted after approval of the hospital Cardiovascular Quality Integration Board.

    According to Dr. Basoor, everything on the checklist is derived from and reinforces evidence-based practices for managing heart failure and lowering the likelihood of another cardiac event.

    The checklist is divided into three parts:

    • medications and their appropriate dose modification;
    • counseling and monitoring intervention; and
    • follow-up instructions.

    The average heart failure patient will need 12 to 15 of the total 27 interventions listed, so using this checklist can help remind both patients and doctors about the various steps that can be taken to manage the condition, Dr. Basoor added.

    “The checklist provides simple reminders to instruct patients about things like diet, weight, blood pressure monitoring and appropriate drug dose up-titration,” said Dr. Basoor. “The physician or nurse practitioner working with the patient uses the checklist, so hospitals don’t have to pay for additional nursing staff or home care follow-up.”

    According to Dr. Basoor, “In addition to lowering 30-day and six-month readmissions and the associated costs, we also showed that more patients in the checklist group were likely to be on correct medications and had appropriate drug doses than patients in the control group.”

    For this new study, 96 heart failure patients were followed for six months after discharge for an initial cardiovascular event. Doctors randomly used the checklist before discharge in half of these patients, while the other half received standard treatment including discharge education and instructions. Data were collected at 30 days and six months post-discharge. Both groups were comparable in terms of other cardiovascular risk factors, age, sex and physician groups treating them.

    After excluding deaths during follow-up, only one person in the checklist group was readmitted to the hospital in the month following discharge compared to nine in the control group. At six months, 11 patients in the checklist group had been readmitted, compared to 20 in the control group. Higher proportions of patients were on ACE I/ARB medications (those used to control blood pressure) in the checklist group compared to the control group (40 of 48 vs. 23 of 48, 95 percent CI = 0.17 to 0.53, p < 0.001). Compared to the control group, the rate of dose up-titration for beta-blockers and/or ACE I/ARB was significantly more common in the checklist group (21 of 48 vs. four of 48, 95 percent CI = -0.5 to -0.19, p < 0.001).

    "Right now the checklist is not part of the standard medical record, so there could be resistance to using it," said Dr. Basoor, "but if we show it’s really beneficial and easy to use, this could become a common practice. We’ve shown that quality of care can be improved at almost no additional cost. In the era of electronic medical records, we are working on transforming the checklist to an electronic form."

    While other studies have shown that home care and patient education can reduce readmissions, this is the first to evaluate the use of such a unique one-page, in-hospital checklist that required no extra cost.

    According to the Kaiser Family Foundation, heart failure readmission costs $12 billion in Medicare spending each year and approximately 25 percent of Medicare patients with heart failure are readmitted to the hospital within 30 days of an event. Previous studies have shown 50 percent of these heart failure readmissions can be prevented. When the Affordable Care Act takes effect in 2014, Medicare will begin to penalize hospitals with high readmission rates by refusing reimbursements.

    Posted in Avoidable ER Use, Disease Management, Healthcare Administration, Healthcare Costs, Hospital Readmissions, Reducing Readmissions, Wellness/Prevention | No Comments »

    Meet Healthcare Case Management Manager Barbara King: Nurses Key to Reinterpeted Vision of Case Management

    April 26th, 2012 by Cheryl Miller

    This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

    Barbara King, BSN, RN, Co-Founder and President of NurseValue, Inc.

    HIN: What was your first job out of college and how did you get into case management?

    Barbara King: My first position was as a nurse, working the night shift on a 33-bed male urology unit. My fondest memory: an elderly man with a TURP (transurethral resection of the prostate) that had clotted. I entered the room prepared to irrigate his catheter, knelt beside the bed, and explained the procedure to the patient. He stopped me and said, “Please go get the real nurse, you look too young to be a nurse.” I explained that I was the ONLY nurse and he did finally agree to allow me to clear his catheter.

    I spent many years in various nursing positions before I fell into the role of case management. I had grown tired of nursing and felt that the lack of staffing would eventually lead to an error that I did not want to make. I tore up my nursing license and took a position outside of the nursing field. A short time later a friend from a staffing agency called and asked me to fill an open position. She described a telephonic case management position to me. She overcame my protests of ignorance and I reported to work as a temporary employee for an insurance company that was rolling out one of the first telephonic case management pilot programs in the country. My friend at the staffing company told me just to listen, follow directions and keep quiet. She assured me that I could do the job. I received a superb orientation and began working as a telephonic case manager. I loved the work and was assured by my manager that I would soon be hired. The next thing I knew I was the supervisor of the western division of the company handing all corporate accounts. At this point, I went to my manager to ask if they had made a determination about a permanent position. She said, “I thought we already hired you. You have already been promoted.” I was hired that day and found my staffing friend was right. Listen, follow directions, keep quiet and you can do it.

    Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

    Approximately seven years ago I grew tired of seeing case management interpreted by those who did not really understand the service. Knowing the way I wanted to perform as a case manager, it was time to make a professional change. I resigned from my corporate position on Martin Luther King’s birthday because “I had a dream”. That was the birth of NurseValue, Inc. Yes, I believe nurses have value and so does the population they serve.

    In brief, describe your organization.

    NurseValue, Inc. offers comprehensive custom consulting services for individuals, attorneys, managed healthcare companies, insurance companies and organizations that require field and telephonic case management, legal nurse consulting, life care planning, disability cost analysis for worker’s compensation, third party medical bill review, and Medicare set-aside allocation services.

    What are two or three important concepts or rules that you follow in case management?

  • The number one rule in both business and nursing is to always be honest.
  • Next I would say that the nursing process is useful when providing any service: assessment, diagnosis, planning, implementation, and evaluation.
  • Lastly, continue to learn throughout your career as you never know when that tiny bit of information will help to solve a pressing issue.

    • What is the single most successful thing that your organization is doing now?

    NurseValue provides custom solutions to our clients. Our experience opens the door to complicated case referrals. We then use our understanding of the health system, our knowledge of health, injury and illness, and our collaborative communication process to drive cases to the most successful end point possible. Our clients appreciate the fact that we have developed a successful case management model that combines the telephonic and field case management services in a unique delivery system that provides a cost conscious solution.

    Do you see a trend or path that you have to lock onto for 2011?

    Healthcare is trending toward benchmarking utilizing clinical treatment guidelines. Utilizing benchmarking tools to measure success will become increasingly important to the practice of medicine and nursing.

    What is the most satisfying thing about being a case manager?

    I love so much of this profession it is hard to determine what I like most. I guess, it is most satisfying when the client I am working with reaches full potential and returns to life with the tools to be successful.

    Where did you grow up?

    I grew up in Iowa. I was an Iowa “pig farmer’s daughter”. You can take the girl to the city, but a little bit of country will always remain.

    What college did you attend? Is there a moment from that time that stands out?

    My post-secondary education was completed at the University of Iowa, in Iowa City Iowa. If there was one time in history that I could return to it would be nursing school. So…there are so many fond memories that I could not choose just one.

    Are you married? Do you have children?

    My husband and I have been married for over thirty years. We raised two sons who live out of state and visit whenever they get a free moment in their busy lives.

    What is your favorite hobby and how did it develop in your life?

    My sanity is my gardening. The plants still respond to the nursing process, but they are like babies – they present with silent problems and need a lot of TLC.

    Is there a book you recently read or movie you saw that you would recommend?

    I use to read a great deal of fiction, however now my reading is limited to professional journals. There never seems to be enough time to absorb the ever changing treatment protocols and healthcare regulations.

    Any additional comments?

    Thank you for the opportunity to express my views. When I left for nursing school, my father said, “whether you become a nurse or not, no one can ever take the knowledge away from you.” I don’t believe he realized how prophetic his comment was. Nursing enables us to advocate for our loved ones, our patients (clients), and even strangers that we meet along the way. The opportunities are endless.

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