With the current COVID-19 pandemic, healthcare facilities in the US are working either at a frantic pace in pockets of a growing sick population that is rapidly testing positive or in frantic preparation bracing themselves for what is to come. High priority needs for personal protective equipment (PPE), and alternatives to use in place of standard PPE as items run out, dominate the national conversation. Social distancing and self-isolating have become the most frequently used catchwords, and toilet paper memes have consumed social media. While the lights go out at restaurants, bars, large convention venues, and businesses, and nonessential workers are asked to stay home and/or work from home, many in the world of case management may be asking: Am I considered essential?
The answer is yes, and now more than ever. Those who primarily do telework are already well equipped to communicate and coordinate from a distance while maintaining HIPAA and compliance requirements. These case managers (CMs) have become more proficient at providing guidance from a distance and giving patients and their families direction and coaching; whereas hospital CMs are used to interfacing regularly with patients and families to perform their activities, from assessment to discharge planning, and doing more for the patient in a care-delivery setting. Those who deal more with community cases and worker’s compensation cases may have a combination role in working telephonically and interfacing for assessments or attending appointments. Regardless of the CM role, because of the COVID-19 pandemic, the needs of most patients have become more challenging, and the stable routines that were established have abruptly changed.
Necessity is requiring CMs to find new and inventive ways for patient screening, stratifying risk, assessing, planning, coordinating care, and performing follow-up, care transitions, communications, and evaluations. Any current activity that can be performed telephonically or by other technology or artificial intelligence should be implemented immediately, if it is not already in place.
Hospital CMs must create new ways to meet patient and family needs while maintaining distance for the sake of the patients, themselves, and their own families. For example, they can take the time to coordinate more thoroughly with interdisciplinary team members to accomplish multiple tasks at once when a single member is entering a patient’s room. That may involve the bedside nurse or a respiratory therapist getting a signature on the IMM or Patient Choice document, while the case manager explains its purpose by phone. Make sure there is a pen provided that stays in the patient’s room.
CMS provided some relief to case managers dealing with care transitions when it enacted an 1135 waiver (1135waiver@CMS.hhs.gov), which loosened requirements such as three-day inpatient stays before discharging to a skilled nursing facility (SNF) or swing bed, and critical access hospitals being limited to 96-hour stays or twenty-five patients or less, and housing inpatients on excluded units. These changes will be a helpful part of the hospital’s overall surge plan by allowing discharge to SNF and swing beds from the ER or observation status with appropriate documentation. For additional waiver clarity, contact Sandra Pace, the acting 1135 waiver coordinator, at Sandra.firstname.lastname@example.org.