Hi Ron et al, Vent away!
I think that the increasing trend towards case management is based on the practice in the insurance industry of using case management to contain costs. However, this practice in the healthcare setting is fatally flawed: Case Managers succeed in the insurance industry because they simply contain costs (while quality tends to be given lip/ink service on glossy brochures). I have been trying to promote the idea of case auditors instead. So far it has been a one man campaign, but I believe that it needs to replace the use of case managers. The difference between case managers and case auditors would be this: Currently case managers are trained in a health profession (usually nurses by sheer numbers). They try to interpret the administrative restriction of resources to the clinical recommendation of services. That is a pointless exercise. If there are not enough resources to support certain services, or to cap certain services, then that is a very simple clerical function that can be filled by a clerical role once the policy is established. By using more expensive personell to try to second guess the clinical judgement of the clinician who has assessed and recommended treatment, money is wasted. I would suggest that as clinicians we put our licence on the line and risk criminal prosecution if we act fraudulently, or practice in a substandard way. Case auditors would be a smaller number of individuals who would be specifically trained to recognize indicators of quality in the different professions (probably being members of the different, relevant professions.) Case Auditors, instead of baby-sitting every case to second-guess the clinical judgement, would only review a case only if it deviated from pre-defined quality indicators (e.g. 3 OT visits for an uncomplicated knee replacement without a relevant secondary diagnosis) In Ontario (Canada) our homecare system (called Community Care Access Centres or CCAC) have mushroomed out a massive bureaucracy of case managers who "assess" things like ADLs by interview alone. They over-ride specific recommendations by various professions routinely. While the number of case managers was increasing, the number of direct treatment providers was being choked to a minimum. Case managers do not recieve sufficient training to be able to make competent judgements about other professions. If they did have the adequate training to be able to make those judgements, then they would be far too expensive to be efficient for the system. We are in quite a bind here, but we need to be able to advocate effectively to increase the quality of healthcare. There is my rant. Let me know what you think. Greg ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, August 05, 2003 4:48 PM Subject: [OTlist] Large Fl. Hospital Case Managers and OT referrals > Hello: > > This morning, I met with one of Central Florida's largest hospital's > case manager staff. I personally asked with approximately 10 case > managers and asked if the refer their d/c'd patients for OT. Every one > of them said something like: "not too much for OT, but quite a bit for > PT". > > How can it be? How can a large hospital's case manager staff not refer > to OT, except in rare cases? > > I get so frustrated with such scenarios because, in my experience, it > happens all the time. It is so rare to speak with someone in the medical > field that utilizes OT for clients with occupational performance issues. > On those rare occasions that someone does mention OT, it has been from > an orthopedic setting and they refer to OT for upper extremity > issues.... YUCK! > > Ron > > P.S. Just needed to vent! > > > *****************************��********************************** > > To remove yourself from the OTnow mail list, send a message to: > > [EMAIL PROTECTED] > > In the message's *body*, put the following text: > > unsubscribe OTlist > > - > > List messages are archived at: > > http://www.mail-archive.com/[EMAIL PROTECTED] > > *****************************��*********************************** > > *****************************��********************************** To remove yourself from the OTnow mail list, send a message to: [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist - List messages are archived at: http://www.mail-archive.com/[EMAIL PROTECTED] *****************************��***********************************
