The advantages and pitfalls of being an independent case manager
Calling the shots also means paperwork, irregular income
Executive Summary
The new healthcare arena offers case managers the opportunity to go out on their own as independent practitioners, but there is a downside to being your own boss.
- Independent case managers get to choose their clients, make their own hours, and avoid the meetings, layers of bureaucracy, and delays inherent to large organizations.
- But there are no paid vacations, no sick leave, lots of paperwork, and you have to pay for business equipment and supplies.
- There are opportunities where you make them, including contracting directly with individuals, making post-discharge calls for hospitals, helping primary care patients navigate the healthcare system, and contracting with companies to advise employees on benefits plans.
Would you like to have a job that allows you to set your own hours, choose only projects you want to work on, and be your own boss? Then you might consider becoming an independent case manager.
On the other hand, can you afford to have little or no income while you get your business up and running? Would you enjoy marketing yourself to potential clients? Does handling business paperwork such as writing reports, sending out bills, dealing with tax forms, and keeping meticulous records appeal to you? If not, being self-employed may not be for you.
"There are advantages and disadvantages to going it alone. Anyone who is thinking of starting a business should carefully evaluate all aspects of becoming a solo practitioner," says Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.
Being an independent case manager has a lot of benefits, says Teresa M. Treiger, RN-BC, MA, CHCQM-CM, CCM, principal of Ascent Care Management, LLC, in Holbrook, MA.
"When I worked for an organization, I never worked a 40-hour week. It was always 60-plus hours, and I was away from home a lot, which was difficult. I’m much happier being on my own," she says.
"Clients come to me because they want help, not because they were on a trigger report as having have multiple comorbid conditions or are projected to have a lot of expenditures or have been told they have to have a case manager. The individuals I contract with are willing and interested in participating," she says.
Treiger became an independent case manager almost by accident. "When I was president-elect and president of the Case Management Society of America, I knew I would not be able to continue working at a full-time job in addition to those responsibilities, so I made a conscious decision to resign. During my years as an officer in CMSA, I started getting invitations for engagements and realized that going into business for myself was a viable option to working for someone else," she says.
Treiger has private case management clients, consults with companies that want a case management program or to improve the one they have, and consults with technology companies, advising them on case management products they are developing. She also has an active speaking and writing career.
"I love having a wide range of clients and not having to do the same thing every day. I can call my own shots," she says.
Treiger takes private case management clients who are a good fit to her expertise. "I can work as their advocate because I’m not aligned with a hospital or a managed care agency. I’m solely aligned with that client. I am able to control the number of clients I have, and although I prefer face-to-face interaction, I can be in touch with clients from anywhere there is a telephone or a computer," she says.
Independent case managers can focus on what they like to do and set their own schedule around their other commitments, says BK Kizziar, RN-BC, CCM, owner of BK & Associates, a Southlake, TX, case management consulting firm. They can choose their clients and control their hours, she adds.
Being an independent practitioner gives you the ability to be self-directed and to create a unique niche, says Mullahy, who was sole owner of a case management company for 20 years.
"When you are in business for yourself, you can achieve a work-life balance," she adds.
Being your own boss means you avoid having to deal with the problems that characterize large organizations, such as too many layers of management, too many meetings, and too many delays, Mullahy says.
"Having autonomy is a big advantage to being on your own. Creating a company gives you the opportunity to develop and use talents and skills that include marketing, negotiating, risk management, and others that give you an opportunity to learn and grow," she says.
There are almost as many disadvantages to starting a business as there are advantages, Mullahy adds.
If you don’t work, you don’t get paid, Kizziar points out. In the beginning, your income will vary depending on how busy you are.
"It will take months, or maybe years, to get to the point that work is coming your way regularly, and when that happens, you have to know when to turn it down so you can give your full attention to all your clients," Kizziar says.
When you are self-employed, you don’t get paid vacations or sick leave, Kizziar points out. You have to pay for your own health insurance, unless you’re on a spouse’s policy. You have to pay for office supplies and equipment, telephone service, and all the other items your employer provided.
You have to keep records of your time and expenses, tabulate and send out bills, market yourself, and go after contracts, she adds.
When case managers go out on their own, they often miss the camaraderie of colleagues at work, Mullahy says. "The kind of isolation that comes with independence can be truly overwhelming when problems arise because there’s no one to share it with or brainstorm with when you have a difficult case," she says.
In today’s new healthcare environment, opportunities continue to grow for people who want to be independent case managers or direct-to-consumer case managers, Mullahy says. Care coordination is an important part of provisions of the Affordable Care Act and other healthcare reform initiatives, she adds.
"The healthcare industry is beginning to understand what case managers do and realize how valuable our services are. As the healthcare system gets more and more complex, it’s more important than ever for patients to have someone shepherd them through the healthcare maze," Kizziar says.
In the past, independent case managers mostly contracted with payers or workers’ compensation firms, Kizziar points out. "Now there are opportunities wherever you make them. Case managers can provide services to individuals, companies, physician practices, and hospitals," she says.
The rising costs of healthcare are driving the need for professionals who are directly involved with and accountable to patients, and only patients, Mullahy says. Direct-to-consumer case managers may be hired to coordinate care for a disabled child, an aging parent, or someone with a complex medical condition, she adds.
Hospitals offer opportunities for experienced case managers as consultants on compliance issues, efficiency measures, or to help restructure case management programs, Kizziar says.
Hospitals also are contracting with independent case managers to provide transition care planning and to make post-discharge follow-up calls, Mullahy adds.
Group medical practices that aren’t big enough to have a full-time case manager are contracting with part-time case managers to coordinate care for patients as part of their patient-centered medical home initiatives, she adds.
Large companies are hiring case managers to help employees navigate the maze of insurance options so they will make informed decisions when they choose their coverage, Kizziar says.
"It saves companies money in the long run because if employees have the benefits they need and receive the healthcare they need, they are more likely to stay healthy and miss less work," she says.
