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When case managers think about ethical dilemmas, they are thinking about much more than when to discontinue a ventilator, or to stop treatment, or any of the myriad of clinical ethical decisions that must be made every day in hospitals throughout the United States.
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I will never forget my biggest ethical dilemma. It happened when I was a director of case management at a large medical center in New York City. It was the day after Thanksgiving.
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One solution to perennial problems such as ethics issues might be the formation of an organizational ethics committee. Different from a clinical ethics committee, an organizational ethics committee deals with organizational dilemmas that should be solved in a formalized manner.
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Now that the Centers for Medicare and Medicaid Services (CMS) has launched a program that adjusts Medicaid payments for provider-preventable conditions, including healthcare-acquired conditions, it's essential for case managers to work with physicians to make sure all conditions that are present on admission are clearly documented on a patient's chart.
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The ethical decision-making process is similar to the case management process and the nursing process. The steps include:
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Since beginning a "financial advocacy initiative," Advocate Illinois Masonic Medical Center in Chicago has seen nearly a 160% increase in its point-of-service (POS) collections.
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If you tell patients they owe their entire deductible of $2,000 for an inpatient procedure, and they know that $1,700 of the deductible already was met, your credibility and competence are suddenly in question.
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Some emergency department (ED) patients are destitute, drug-seeking, or have nowhere else to obtain care, and they might pass themselves off as others to obtain insurance coverage, says Marsha Kedigh, RN, MSM, director of admitting, emergency department registration, discharge station, and insurance management at Vanderbilt University Hospital in Nashville.
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If a worried and anxious patient or family member is kept waiting, it might help to convey the underlying reasons for delays in registration, treatment, or room placement, says Diane Manuel, director of patient access for admissions and the emergency department at Wake Forest University Baptist Medical Center in Winston Salem, NC.
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Suspected 'red flags' must be handled differently in the emergency department than other registration sites, according to Joyce L. Predmore, associate director of patient access services at Ohio State's University Hospital East in Columbus.
