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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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It is expected that metrics will be available so that the contributions of case management are quantified, as outlined by Toni Cesta, PhD, RN, FAAN, senior vice president, Lutheran Medical Center, Brooklyn, NY, in her April 2011 Case Management Insider article "You're only as good as yesterday's discharges Strategies to demonstrate case management's value."
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The devil is in the details when it comes to convening a successful interdisciplinary meeting.
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To maintain stability and effectiveness in meetings, the following steps should be considered.
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It's a new era for hospitals and for case managers as a multitude of auditors from the Centers for Medicare and Medicaid Services (CMS) and commercial payers scrutinize patient records looking for errors.
