1. :
The Code of Professional Conduct: your GPS for navigating the care continuum, resolving conflicts and providing ethical care
Presented By Laura Ostrowsky, RN, CCM, MUP

2. The Roles of a Case Manager
Advocate
Advisor
Coordinator
Clerical Support
Diplomat
Educator
Expediter
Expert
Facilitator
Hospital Employee
Mediator
Negotiator
Navigator
Surrogate Family Member
Therapist

3. Responsibilities of a Case Manager
Utilization Management
Cost Containment
Compliance
Patient Flow
Discharge Planning
Patient Education
Insurance Authorization
Denial Prevention
Denial and Appeal Management
And, so much more

4. Roles vs. Responsibilities
Inherent Conflicts
Confusion
Uncertainty
Ambivalence
Contradictions
Ethical conundrums

5. Navigating the care continuum
What are our tools, our compass or GPS?
Code of Professional Conduct
Mission and Vision
Ethical principles

6. CCMC Code of Professional Conduct
Objective: to protect the public interest
The code provides a framework for ethical, high quality care
It consists of:
Principles
Rules of Conduct
Standards for professional Conduct

7. 8 Principles of the Code Board certified CMs will
Place the public interest above their own at all times
Respect the rights and dignity of all their clients
Maintain objectivity in relationships with clients
Act with integrity and fidelity with clients and others
Maintain competency at a level that ensures clients receive highest quality service
Honor the integrity of the CCM designation and adhere to requirements for its use
Obey all laws and regulations
Maintain the integrity of the Code, by responding to requests for public comments to review and revise the code, thus helping ensure it’s consistence with current practice

8. CMSA’s Mission and Vision
Providing professional collaboration across the health care continuum to advocate for patients’ wellbeing and improved health outcomes.
Case managers are advocates who help patients understand their current health status.
Case managers are recognized experts and vital participants in the care coordination team who empower people to understand and access quality, efficient health care.

9. Ethical Principles Autonomy Beneficence Non-Maleficence Justice
Veracity

10. Patient Advocate vs Employee
Coordinate a safe discharge
Decrease LOS
Maximize reimbursement (Prevent Denials)
Contain costs
Manage scarce resources (UM)
Expedite patient flow How do we reconcile these roles?

11. Dealing with disagreements within the team
Among the team members.
Between the patient and the clinical providers
Which side are you on?
Can you remain neutral?
Who can you call?
Strategies to achieve resolution….

12. Advocates or Adversaries
Hospital case manager and the insurance case manager
With the private advocate
Collaborating with payers

13. Patient Advocate or Fairy Godparent
Is there a “No” in advocacy?
Patient Rights vs. Patient Responsibilities
Non-compliant patients

14. The CM Department in the Hospital Hierarchy
Where does your department report?
Where should CM report?
Is report structure a reflection of perceived value of CM?

15. Coping with Conflict Meditate Eat Chocolate Ruminate Lose Sleep
Exercise
Scream
How do we take care of ourselves and move on?

17. Resources/suggested reading
Article about patients leaving AMA patients-leave-against-medical-advice.html?_r=0
Fadiman, Anne The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors and the Collision of Two Cultures. New York: Farrar, Straus and Giroux, 1997

18. Laura Ostrowsky, RN, CCM, MUP
Contact Information
Laura Ostrowsky, RN, CCM, MUP