Nursing Case Management, 4th Edition
From Essentials to Advanced Practice Applications
This classic resource offers complete coverage of nursing case management — from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include the impact of public policy on health care; understanding the effects of health care reimbursement and its application at the patient level; throughput and capacity management; the impact of the revenue cycle; compliance and regulatory issues; and principles needed to improve case manager-client interaction. This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success.Table of Contents
New to This Edition
- A new chapter, Telehealth Applications for Case Management, introduces the concept of telehealth; provides examples of telehealth usage in women's health, chronic disease management, and mental health; and summarizes the evidence that supports telehealth and identifies existing issues and challenges.
- Case Management: Life at the Intersection of Margin and Mission, is a new chapter that highlights strategies case managers and others can use to optimize their organizations' financial outcomes while simultaneously improving clinical outcomes for their patients. It emphasizes the work of case managers in the financial arena of health care, including revenue cycle management.
- A new chapter, Maximizing Reimbursement through Accurate Documentation and Coding, provides tips and strategies on maximizing reimbursement by designing and implementing programs focused on improving the physician's documentation.
- Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study is a new chapter that discusses strategy maps and balanced scorecards and their role in transforming an organization's mission and strategy into a management system and a comprehensive set of performance measures.
- Features updated information on HIPPA regulation (Health Insurance Portability and Accountability Act), patient safety and confidentiality issues, case management for Medicare patients, Medicare legislation, and utilization management.
- Includes numerous proven case management models currently being used in institutions across the country
- Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program
- Offers detailed guidance for planning, implementing, and evaluating a case management program
- Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships
- Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues
- Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice
- Presents acute care and community based models of case management
- Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care
- Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level
- Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities
By Elaine Cohen, EdD, RN, FAAN, Director of Case Management, University of Colorado Hospital, University of Colorado Health Sciences Center, Denver, CO; and Toni G. Cesta, PhD, RN, FAAN, Director of Case Management, Saint Vincent Catholic Medical Centers of New York, Manhattan Region, and Principal, Case Manager Solutions, LLC, Tucson, Arizona