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Welcome to the case management learning portal, where it is our business to keep you informed. In this section you will find the latest headlines, trends and studies that bear importance on the practice and the industry. In addition, you will find a fleet of articles intended to keep you current on the issues and outcomes that impact your practice on a daily, weekly and monthly basis. Industry experts and seasoned professionals contribute their acute insight on professional and clinical topics alike. Visit with our experts now and secure the strength of your work in the future.

Strong in the Skeleton

Disease Management | Friday, 26 February 2010

How Exercise Prevents, Treats Osteoporosis It may seem counterintuitive to think that someone with brittle bones could prosper from exercise. The fear of fracture or a worsening of the condition may prevent those with osteoporosis from engaging in physical activity. But the latest research shows that, on the contrary, exercise can reap huge benefits for someone with osteoporosis by strengthening the bone structure and, if done accordingly, decreasing the risk of fractures and disease progression. Osteoporosis is a bone-decimating disease that predominantly affects women, including four out of five of the 10 million U.S. adults over 50 who are diagnosed with the condition. According to data from the National Institutes of Health, one in two women over 50 will experience a fracture related to osteoporosis in her lifetime. As the perception of the bone disease has changed from an unavoidable deterioration of bones due to age to a preventable occurrence largely predicated on lifestyle choices, exercise has been recognized as a central preventive strategy. Bone is a living organism, and exercise—weight-bearing exercise in particular—helps develop bone mass until a person’s late twenties, when growth of new bone naturally begins to stabilize or decrease. By middle age, both men and women experience a decline ...

Chasing Dreams

Behavioral Health | Friday, 26 February 2010

Some Therapies Help When Sleep Eludes Us Sleep deprivation is a common occurrence in our 24 hour, on-the-go society. One hundred years ago folks averaged a full hour more sleep than we do now. Although the actual, underlying function of humans’ need for sleep remains a mystery, the effects of lack of sleep are seen on a daily basis. The functional effects of mild sleep deprivation can be subtle. However, many studies have shown decrements in cognitive function and performance even with low levels of sleep loss. Unfortunately, the effects of sleep deprivation are cumulative. For example, a person who is one-hour sleep deprived each work day will have experienced five hours of total loss by the end of the work week. Such decrements have been shown to increase driving risks, decrease cognitive skills, worsen mood and increase ...

Chronic + Repetitive + Stress = Opportun

Workers' Compensation | Friday, 26 February 2010

Achieving Value-Based Physical Therapy If you help manage the health care of employees, there are three words you may have come to know that leave you feeling anxious … chronic, repetitive, stress. Many musculoskeletal diagnoses may be related to chronic repetitive stress, such as tennis elbow, plantar fasciitis, anterior knee pain, trochanteric bursitis, temporomandibular joint dysfunction; and two very common diagnoses, often related to work, include carpal tunnel syndrome and rotator cuff strain. As with any physical injury, ailment or disease, the rehabilitation process can be simple and, at other times, very complex. When you think of chronic repetitive stress, do you visualize an overtreated musculoskeletal problem, costly for the employer, draining for the patient, and enduring for you? Have you ever seen a physical therapy referral requesting continuation at three times per week for six to eight weeks, following an excessive number of visits without evidence of progress? Have you ever wondered if physical therapy would ever end? Or why the patient would continue in the absence of progress? Do you find yourself feeling as though you have no authority to improve the situation, simply because it is directed by a medical doctor? If so, you will be pleased to know ...

Ask the Expert: Ethics, Utilization and

Advice | Friday, 26 February 2010

Editor in Chief Anne Llewellyn sits down with Dr. Dennis Robbins, MPH, an ethicist whose work touches on quality, health law and health policy, to talk about medical utilization management, denials, and the potential impact of the burgeoning area of comparative effectiveness research. Q: What is one area of medical management you see changing as a result of health care reform efforts? A: One of the most controversial areas of health care arises when coverage for medically necessary treatment is delayed or denied. The logic of denial is based on deflecting services or interventions that are not “medically necessary,” which is good if it protects patients against overtreatment and reduces waste. It is a negative when denying becomes an overzealous and medically unjustified crusade fueled by spurious denial criteria. Hopefully, shifting from denial-based approaches into validated, data-driven, evidence-based and comparative effectiveness standards will significantly decrease unfounded denials while ensuring the integrity of medical utilization management. What new model do you see as a way to improve utilization of health care resources? Reform initiatives to remove restrictive rating criteria and pre-existing illness exclusions as well as such “new” models as comparative effectiveness (CE) will play an increasingly important role in rethinking exclusions. CE is positioned to help ...

The Art of Documentation

Profession | Friday, 26 February 2010

Practical Tips When Professions Collide Documentation. It’s the written proof of your professional work. How many times in nursing school did you hear the admonishment, “If you didn’t document it, you didn’t do it”? I know it still rings in my head, along with other phrases like “Your handwriting is too fancy” and “Your e’s looks like i’s.” The phrase certainly brings back some fond, and perhaps some not so fond, memories. But I am of the opinion that the art of documentation continues to be one area in which all medical professionals can improve. As you will read below, each particular area of practice requires varying degrees of documentation and unique language for the respective areas. My experience in documentation began with my first job out of nursing school on the traditional med-surg floor focusing on the assessment of post-surgical issues such as vital signs, wound management, neurological status, I and O, etc. Once I felt comfortable and confident with those skills I moved on to the surgical ICU, which demanded much more keen assessment skills and brief but extremely detailed documentation....

Q and A: Electronic Medical Records and

Best Practice | Tuesday, 9 February 2010

Managing Editor Richard Scott sits down with Betty Pyle, RN, MS, FAACM, CMCN, CMC, the Director of Care Management at Oregon’s Salem Hospital, to talk about her department’s role in expanding the use of electronic medical records, including obstacles she has faced and tips for creating a streamlined flow. Could you describe your role at Salem Hospital? How large is the CM department there? I am the Director of Care Management. The department is comprised of a staff of 49 including care management, social services, and spiritual care. Leadership staff is comprised of a director and manager of care management, two assistant managers, documentation specialist supervisor, mental health evaluator supervisor, and the resource center coordinator. Staff includes care managers, clinical documentation specialists, appeals coordinator, discharge coordinators, Medicare specialists, social workers, social counselors, mental health evaluators, and chaplains. We are unit-based and cover 10 units, Rehab, and the ED. I understand case managers at Salem have played a role in the education of physicians regarding electronic medical record use. First, what is the importance of this area today? Every hospital must begin implementing the electronic medical record, as this is vital to ensuring that all providers have access to the patient’s medical history ...

This Is an Emergency
Scoping the Challenges of Trauma Case Managers Hospital case management is a demanding field, where challenges spring up in a moment’
Resisting Diabetes
A Health Plan’s Active Measures to Curb the Disease Overweight and obesity affect all of us, whether it is a personal struggle or trying to s
Standing Up to the Bully
Repudiating the abuse of a harmful, yet prevalent, act Bullying, a word that may conjure up the image of a belligerent provocateur kicking sand in
Maximum Engagement
Creating a Successful Return to Work When an employee is off work due to an illness or injury, the ideal goal from a vocational standpoint is
Ask the Expert: Case Management and Social Network
To explore recent and potential changes to the practice, we consulted with Garry Carneal, JD, MA, the president and CEO of Schooner Healthcare Service
Q and A: Pamela Doty and Consumer Direction
To better understand the intricacies of the consumer direction movement, Richard Scott sits down with Pamela Doty from the Department of Health and Hu

Marcia Colone on Advancing Care, Escalation
Richard Scott In this inaugural edition of The CM Insider section of Case In Point Weekly—a section that will bring readers face to face with
The Constant Rebalancing of Lee Woodruff
Confronting the Demands of Life in the Face of Traumatic Events The news shattered the quiet veneer of the morning. In a hotel room on the oneiric
Home Care Guardians
The specialized services of Visiting Angels Today, more than 7.5 million Americans receive home care services. In light of demographic and political t
Stories of Cancer Survivorship
Glimpses of Hope Dear Readers, To complement our cover story in the December 2009 issue of Case In Point—A League of Survivors
No Innocent Bystanders
A Critical Building Block for Successful Good-Conduct Policies This past January, the Joint Commission’s new standards addressing behaviors t
Uplifting an Aging Workforce
Addressing the Physical, Psychological and Psychosocial Needs of Older Workers When an employee becomes injured on the job, it is essential to cons

Ask the Expert: Quantifying Caseloads
We pose a series of questions to Kathy Craig, MS, RN, CCM, president of Craig Research Continuum, to learn about the growing set of tools surrounding
Integrated Case Management
Merging Physical and Behavioral Health It’s no secret that the future of health care delivery is somewhat uncertain. While few will disagree
A Fix on Frequent Flyers
How an ED Countered Overuse Three years ago Dr. Salvatore Vertaramo came up with an idea. As with most emergency departments, we had developed
Taking a Second Look
Two Patients with Spinal Cord Injury Undergo Continuing Care at the Rehabilitation Institute of Chicago Visiting a friend one day in 1993, Charl
Young at Heart
Recognizing the Elderly Marks a Boon For Appropriate Care Though Taber’s Cyclopedic Medical Dictionary describes an “elder” as a
Update on Bloodborne Diseases
Exploring Hepatitis B and C and HIV The research-based facts for bloodborne diseases are constantly changing, requiring case managers of all popula

Grappling with a Hard Case
Assessment and Case Management of the Substance Abuse Patient The assessment and treatment of addictions is a challenging area for both clinicians an
Pain: Do Your Patients Have It?
On March 30, 2009, the House of Representatives passed the National Pain Care Policy Act, a piece of legislation designed to improve, as it is written
Ask the Expert: Illness and Return to Work
In this edition of Ask the Expert, we consult with Rosalind Joffe, the founder and president of cicoach.com, a career coaching firm dedicated to helpi
Coaching as Coaxing
Ask the right questions, listen carefully, and empower clients to choose Last issue, I cited 10-time NBA championship coach Phil Jackson to illustr
New Dimensions in Disease Management
Best Practices in Telemanagement The cost of managing chronic illness has become astronomical. Congestive heart failure is now a major chronic cond
Trials of Redemption
Kasey Edwards Combats the Loss of Limb It was well past midnight when Kasey Edwards dove into the canal. A native of the region surrounding Lake O

Exploring Long-Term Care
The scope of enduring care, the benefits of long-term acute care hospitals, and what the shift in demographics means to the viability of the industry
Monitoring Rare Disease, Remotely
With rising health care costs and greater longevity of people living with chronic diseases, case managers must provide services that are cost-effectiv
Handling Hardship
Dealing with Loss in Lay and Professional Roles Everyone loses a loved one at some time or another. As practicing psychologists for many years,
Pain Sage
A pain expert discusses the varieties, the management and the modern medical advances in the thorny field of pain Dr. William Witt, a profess
Ask the Expert: Coding
In this edition of Ask the Expert, Teri Treiger, RN-C, MA, CCM, CCP, CPUR, a Clinical Product Manager at McKesson Health Solutions and forthcoming Pre
Downsizing, Right-sizing, Re-engineering, Restruct
Managing Before, During and After the Crisis In Part I of this series, the discussion centered on workplace restructuring and how that affects the ma

Community Care at Shepherd’s Hope
The ongoing series called A Passion for Practice continues with a look at a community clinic in Arkansas An unfortunate circumstance is all too commo
Guiding Hands
Ethical and Cultural Considerations During the Final DaysComprehensive case management continuously addresses the complexities of illness and the prom
The Uncertain Unraveling of ALS
The rollercoaster began in 2003. It was in the summer of that year when my dad first exhibited symptoms that were later diagnosed as manifestations of
The Aging Family
Behavioral Health Across the Continuum of the Over-50 Divide Few care managers have studied the continuum of care across the aging family. Gerontol
The Forest for the Trees
How To Identify the Variables of Chronic Pain To Achieve Holistic Return to Work Researchers estimate that there are currently at least 75 mi
Ask the Expert: Accreditation
In this edition of Ask the Expert, a reader proposes a question about accreditation standards. We consulted with expert Cynthia Whitaker, a clinical a