It’s the holiday season once again and we want to help you celebrate!  We’re offering you the chance to win a membership or renewal to your preferred professional organization. 

All you have to do is click on the membership that you’re interested in below, follow the instructions and you’ll be entered to win.  Hurry! The contest ends December, 16^th at midnight.

Wishing you every happiness this Holiday Season and prosperity in the New Year.

P.S.  Feel free to enter both if you wish! 

Happy Holidays from Pathway Medical.

Stories from Case Managers in Honor of Case Management Week…

As a Rehab Nurse Case Manager my story spans 25 years of friendships and life’s lessons that grew from catastrophic injury.

Teenage life tragically devastated in a heartbeat, suddenly quadriplegic. I was privileged to work 1:1 with them, their families, their homes, their vehicles and, specialized equipment to restore their lives and futures. Now adults, these friends are married with families. They have professional careers as teachers, counselors, social workers. I watch them raise their children and give back to society with a joyful heart, hopeful that something I said or did helped them climb their mountain.

I’m overcome with awe and respect for them and their accomplishments. It is I who have learned life’s greatest lessons from them. I’m so honored to be a part of their lives and success.

Respectfully submitted,

Margo P.
CRRN, CCM, LNC

Stories from Case Managers in Honor of Case Management Week…

My name is Stacey I am a case manager, and have been in my position for approximately 10 months. I am new to case management and I have gained a wealth of case management knowledge. But I must say the most rewarding thing about my experiences is that I am able to maintain my compassion for being a RN and advocate for my patients. 

A most memorable moment as a case manager and a life lesson is one of a recent experience I had on my assigned unit. I had a patient with a specific managed insurance that normally, 98% of the time, denies and does not grant authorization for acute rehab. The patient was refferred to acute but did not meet the obvious criteria so I was told by the team that the patient should go to SAR because “her insurance won’t give authorization anyway.”

I met with the patient because the social worker stated the patient had some insurance concerns. I met with the patient and she really wanted to “bounce back” and receive acute rehab. She became very anxious when she was told that she would not get into acute rehab because of her insurance. I listened and heard her cry and went through her chart and found a qualifing factor: neurological defict that was a new onset event post op. I advocated and presented this to her insurance asked them to please consider this case.

That afternoon I received a call she was granted approval and authorization was given. I met with the patient again and informed her that she had been granted authorization for acute rehab and that she would be discharged there. She became tearful and gave me a big hug. She was thankful which made me feel like that bedside nurse I will always be in my heart. I learned that case managers play a significant part in the admission stay and discharge of patients. I learned that we are dependent on by many, number one: the patients. It was rewarding to put a smile on her face and play the role of patient advocate; as I feel a nurse should be.

Stacey

It should be an exciting time for case managers. Healthcare reform is in it’s creation and The RAC (is it not the perfect nom de guerre?) is knocking on our doors. Yet I hear nothing from our ranks or leadership weighing in on the issues.President Obama recently made notice of an article in the New Yorker by Dr. Atul Gawande. This article was about a Texas city that had the highest cost per Medicare patient in the US. It’s conclusions said nothing that any nurse case manager could not have told him about over utilization. The reform issue of “how are we going to make universal healthcare affordable?” is all about case management principles. If the future of healthcare delivery is going to be based on the principles of the right care and the right time, it is going to take case managers to make it work. Focusing on the here and now, The RAC is the best thing ever to happen to hospital based case management. Hospitals will not be able to survive without strong UR/ case management programs.
Ray Gridey, RN BS, CPUR – Case Manager

Case managers in a hospital are positioned in the political middle stretching between the needs of patients while your efforts to meet your organization’s strategic goals are pulling in the opposite direction.

But how do you meet the needs of your patients and your organization, and garner the support you need from your organization’s executive team?

Too often Hospitals seem simply to want to “ Get the patient out”, focus on length of stay issues and do not have support strategies for case managers to bring full support for patients to feel they are going home where they can be safe and manage themselves and their care needs.

How do you obtain medications not covered by insurance or even more difficult, the patient has no insurance and needs antihypertensives, hyperglycemics or other medications? Knowledge of community services is imperative as well as finding local programs that provide low cost prescriptions such as the $4.00 for 30 days that are advertised in the media.

Believe it or not patients are often unaware of these programs. What about patients who are going home and need dressing supplies ? Help with obtaining these supplies? Or no insurance to help them with these needs? Hospitals are strained financially these days and cannot supply a patient with these things at the time of discharge. Many of my patients are very poor, and do not have resources to purchase these items.

Does anyone have information on resources for dressing supplies, DME etc?

by Donna Berry, RN, BS, LNHA – Case Manager