Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739
E-mail: ElizabethHogue@ElizabethHogue.net
Standards governing the practice of case management were first published in 1995 by the Case Management Society of America (CMSA). The standards were revised for the first time in 2002 and again in 2010. This is the second in a series of articles about the legal and ethical implications of the standards revised this year.
Standards by CMSA clearly require case managers to behave and practice ethically. Specifically, according to CMSA’s standards, case managers must comply with this Standard by demonstrating:
“Awareness of the five basic ethical principles and how they are applied: beneficence (to do good), nonmalfeasance (to do no harm), autonomy (to respect individuals’ rights to make their own decisions), justice (to treat others fairly) and fidelity (to follow-through and to keep promises).
Recognition that a case manager's primary obligation is to his/her clients.
Maintenance of respectful relationships with coworkers, employers and other professionals.
Recognition that laws, rules, policies, insurance benefits, and regulations are sometimes in conflict with ethical principles. In such situations, case managers are bound to address such conflicts to the best of their abilities and/or seek appropriate consultation.”
These requirements, especially adherence to the principle of autonomy, must govern the practice of case managers/discharge planners in hospitals, who are required to honor patients’ right to freedom of choice of providers.
The Balanced Budget Act of 1997 (BBA) and Conditions of Participation (CoP’s) of the Medicare Program require hospitals to provide lists of home health agencies that meet applicable criteria. Prior to discharge, this list must be presented to all patients who may benefit from home health services, so that patients may choose the agency from which they wish to receive services. Based on Interpretive Guidelines published by
the Centers for Medicare and Medicaid Services (CMS), there is a sound basis for concluding that hospitals must also present lists of hospices from which patients may choose.
The problem remains, however, that may patients and their families do not know enough about home health and hospice services to make a choice. Anecdotally, it appears that case managers may then decide to choose post-acute providers for patients and their families. This practice is clearly contrary to the Standard of practice for case managers described above. Case managers/discharge planners must demonstrate respect for individuals' right to make their own decisions. Deciding for patients is inconsistent with this standard.
Instead, case managers/discharge planners must help patients to make their own decisions. They may, for example, point out that an agency has a specialty program in the area of patients’ greatest need, such as orthopedics. In short, case managers/discharge planners never choose for patients; they carry out the wishes of patients and their families. This conclusion is reinforced by language in the Standard that makes it quite clear that case managers’ primary obligations are to clients or patients.
Patients and their families are becoming more knowledgeable about post-acute services and are better equipped to make choices. They may, however, still require assistance from case managers/discharge planners. Remember that the patient remains solidly in the “driver's seat” at all times!
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Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author. |
