South Florida Hospital News
Wednesday August 5, 2020

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October 2004 - Volume 1 - Issue 3


National Case Management Week Spotlights a Vital and Valuable Specialty

For over twenty years, case management professionals have played a vital role on the health care team, making a positive impact on care, outcomes and cost containment. They collaborate with patients and families, with physicians, nurses and other professionals, and with payers, facilitating care and services while assuring that resources are utilized effectively. But despite their growing role and presence in hospitals, clinics, private practices and insurance companies, case management professionals remain somewhat unknown to the general public and even misunderstood within the health care industry.

The Case Management Society of America (CMSA) hopes to change that this month. They are sponsoring National Case Management Week from October 10 Ė 16, 2004, a period designated to honor the specialty and, most importantly, to educate the public about the essential role and significant contributions of case managers to quality health care. The weeklong celebration, titled "The Passion, the Power and the Promise of Health Care," will unite case management professionals, promote awareness of the profession and spotlight the diversity and range of responsibilities within case management.

Anne Llewellyn, R.N., immediate past president of CMSA, believes that case managers are finally gaining greater recognition for the valuable assistance that they provide to physicians and patients.

"Some people still think that the role of a case manager is to deny care and that is simply not the case," she says. "We help people get access to care and get the best possible care. Utilization looks at the use of services and makes sure that it is line with the personís benefits, but a case manager looks at what is covered and then says, ĎOkay, what else can we do for this person?í We go the extra mile, finding the right resources, proactively coordinating care and making certain that the patient and family understand. We educate the person about the disease so that they understand and then are able to be compliant with the treatment plan. Essentially, we do whatever it takes to move the patient to wellness, to the next level of care or to a peaceful death, depending on the case."

Llewellyn compares case management to a three-legged stool: "There is quality of care, access to care and the cost of care Ė and case managers influence all three. Our goal is always quality care, delivered effectively and efficiently. We are looking for the barriers to care, for the cracks in the system. We are advocates, facilitators and educators. Case managers are the safety net."

A majority of case managers are registered nurses, but case management is actually a specialty within a profession rather than a profession itself. There are social workers, physical therapists and professionals in other disciplines who are case managers in different settings; any health care professional can become one and certification is available through the Commission for Case Management Certification (CCMC), a separate organization from CMSA.

Based in Little Rock, CMSA has 66 chapters and is an international, non-profit organization. It was created 14 years ago to support the development of the case management professionals through education, networking and legislative activity. The dynamic organization sponsors many annual conferences and has a comprehensive, highly informative web site.

In the early days of case management, the focus was on those patients who had catastrophic illnesses and injuries. Today, case managers often work with an additional population Ė those who have chronic conditions and especially those who have multiple chronic conditions, an increasingly common phenomenon.

Llewellyn says, "We are seeing many more people who have diabetes, plus hypertension, plus heart disease, for example. These are complex patients who are seeing many specialists and taking multiple medications. Itís difficult for any one provider to be on top of it all, and itís difficult for the patient to keep everything straight. Thatís where a case manager comes in Ė we see the big picture, coordinate all of it and make recommendations to the physicians. We can also streamline things, cutting through red tape. Physicians have discovered how helpful a case manager can be and are appreciative of the job that we do."

While their role may be less visible than that of the direct, hands-on caregivers, case management professionals play an increasingly significant role in the health care industry. As expert advisors and advocates, they shepherd the patient through the often intimidating maze that is modern health care, finding the optimum value for the patient and the reimbursement source while helping physicians through the identification of resources and services.

To learn more about case management, go to

The South Florida Chapter of the Case Management Society of America presents "Conquering Health Care Delivery: Navigating through the Continuum of Care" on November 4 and 5, 2004, at the Airport Sheraton Hotel, 825 Griffin Road in Dania, Florida. For information about registration or exhibiting, contact Lynn Goldenberg at

West Boca Medical Center Recognized Case Manager Bernadette Quilter

Case Managers are patient and family teachers, liaisons with the multiple disciplines involved with the patientís care, they are advocates for the patient and they provide a link to the providers, the payers and the community. Todayís Case Managers are faced with complicated and challenging work that requires talent and resourcefulness. They are unsung heroes who work tirelessly behind the scenes to make sure every patient has the best outcome possible.

We are proud to recognize Bernadette Quilter, a case manager at West Boca Medical Center for the past 10 years. Bernadette also served our hospital for 10 years prior to becoming a case manager, in roles that included charge nurse and admitting nurse. She has proven her ability to adapt and overcome obstacles including mastering new technology and the constantly evolving role of the case manager. Bernadette is known for her quiet sense of humor and some claim that she moves mountains and makes the impossible possible for her patients. Bernadette has won the respect of her patients, coworkers, physicians and nurses alike. She is a highly skilled case manager, a strong patient advocate and a valued asset to West Boca Medical Center and our community.

Case Managementís Finest - Rocio Zambrana

Rocio Zambrana knew she wanted to be in healthcare at the young age of 19 when she worked with local physicians as a medical assistant and office manager. Working as a respiratory therapist she began her case management career assisting her tracheotomy and ventilator patients.

"Rosie" as she is known at St. Catherineís Rehabilitation Hospital and Villa Maria Nursing Center is now a certified case manager. In 6 years she has become a respected and valuable employee as she uses all her skills to deal with acute rehabilitation criteria and case management issues within St. Catherineís and then without hesitation moves into Villa Maria as case manager.

Rosie says she enjoys working as part of an interdisciplinary team. "It is truly a team." as she refers to the many therapists, nurses, physiatrists and neuro-rehabilitation physicians, respiratory therapists, dieticians, recreation therapists and neuro-psychologists who are part of the team. " We all work together to make sure our patients have the best outcomes."

Rosie is proud to be a member of the team and states "The case manager has one of the most important roles in healthcare today. "We must make sure the patients medical and rehab needs are met, work with the payer source to conserve healthcare dollars and provide a safe and effective future with discharge plans. I enjoy my job!"

Kathleen Kysela, RHIT
Cedars Medical Center

Katy has been with Cedars Medical Center for 25 years and in the Case Management Department for 12 years. She is respected by her peers and is a mentor and trainer for case managers new to the department. Physicians, Nursing and the ancillary departments that work closely with her speak of her innate ability to manage the most difficult situations with efficiency and professionalism. Katy maintains high personal standards and is committed to promoting and providing excellent patient care. Many patients and families have commented on her personal, caring and respectful interactions with them during their stay at Cedars and in planning for their discharge needs. She truly believes that her role is to meet the needs of her patients and to act as a patient advocate. She displays patience and understanding and offers gentle guidance in the most stressful of circumstances. Katy exemplifies the Case Management role in showing a genuine concern for the well being of all of her patients by being responsive to their requests, needs and concerns.

Helping People Move from Great Need to Greater Independence

Imagine what it takes to help a person manage both a significant mental disorder and a chemical dependency. He/she has probably had encounters with the legal system and law enforcement, was hospitalized for at least one acute psychiatric episode and may be diagnosed as having a severe and persistent mental illness. He/she may or may not be sober right now and may/may not be taking the psychotropic medication that has been prescribed. Now imagine you are trying to do that for fifteen or so people. Difficult, right? Thatís the work of a case manager in a dual diagnosis assertive community treatment team program.

Now imagine what it takes to manage the team and you begin to get some idea about the remarkable work done by Bertha Highsmith, the Program Supervisor at the Synergy Assertive Community Treatment Team of Oakwood Center of the Palm Beaches.

Bertha, a graduate of Howard University in Washington, D.C. who received her Masters degree in Social Work from Indiana University considers each day a success when none of the individuals served at Synergy has an encounter with law enforcement and when the staff and clients are able to work together to avert or prevent loss of control so that the work of recovery and reintegration into the community can continue.

Bertha says that her greatest on-the-job gratification comes from mentoring, teaching and training. "Working with new staff to help them learn what the job is all about, really about, especially when they ĎGet It.í. Thatís a great feeling when you see that!" Inspired to pursue her graduate education by one of her early supervisors at the Department of Public Welfare, Helen M. Sawyer, Bertha has tried to emulate Ms. Sawyerís mentoring style throughout her supervisory career. She creates agendas for staff meetings that include inspirational notes and bits of wisdom. She includes acknowledgements of staff membersí good work, or personal milestones. She takes opportunities to demonstrate caring!

For a person to succeed at a supervisory job in this kind of behavioral healthcare setting, Bertha says, "you need to have a great deal of organizational ability because there are so many daily, weekly, and monthly tasks to be done. However, you need to be flexible because you are always being drawn away Ė by clients, by staff, by numerous phone calls, and/or unanticipated emergencies. You need to be willing to really hear people when they present to you because they may have trouble easily expressing what they mean to say. You need to have patience and not rush people. You need to have a thick skin. People with emotional difficulties sometimes get agitated and take out their anger on you and you canít respond in kind. You must be knowledgeable and if you donít know the answer, you must know how to find it yourself or how to help someone else find it." Bertha, who is an active member of Grace Episcopal Church, believes her faith keeps her inspired to work with people who are less fortunate than she is and sustains her on those days when she asks, "Why am I still here?"

Perhaps the most valuable lesson Bertha has learned in her 38 years of work in social and mental health services is that "You never catch up. There is always something else to do, something undone at the end of the day. Thatís the nature of the work."

To young people considering entering the mental health field with an interest in case management Bertha says, "You need to come with an open mind about people, what makes them who and what they are. You canít impose your own values on others whose values differ from yours. More than anything else, you have to care about people. The money in the field is not that great, so if money is your priority youíll miss out on the rewards you get in this field from helping folks move from great need to greater independence. And last but not least, be aware that you need to look elsewhere if you cannot handle a lot of paperwork!"

Bertha can be reached at (561) 383-5788.

Step Up, Step Into Case Management as a Nurse Professional
by Linda DeBold, RN, MSN

At the Heart of Health care are the individuals that carry the job title of Case Manager. At Northwest Medical Center a "step beyond" staff carries out case management. Seven days a week 8 to 10 hours a day in any patient care unit at Northwest you will encounter the nurse case manger. From the Emergency department to the same day surgery area a case managerís expertise is available when needed.

The core expectations for the case manager lie in their ability to deliver safe, effective, quality care despite the many sides of health care. Flexibility runs through their veins while they breathe professionalism.

The ER case managers, the newest evolution to hospital case management here at Northwest, is quickly earning their place as strong members of the emergency services staff. Major roles adapted by these professionals include the Herculean job of educating the physicians and ER staff regarding medical necessity for an admission. "Doing the right thing" for patients include a through knowledge base of community services available and the ability to articulate state regulations regarding the mentally ill.

Building strong relationships with the community such as EMS transport services and a variety of eldercare services is a primary responsibility of these individuals. Stepping up to the demands Northwest are two professional nurses, Florence Alvarez RN CCM and Maureen Bogdan RN. On any given day these two individuals will screen 80% of ER visits that may lead to an acute transfer, or patients discharged home with services or high tech equipment.

Gate Keeper or Guard Dog are common nicknames given to the ER case manager is a well-deserved title here at Northwest. Orchestrating a skilled nursing home placement out of the ER takes a multi disciplinary focus of physical therapy, wound care nurse and patients support system to keep patients from being hospitalized inappropriately.

On any given day the initial assessment for inpatient admissions will be completed on approximately 65% of ER patients. This support for the inpatient case manager is invaluable. This program directly affects the hospital capacity. Because of the diligent work of ER case managers, referrals, transfers and placements can save the misuse of inpatient beds. Here at Northwest our data shows 5 to 6 cases weekly. Netting us approximately 48 beds monthly that remain open to acutely ill patients. As you can tell case management is alive and well at Northwest.

Linda DeBold, RN, MSN, Director Case Management, Northwest Medical Center, can be reached at or (954) 978-4007.

Mercy Hospital Case Management: An Interdisciplinary Approach to Benefit Patient Care
by Berta Cabrera

Since the 1900s, when case management was first provided by public health nurses and social workers, and following World War II when the government employed them to coordinate the vocational rehabilitation of injured soldiers case management has evolved into a complex role. Although there are a number of different case management models used throughout the healthcare industry, Mercy Hospital believes that its interdisciplinary approach is the most effective in providing the care needed for its patients.

Mercy Hospitalís Case Management (CM) department was created in 1995. Since then the department has endeavored to become a focal point in the high quality care provided at Mercy Hospital. The Hospital places an emphasis on collaborative care at all levels; this is especially reflected in the Case Management teamís composition which is comprised of a dedicated social worker and utilization management nurse on each unit. The Hospitalís interdisciplinary case management model also involves the participation of physicians, nurses and others on the healthcare team who bring their knowledge and expertise to the care planning process.

The Case Management department begins the discharge planning process upon a patientís admission. The initial patient assessment identifies the patientís medical, physical and psychosocial needs and the support systems available to the patient. Based on this initial assessment and with input from other members of the healthcare team the CM staff begins to develop a plan that will be ready for implementation at the time of discharge. The case management team ensures that the patientís discharge plan meets the continuity of care needs that have been identified by coordinating community support systems to enable successful outcomes.

At Mercy Hospital the Case Management department not only advocates for the patient, but plays a major role in the hospitalís financial results. The CM department has mastered this complex balance by assessing the appropriateness of admission and discharge. This balance is achieved by serving as the link between the patient, hospital, payer and community resources to ensure a seamless transition throughout the continuum of care.

Mercyís Case Management department has further developed its proactive approach to improving the quality of care provided to patients with the recent implementation of a prescription assistance program. The CM department was awarded a grant from the Allegany Franciscan Foundation of Dade County to pilot a prescription assistance program that facilitates access to free medications for patients who suffer from chronic conditions that lack insurance coverage and the financial ability to pay for the needed medications. This program further enhances the mission of Mercy Hospital and the department's role in care coordination and advocacy.

Berta Cabrera, ACBSW, CCM, director of the Case Management Department at Mercy Hospital, can be reached at (305) 285-2710.

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