by Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
Today’s case managers face increasingly complex ethical and legal issues. They wrestle privacy, confidentiality and quality-of-care challenges amid health-care reform legislation, HIPAA compliance and social media.
To help produce optimal clinical and financial outcomes for their organizations while navigating ethical and legal boundaries, case managers must use unique strategies.
1. Trust your clinical intuition.
You are grounded in knowledge, theories and defined skills, plus unique intuition. Trust that package. When you find yourself in a situation that doesn’t feel right, hit the escape button. This extends to work policies or situations with colleagues and clients.
2. Consult those in the know vs. those you know.
While it may be easier to seek guidance from colleagues, easy may not be best. Access expert resources like mentors, members of ethics committees or risk-management specialists. Seek advisory opinions from relevant certification and regulatory boards or from a private lawyer. Several case-management certifying entities, such as the Commission on Rehabilitation Counselor Certification and the Commission for Case Manager Certification, provide advisory opinions to those who have achieved certification.
3. Teach case management competencies.
Set an example with new hires, and engage your current teams. Use established professional documents like the CMSA Standards of Practice for Case Management to guide developing job descriptions and/or department policies. This assures consistency with established practice and strengthens case management's professional foundation.
4. Know the law.
According to an HHS report, almost 11 million individuals have been impacted by health-care breaches since the HITECH ACT breach notification rule took effect in September 2009. Penalties are in the millions of dollars and rising with each identified occurrence. Another report notes that malpractice lawsuits against hospitals are up for the past three years. The report further adds that 23 percent of hospital professional liability costs are associated with health-care acquired infections or injuries, medication errors and objects left in surgery. While case managers can’t be held accountable for the outcome of every patient interaction in the hospital or post-acute facility, they are involved in ensuring that both legal and ethical guidelines are being followed.
5. Understand boundaries to reduce risk.
Following employer guidelines that may contradict state licensing regulations can cause daunting legal problems. The complexities of inconsistent multi-state practice regulations for licensed case managers muddy both the legal and ethical guidelines and can create confusion. Often, case managers are called upon to intervene with clients in various states and across state lines. Without a clearly defined system to ensure consistent licensing for the health and human service professionals employed in case management, there’s risk.
As an example, nurses who live in one of the current 24 Nurse Licensure Compact states may not have to pay for multiple licenses if they practice within these states, but it becomes a problem if they venture outside these states without a license. Social workers have a rougher time with no such compact, no state-to-state reciprocity and securing an endorsement a necessary step in order to apply for additional licensing, with fees per state.
6. Be a change advocate.
In the face of ethical and legal challenges, you are grounded by your practice experiences. Be sure to escalate ethical dilemmas and legal questions to your superiors, should they arise. Stay aware of federal and state initiatives to move forward multi-state licensing, plus any relevant laws. With the changes in legislation that can affect your organization, be sure you are paying attention. Engage in public comment and review current violations.
7. Understand social media.
It may seem like a harmless decision whether to “friend” clients, former clients and colleagues on Facebook, but doing so can create privacy concerns that end up in court. There are emerging resources for social media governance for health-care organizations. Use sites that provide examples of best policies as empowerment with accountability.
8. Be visible in the case-management circuit.
Stay in the know by getting out there. Conferences and training sessions have a lot to offer and give you a good opportunity to discuss both new and proven ideas with clinicians who are facing the same challenges. Don’t fall into the trap to think you already understand “best practice” strategies on your own. “Best practice” holds little value in today’s ethical practice climate where the only thing constant is change and what was “best practice” five minutes ago becomes obsolete soon after it is coined as such, replaced by yet another “best practice.” Be visible, network, listen to new ideas and be willing to share your own.
9. Embrace online resources.
There are some terrific online resources for reviewing regulation changes and technology’s impact on professional practice. One I would highly recommend is the Commission on Rehabilitation Counselor Certification, which revised its code of ethics to include a detailed section on technology and distance counseling.
10. Broaden your perspective.
Ethical and legal issues are indeed undeniably intertwined. Approach your role through both an ethical and legal lens. With the current practice climate, can you afford not to?
Ellen Fink-Samnick, MSW, ACSW, LCSW,CCM, CRP, is the principal of EFS Supervision Strategies, LLC. Case management legal expert Lynn S. Muller, RN, J.D., a nurse attorney and managing partner of Muller & Muller, contributed to this article.
Related Links:
> Proposed New QIO Standard on Patient Rights May Link to VBP
> CMS: Face-to-Face Encounters Now Required for Home Care
> New HITECH Requirements for Providers and Business Associates
> Costs of Noncompliance Continue to Rise
> Legal Resources Center
