Care Management Work Research Articles

Care Progression: Care Management Alignment.

Care Progression: Care Management Alignment.

Informal care management after traumatic brain injury: perspectives on informal carer workload and capacity

Purpose: Much of the support required to live in the community post-traumatic brain injury (TBI) is provided by informal carers. Understanding the nature of caregiving work is important to better support informal carers. This study explored the work being performed by informal carers, and factors impacting on their capacity to manage the workload.Method: Participants comprised 21 dyads each consisting of an adult with moderate to severe TBI and a nominated carer. Thematic analysis was done on semi-structured interviews with injured participants and carers during the 12-month period post-discharge from hospital.Results: Results revealed two main themes and eight subcategories: (1) The nature of informal care: describing informal care management work, (personal assistant work; care provider work; family support work; and emotional self-regulation work), and (2) Mediating factors that impacted people’s capacity to manage workload (carer intrinsic factors; injured person characteristics; family circumstances; and changes over time.)Conclusion: Rehabilitation providers supporting people following TBI need to focus on broad family contexts; understand the nature of work being undertaken, and carer capacity to carry out that work; and be aware of the unique and changing circumstances of families to better support informal carers.Implications for rehabilitationRehabilitation services need to focus on broad family contexts rather than focus on the injured individual in isolation.Understanding the nature of the work being undertaken by informal carers, and their capacity to carry out that work is important when considering supports.Rehabilitation professionals need to consider and respond to the impact that changing circumstances have on the capacity of informal care networks to manage care workload.

APA Supports New Complex Chronic Care Management Codes

Back to table of contents Previous article Next article Government NewsFull AccessAPA Supports New Complex Chronic Care Management CodesMark MoranMark MoranSearch for more papers by this authorPublished Online:30 Oct 2013https://doi.org/10.1176/appi.pn.2013.11a17AbstractA proposed Medicare rule, issued in August, addresses regulatory and payment policy issues but does not include the fee schedule. A final rule with the fee schedule will be issued this month.APA is endorsing the government’s move toward incorporating “complex chronic care management codes” as part of the Medicare fee schedule for 2014.In response to a proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) in August, then-APA Medical Director James H. Scully Jr., M.D., told CMS in a letter that the codes can create a means for compensating physicians for non-face-to-face services they provide to patients with complex chronic conditions.(The proposed rule by CMS was issued in August and addresses a variety of regulatory and payment policy issues, but does not include the 2014 fee schedule; a final rule, with the fee schedule, is expected this month. Look to Psychiatric News for coverage.)“APA strongly favors compensating physicians for the non-face-to-face care management, including, but not limited to, team conferences, telephone calls, and patient education they provide to Medicare beneficiaries suffering from chronic care conditions,” Scully wrote. “We commend CMS for moving in this direction, which we believe is a starting point. These codes cross an important barrier in not requiring face-to-face time. We support CMS’s proposal to utilize the parameters described in the CPT guidelines to identify patients eligible for complex chronic care condition management services. A disproportionate share of Medicare beneficiaries suffering from two or more chronic conditions are suffering from a mental illness as shown in CMS’s analysis of Medicare claims for patients with multiple chronic conditions.”But Scully also said that the conditions currently required for billing the newly proposed complex chronic care management service G codes are unlikely to capture the non-face-to-face care management work many psychiatrists are performing for some of Medicare’s most chronically ill beneficiaries.“Among the population of Medicare beneficiaries who comprise the severely and persistently mentally ill, our members often function additionally as primary care physicians, coordinating all or most of this population’s health care,” he wrote. “We urge Medicare to design complex chronic care management codes that our members can use when coordinating the health care of the chronically mentally ill Medicare population. This necessitates the design of complex chronic care management codes that have broader conditions of use, such as the two existing non-face-to-face CPT codes. We prefer the CPT codes because their use permits use of CPT guidelines and, consequently, other payers’ likely adoption of these codes.”Scully also expressed support for the adoption of the psychiatry CPT values, reviewed and approved earlier this year by the Relative Value Update Committee (RUC) for the 2014 Fee Schedule. “Adoption of the RUC recommended values is necessary to correct the current rank-order anomaly that exists between the psychiatric diagnostic evaluation with medical services (90792) and the psychiatric diagnostic evaluation (90791), which does not include medical services,” Scully wrote in a September 5 letter to CMS. “A disparity in payment was created by the adoption of RUC-recommended reductions in practice expense values for only 90792. The inequitable result of this is that psychiatrists and advance practice nurses have been paid less this year for doing more work with more complex patients. We believe this inequity created inappropriate incentives on the clinical level. This issue will be resolved if CMS adopts the RUC recommended practice expenses for the 90791.”Scully also urged the government to adopt new values for CPT codes for psychiatric services, as recommended by the RUC. Other issues Scully addressed included proposed rules around telehealth, liability for overpayment, quality measures, and the Medicare Physician Quality Reporting System. ■Scully’s letter to CMS is posted at http://www.psychiatry.org/advocacy--newsroom/advocacy/9e9023b8-d3da-4c85-a2a2-c02fa8cbad9a. ISSUES NewArchived

Which skills do care managers need? A research project on skills, competency and continuing professional development

This paper discusses a research project on skills for care managers. The acquisition of skills is discussed from the perspectives of those engaged in that work both as care managers and as alumni from a post-qualification course. Care management work that involves decision-making and risk management is considered to be professional activity that demands the acquisition and develop ment of specific skills. Findings from this research emphasise that continuing professional education for care managers should incorporate both an awareness of context and personal development. The paper concludes that quality strategies to enable planned care in the community to succeed should include investment in the continuing professional development of care managers.

Winning hearts and minds? - Emotional labour and learning for care management work

This paper is based on empirical research into the skill needs of care managers and examines the legacy of care management and the effect that 'new managerialist' approaches have had on care management work. The concept of emotional labour is used in context and applied to the work of care managers where the ultimate aim is quality outcomes for users of services. The paper argues that recognising the validity of the concept of emotional labour in context relates to the need for a greater acknowledgement of the skills required by care managers. 'Soft skills' that involve improving own learning and performance through reflection, problem solving and working with others are the key skills required for complex care management work. A rationale is made for reconsidering competency approaches to training in favour of continuing professional development. A preferred approach is one that emphasises both the personal and professional aspects of learning and the social world of the learner.