Problems encountered with DMs

joannep · Aug 9, 2008

1. some doctor's office are really hostile against DM/CMs.Some dont even bother returning your call or fax how do you handle that?

I have found that doctors either love DM or are totally against it. It is probably due to the fact that they believe that nurses are trying to tell them what to do, or are checking what they do. I don't take it on board and ignore it.

2. Non compliant patients who goes back again and again in the hospital after you work your behind off managing them.

Yep, there are probably a large percentage of patients who say "I really want to loose weight (or whatever) I really will change my behaviour" but don't and never will. You can't change that. Just focus on the ones that do.

3. unable to reach patients.

Again, same thing, some patients say they really want to be part of the program, but their actions say otherwise.

Don't sweat it too much, people are people!

snotpikkr · Aug 9, 2008

Welcome to the world of frustration and rebound patients. You have to know that what you did on the last discharge will have no impact on the patient for his/her readmission. When a patient is noncompliant, there's little you can do to help or teach them. If the patient is connected to an insurance plan (frequently they aren't and the hosp is their only medical care) you can call and have them case managed by the insurance company. The MD office has an obligation to return a call to you. You are doing HIM a favor by assisting his patient in the safest discharge possible. Be insistent, talk to the head of the department (medical, surgical, etc) and voice your frustrations. One of my case managers called the office and said she was the Dr's wife just to get him to come to the phone!

luvmyworld · Aug 11, 2008

thanks for all your replies.

I work for an insurance company. I felt so guilty the first time I found out that I have 5 people admtted in the hospital. Its a good thing a friend of mine told me that its not my fault if i have done my job but still they keep going back to the hospital.

what issues do you have with disease managment and how do you cope ?

I am still learning and Im pretty sure I can learn from your experiences.

thank you.

dria · Aug 13, 2008

were the admissions emergent or scheduled?

what was the admitting diagnosis?

when you f/u with the member after discharge (i assume you do since you know they are inpt) read the ur notes. ask the member what landed them in the hospital. was this a preventable admission?

as a dm, you manage a high risk population, and as such, they have this annoying little habit of bouncing in and out of the hospital.

sometimes, you just have to let it roll. put it in the "nothing personal" file and keep going...

snotpikkr · Aug 13, 2008

We as acute hospital case managers don't routinely call the patients after discharge- we rely on the health plans to do that- it is their responsibility to follow up and case manage the patients. We encourage and sometimes make the follow up appointments for the patients even thought they may not follow through with keeping it. The under/unfunded or homeless patients do not want your assistance. They want to come in, get the acute problem fixed, and be on their merry way until they aren't feeling well again. We do offer to fill a few days of prescriptions for them if they really have no funding. Not ideal, but reality.

dria · Aug 13, 2008

the op has clearly stated that she does work for an insurance company, aka health plan, so she/he will be calling the member after d/c.

i do understand that the role of the cm varies by setting, and i understand that my life (as a cm working for an insurance company) would be a lot more difficult if it weren't for the inpt cms setting the stage for a successful d/c plan. however, in order to engage in meaningful dialogue, it is important to read and understand what the other posters are saying.

added thought to the op.....when i have md offices that don't want to play nice, i usually send them to my medical director. and the unable to reach members make me nuts....sometimes they just don't answer the phone rather than saying they don't want to participate.

snotpikkr · Aug 14, 2008

My mistake, Dria. The first post I read did not state she worked for an insurane company so I offered my opinion, which is what this is for.