Case Management and Patient Centered Care

One of the prominent topics covered in this week’s reading was patient case management. The nurse's role as a case manager or coordinator of care has expanded significantly over the last quarter of a century (Huber, 2010). With the decline of general practitioner MDs and provider-to-patient ratios increasing, the case management role is one that we, as nurses, must continue to develop. Assessing patient needs and information will become more critical than ever as the Affordable Care Act comes to fruition in the coming years.

One important aspect of the Affordable care act that will be going into effect is a bundled payment per beneficiary policy.  This is officially referred to as Efficiency of Care, one of the Care Measures to be instituted. More important is the bundling payment time period that will stretch 3 days before a hospitalization or clinic visit to 30 days following discharge (Cesta, 2012).

This is important to case management because there is now a financial benefit and imperative to efficiency. Let’s say a man goes to the clinic with a fever and they run a CBC. Later that night the man goes to the ER and another CBC is performed. This second test lends no new diagnostic information, yet under the current system these providers are rewarded for their redundancy. The clinic and hospital bill separately for their services, even if they are both under the same umbrella health system.  Thus, they profit twice from duplicate testing. The patient has double the number of invasive procedures, higher potential for site infection and has to spend that much more time around potential nosocomial infections. Under the new system these redundancies will be decreased and patient care will improve. Medicare will still likely pay for services rendered within reason but they will now be able to pay attention to Efficiency of Care and assess how institutions measure against one another (Cesta, 2012).

Increased case management and communication will be required to institute this new level of efficiency. My hope is that the end result of increased case management is a higher level of patient centered care. After everything is running smoothly that the extra time saved by not repeating tests gives a provider the time and resources to order that screening that saves a life. I would like to work in a system that offers more that just treatment for the most severe conditions. I believe we can get there as a nation if we focus on attempting solutions as opposed to profiting off of the loop holes.


Cesta, T. (2012). The Role of Case Management in an Era of Healthcare Reform -- Part 3. Hospital Case Management, 20(9), 135-138.

Huber, D. (2010). Leadership and Nursing Care Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO