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Case Managers and Social Workers: Interprofessional Education Series

Core IM

This episode is part of the Interprofessional Education Series, covering social workers and case managers. 

First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.

CME/MOC:

Up to 0.5 AMA PRA Category 1 Credits ™ and MOC Points
Expires February 6, 2023   active

Cost:

Free to Members

Format:

Podcasts and Audio Content

Product:

Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.

Part 1: Setting the stage

  • The demands to our healthcare system – increased volume of patients, new metrics to which we are held, documentation requirements – have compressed the pace of our day-to-day work on the wards and in the clinics.
  • This compressed pace impacts all members of the interprofessional team – including social workers (SWs) and case managers (CMs).

Part 2: 5 Ways to Improve Collaboration and Understanding

  • #1: Role Confusion
    • “Role confusion” is defined as a lack of knowledge around the precise scope of practice of SWs or CMs (or how these two roles differ from one another). This is thought to contribute to workplace tension on interprofessional teams.
    • The codes of ethics for each emphasizes empowering patient autonomy and facilitating patient decision-making.
      • Training: 
        • SW: bachelor's or a master's degree in social work (BSW or MSW) as minimum requirement. Those with additional training in providing mental health services and counseling are called Licensed Clinical Social Workers (LCSW).
        • CM: Less standardized, varies by state. Usually hold a bachelor’s degree, can sometimes be nurses or SWs by training. About 4% of CMs are SWs.
      • Team care roles:
        • Both: experts in facilitating and coordinating transitions of care and accessing community resources 
        • As above, LCSWs can provide counseling to address social and/or mental health needs
        • CM have emphasis on addressing barriers to care. They often follow patients longitudinally and act as an advocate in:
          • Accessing resources such as housing, medications, transportation, equipment, medical appointments.
          • Facilitating cost-effective care 
      • In practice, these roles are defined differently at every institution. Ask your SW/CM colleagues early and often what their individual scope of practice is (and remember – social workers often ask each other!)
  • #2: Understanding limitations of SW and CM
    • Because we aren’t always 100% clear on what’s in the purview of our interprofessional colleagues, our referrals to SW or CM often lack specificity or a clear “ask”.
    • We may be making things worse by over-promising solutions that are not feasible. SW and CMs often have their hands tied by insurance, time, and other limitations.
    • Be realistic of the limited resources our case manager and social work colleagues have in their toolboxes. 
  • #3: The “Behind the Scenes” Paperwork and Documentation 
    • IPT members are often sensitive about approaching clinicians to sign off on documentation (e.g. peer-to-peer reviews, wheelchair scripts, letters of medical necessity for hospital bed).
    • Although seemingly mundane in the scheme of sick patients, these requests are important.
      • Moreover, IPT members may have already spent hours on the phone interfacing with insurance companies before they come to you – meaning that the “last minute form” may represent a significant amount of work and coordination on their part.
  • #4: Insurance and Medications
    • Harness your EMR’s ability to make insurance status front and center 
    • Become familiar with “big-ticket” medications that may receive approval by insurance (see below for examples). When you see these on your med list, give a heads up to the CM can run a test claim:
      • DOACs
      • Certain insulins
      • Newer diabetic regimens
      • Oral chemotherapeutic agents
      • Newer antiplatelets (e.g. ticagrelor). 
  • #5: Disposition Planning
    • Insurance status materially impacts where a patient can go after hospitalization. 
    • If you have a medically stable patient waiting for authorization or making a choice for disposition options, consider speaking to the patient regarding their expectations, fears, goals. That extra “nudge” from the clinician may very well be exactly what they need to make a decision!

Part 3: Improving Teamwork

  • In organizations such as healthcare, we often don’t prioritize intentional training around teamwork;  “It is naïve to bring together a highly diverse group of people and expect that by calling them a team, they will, in fact, behave as a team. It is ironic indeed to realize that a football team spends 40 hours a week practicing teamwork for the 2 hours on Sunday afternoon when their work really counts. Teams in organizations, though, seldom spend 2 hours per year practicing when their ability to function as a team counts 40 hours a week.” 
  • Consider creative ways to create psychological safety among the interdisciplinary team.
  • Vocalize your appreciation for the work your IP colleagues do.
    • Not only does it feel great to share in the gratitude – it often fosters a culture of goodwill and cooperation at your workplace!

Contributors

Shreya Trivedi, MD - Author, Producer

Gabrielle Mayer - Author, Producer

Ryan Chippendale, MD - Author, Producer

Todd Selmer, RN - Guest

Drew Grabham, LCSW* - Guest

Susan Hedlund - Guest

Cynthia D. Smith, MD** - Guest

Reviewers

Donna Flaherty, RN, CM

Megan Young, MD

Tabassum Salam, MD, FACP

* Drew Grabham reports that he is a board member of Portland Street Medicine.

** Cynthia Smith reports stock holdings in Merck & Co., where her spouse is employed

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

Release Date:  February 6, 2020

Expiration Date: February 6, 2023

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.5 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz. To claim CME credit and MOC points you must achieve a minimum passing score of 66%. You may take the quiz multiple times to achieve a passing score.