Case Managers and Social Workers: Interprofessional Education Series
A lack of understanding of the differences in the roles, training, and expertise of interprofessional team members including social workers versus case managers can lead to role confusion. Adding to this confusion is an overabundance of paperwork, authorizations, and discharge barriers. In this episode of Core IM, the team will discuss these challenges and others to offer a better understanding of major challenges social workers and case managers face in the current health care system to avoid contributors to burnout. Join us for this episode of Case Managers and Social Workers: Interprofessional Education Series.
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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.
- 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:
- 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!
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
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
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.
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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.
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