Tag: Professional obligations

ERCI’s 2025 Top 10 Patient Safety Issues and Heeding Case Management’s Professional Obligations

ERCI’s 2025 safety issues represent a clear and present danger for patients with opportunities for all healthcare professionals. Yet, these quality missteps also yield concern for how case managers understand their professional obligations to the practice principles that underlie our licensure, certification, and organizational accreditation. 

I am a quality warrior! This fact means that my brain goes into overdrive when certain reports cross my radar.  The latest intel to have this impact was ERCI’s 2025 list of Patient Safety Threats. My focus immediately focused on the #1 issue, “Dismissal of the Patient and Caregiver Voice”. As a social worker by education and licensure and board-certified professional case manager, I am responsible for mitigating this quality gap. I also happen to be a fierce industry disruptor courtesy of my Doctorate in Behavioral Health. My DBH colleagues and students will get this one,  but I digress. 

I am an enduring ethical, legal, and regulatory champion to my core. I have been digging deep into the research, writing about, and presenting on medical gaslighting and invalidation for the past year. The dismissal and devaluing of any patient and caregiver voice is clearly associated with this obstructor to care. Medical gaslighting’s connection to increased costs of care is significant with billions of dollars lost from delayed and missed diagnoses. Increased healthcare utilization has come from unnecessary hospitalizations, readmissions, treatment missteps, yielding poor health outcomes. Mortality rates are equally higher when a patient’s voice or that of their caregiver is ignored.

Yet, two other areas of concern stood out to me as I reviewed the list of other patient safety priorities on the ERCI list:

  • #5. Caring for Veterans in non-military health settings
  • #9. Inadequate coordination during patient discharge

These two issues speak loudly to all of my colleagues, but particularly those in my professional case management world.

Professional Obligations Matter

Colleagues frequently ask me, why I get so hot about our established resources of guidance (e.g., accreditation and credentialing requirements, standards of practice, codes of ethics) ”. Yes, the hashtag or #EthicsMatter has become my hallmark. However, the list of 2025 safety issues represent a clear and present danger for patients. Quality missteps and patient safety concerns mean case managers are not heeding their professional obligations to the practice principles that underlie our licensure, certification, and organizational accreditation. This action represents potential professional sanctions for breach of the very requirements that bolster our case management profession. 

Standards of Practice

Those professionals who walk in the world of case management are accountable to assorted standards of practice and codes of professional conduct. The Case Management Society of America (CMSA) set the tone for these seminal documents, crafting the initial version in 1995. Updating of each version of the standards occurs through a formal vetting process that was completed in 2002, 2010, 2016, and 2022. The addition of Standard Q: DEIB and Health Equity yielded a revised version of the document in 2024. 

The intent of the standards are simple: to “serve as a compass for all who practice case management. They stand as a blueprint for excellence in practice”. They are not meant to be prescriptive in intent. Instead, they serve as a guide for professional case managers and their organizations to define optimal practices for the industry that meet ethical, legal, and regulatory guidelines and requirements. The relevant standards of practice by CMSA that address these patient safety realities include: 

D. Ethics

E. Advocacy

G. Resource management

I. Client selection

J. Client assessment

K. Identification of care needs and opportunities

L. Planning

M. Facilitation, coordination, and collaboration

N. Monitoring

O. Outcomes

P. Closure of professional case management services

Q. DEIB and health equity

Each standard details clear guidance for the workforce in each of these critical areas of case management practice. 

Licensure and Certification Requirements

Case managers have a primary responsibility to the licensure and scope of practice that underlies their professional discipline, whether in counseling, medicine, nursing, occupational, physical, respiratory or vocational therapy, social work or other qualified disciplines to practice (CMSA Standard A. Qualifications).  Yet, we are then responsible to our case management credentialing, which is often dependent on this primary licensure. 

Our credentialing entities prioritize the importance of critical competencies for their certificants through dedicated resources. The Code of Professional Conduct for Case Managers authored by The Commission for Case Manager Certification (CCMC) details keenly defined ethical standards, rules, procedures, and penalties for the workforce. The document’s Preamble sets a critical tone by defining case management as “a professional, collaborative, and interdisciplinary practice guided by the Code of Professional Conduct (the Code)”. The resource goes on to further denote the main purpose of the code; “to protect the public”. While the guidelines provided are advisory in nature, they still set a professional standard to which all board-certified case managers are held accountable.

The American Case Management Association (ACMA)’s Scope of Services and Standards of Practice also define clear competencies for practice. This resource also aligns with the association’s Accredited Case Managers Credentialing Exams, which have oversight by the National Board for Case Management:

Relevant Scope of Services, including but not limited to::

  • Assessment
  • Care coordination
  • Facilitation
  • Transition management  competencies 
  • Longitudinal care management
  • Identification
  • Implementation

Relevant Standards of Practice, including but not limited to:

  • Accountability
  • Advocacy
  • Resource management

Organizational Case Management Accreditation

Attention is also paid to these critical domains of practice by each of the entities that are tasked with providing, regulating, and monitoring of organizational case management accreditation. These include NCQA, URAC, and ANCC’s Magnet Recognition Program. The agencies define strict compliance requirements and standards for case management practice, as well as for the entities by which they recognize certification through. 

The workforce should remain aware of the following: 

Note: As of January 1, 2024, Magnet Status Recognition only accepts certifications accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC) or the National Commission Certifying Agencies (NCCA). Included are  ANCC’s Nursing Case Management board certification (CMGT-BC) and the Commission for Case Management Certification’s Board-Certified Case Management Credential (CCM).

The Bottom Line

Case managers have a critical role in ensuring compliance with the ethical, legal, and regulatory  standards and requirements that underlie our practice. Each one of the established resources of guidance for case management prioritize our professional obligations to advocate for, monitor, and ensure patient safety; public protection remain a priority. They also heed every case manager’s accountability to the industry’s Quality North Star of the Quintuple Aim: patient- and family-centric care rendered at the right time, for the right cost, by professionals who embrace the work, and delivered in a way that is equitable and accessible for all.

ERCI’s Top 10 Patient Safety List for 2025 should be a call to action by every healthcare organization with attention from every case management leader and their teams. How will you and your organization step up to mitigate these gaps in quality and care? 

Working Around the Words to Ensure Health Equity

Considerable time, effort, and energy is being spent on reframing word use in response to Federal mandates and their ripple-effect across the industry. Shifting words should not negate our professional commitments and obligations to the patients, their families, and the workforce. Our actions must continue to advance the Quintuple Aim and what matters most.

Much has been written lately about reframing word use in response to the latest generation of Executive Orders (EO) and other actions by the Federal Government. Yet, what happens when most of the words at issue are aligned with population health funding priorities as in accessibility, health equity, inclusion, or vulnerable populations? What happens when the words are commonly used in daily language, like advocate, expression, gender, or status? What happens when the words inform competencies for public health professions, as in cultural competence, implicit bias(es), oppression, or social justice? What happens when the words speak to evidence-based interventions that support populations across healthcare settings, such as anti-racism, cultural responsiveness, feminist, social justice, and trauma-informed? What happens when the words align with ethical codes of conduct and standards of practice for healthcare professionals whether discrimination, person-centered care, underserved, and vulnerable? What happens when shifting the words eliminates populations, persons, and their identities as in gender affirming, LGBTQIA, pronouns, Trans, or other terms. What happens when the list is ever-expanding and unpredictable? It is an understatement to say resolution is complicated. 

How many ways are there to say, equitable, accessible, and quality-driven whole person healthcare? It presents there are many ways. Of course, the mantra remains that the more things we call these drivers and influencers of poor health outcomes and the persons who experience these factors the most, the less people will know what they are. These words have specific meanings; using so many different terms can invoke unintended misunderstandings. While the explicit intent of this new macro-focus is “to help Americans lead healthier lives” there is a clear and present worry that all populations may not be included in this mix. 

Managing The Latest Information Flow

The constant attack on words is exhausting and frustrating to already weary professionals, practitioners, and providers, but most definitely patients and populations. This is an equally troublesome effort to those in higher education preparing future generations of the workforce. 

The latest funding and programming shifts have left many reeling, including the March 2025 announcement to cease funding on four critical value-based care models: Primary Care First, End Stage Renal Disease Treatment Choices, the Maryland Total Cost of Care, and highly-anticipated Making Care Primary model. These shifts will impact millions of Medicaid and Chips recipients, plus Medicare beneficiaries with complex, costly chronic illnesses and the primary care practices that care for them.

This week saw Joint Commission reframe their highly coveted Health Equity Resource Center to reflect new verbiage of, The Optimal Delivery of Care for All; yes, the familiar language of “page not found” now appears when you one goes to the original website. History of Joint Commission’s focus in the health equity space is provided with emphasis on the entity’s ability to provide individual consultations to meet the new industry framing. In addition. CMS’s Health Equity Framework has been reframed as CMS’s Framework for Healthy Communities. The five pillars have also been reframed. In edition, their Health Equity Index used for Medicare Advantage Star Ratings has been rebranded as…..wait for it….The Excellent Health Outcomes for All Reward ((EHO4all). There is concern that the coveted 1115 Waivers might be next on the chopping block; time will tell.

Valuable time is being spent daily by colleagues to review, consider, and revamp programming to stop the ongoing rise of National Health Expenditures, expected to hit $5.3 Trillion. Much of my current bandwidth is spent staying current on policy and EO interpretations, but also supporting colleagues through job losses, or their fear of potential job losses. My students are coping with a constant flurry of issues from disappearing funding for their education and work-study programs to general concerns for their chosen career trajectory. 

Here’s the Real Deal

Changing the terminology will not eliminate the wrath of health disparities and inequities experienced by historically minoritized and marginalized populations. Shifting words alone will do little to improve the poor clinical outcomes experienced by some populations more than others. Adjusting how populations are addressed will not decrease healthcare utilization or improve fiscal outcomes. Eliminating some populations from the conversation or funding will not dismiss the persons from those communities who experience worse illness morbidity and increased mortality rates. Reframing new initiatives will not identify the drivers of systemic racism, political determinants of health, and other social influencers of poor health for populations. In fact, each of these actions will further deteriorate the outputs of our current healthcare system. The US will continue its downward spiral of having the highest healthcare utilization and costs, along with the worse outcomes compared to other developed nations.

While we reconcile our fury about having to change longstanding terminology, the work to address the true priority at hand must continue. We must work to implement actionable strategies that heed our ethical obligations as healthcare professionals and providers. We must continue to advocate for ALL patients and their families so they receive access to the highest quality care available. That care must also be delivered to all in a fair and equitable way. 

Strategies to Advance the Health Equity Equation

Emphasis needs to focus on defining, measuring, and incentivizing progress to improve access to quality care. A recent article in Health Affairs Scholar, posed clear direction with examples for each element provided. I encourage all to take a deeper dive into the piece to integrated these steps within your organization or practice:

  1. Define clear measures of equitable access and tracking progress at both organizational and national levels.
  2. Develop and implement equity-focused quality measures and aligned incentives to support progress and create accountability for addressing barriers in access to care (e.g., quality metrics, outcomes data).
  3. Health care leaders should undertake efforts to measure the availability and quality of health care services for people who experience inequitable access to health care and track progress towards addressing barriers to access (e.g. dashboard).
  4. Build and leverage cross-sector partnerships that allow collaboration on investing to address shared patient and community needs.

My daily dialogues with valued colleagues are a reminder to continue prioritizing ourselves and our energy. This will fuel our focus on the critical work at hand. Here are a few of my own strategies to push through this muck!

  • Stay informed through your valued sources of intel but limit the amount of time spent viewing the information each day. While old habits have me check CMS Newsroom Posts weekly, there are other personal favorites: The Commonwealth Fund, Peterson/KFF System Tracker, Epstein Becker Green, and others.
  • Explore what actionable strategies are up your sleeve
  • Don’t silo your efforts: continue to discuss and strategize with colleagues who share your passion. Those relationships and conversations will continue to nurture and motivate your efforts.
  • Try not to get lost in the alphabet soup of verbiage! Yes, it is toxic and traumatizing and will get the best of us if we let it! Instead, focus on actions to advance past the toxic energy around us. This may mean using alternative words or language, as posed in the list provided in the Federal Grant Trigger Words Replacement Workbook (yes, many alternatives were provided by ChatGPT).
  • Stay up to date; the 4/3/25 document published by the EEOC and DOJ, What You Should Know About the Recent DEI-Related Discrimination at Work is a must read. 

In the end, it is our actions that matter most to achieving the industry’s quality north star of the Quintuple Aim: patient- and family-centric care delivered at the right time, for the right cost, delivered by those who embrace the work, and assuring equitable access for all. Shifting words should not negate professional commitments and obligations to our patients, their families, and the workforce.