Question 1

Which of the following best describes how a case manager identifies people who would benefit from case management services? (Select all that apply.)

Accepted Answer

A variety of tools are used to identify people who would benefit from case management services.These include health risk screening tools,evidence-based criteria,risk stratification through data management,and referrals from hospitals and health care providers.

Question 2

A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role.Which of the following will be most difficult for the nurse new to this role?

Accepted Answer

Skills to ensure success in the role of case manager include sound knowledge of reimbursement structures,knowledge of available resources within the community,ability to evaluate patient outcomes,and an understanding of financial strategies.Such a nurse would have to be flexible,be creative,communicate well,and be able to work autonomously.Although the text does not discuss this,the typical baccalaureate program does not include courses in reimbursement and financial implications of clinical decisions.

Question 3

Which of the following best describes the purpose of case management from the client's perspective?

Accepted Answer

Client-centered case management assists the patient through a fragmented and often confusing health care delivery system and to achieve specific client-centered goals.Systems-centered case management recognizes that health care resources are finite.Helping clients understand their health problems is a responsibility of health education,not case management.

Question 4

Which of the following best describes the goals of nursing case management regardless of setting? (Select all that apply.)

Accepted Answer

Case management programs aim to provide a service delivery approach to ensure the following: cost-effective care,alternatives to institutionalization,access to care,coordinated services,and patient's improved functional capacity (Lyon,1993).Not all clients need case managers if they have adequate financial resources and can navigate the health care system.Although hospitalization can often be avoided,in acute cases hospitalization would be the most appropriate use of resources.

Question 5

A hospital is going to start a care management program.Which of the following groups of clients would most likely be selected to first receive such services?

Accepted Answer

The overall goal of care management is to improve the coordination of services provided to clients who are enrolled in a care management program.Examples of groups of people who may be served by care management services include the elderly,children from low-income families who receive Medicaid services,and groups of people with chronic illnesses.The other groups do not represent groups who are typically enrolled in a care management program.

Question 6

A health care provider has charged more than a managed care organization (MCO)typically pays for a procedure.Which of the following would most likely be the result?

Accepted Answer

MCOs may deny reimbursement to health care providers who exceed the expected costs.Therefore,at least on the first occasion,the most probable result would be that the provider gets the listed payment,not what the provider charged.

Question 7

Which of the following are considered core functions of a case manager? (Select all that apply.)

Accepted Answer

There is a consensus in the literature that there are four core functions that delineate case management: assessment,planning,facilitation,and advocacy.

Question 8

Which of the following best describes when case management is implemented for hospitalized patients?

Accepted Answer

Health care coordination begins on the patient's admission or shortly thereafter and continues after discharge.

Question 9

Which of the following elderly persons are often the targets of case management?

Accepted Answer

Many older people have special,population-specific health care needs.Case management services frequently target the elderly population,specifically homebound individuals or those with complex problems.However,not all older persons require a case manager.The other elderly groups are not the primary target of case management services.

Question 10

The case manager gave the client a list of eight possible sources for the equipment needed for care after discharge.Which of the following best describes why the nurse did not just tell the client the best source for the equipment?

Accepted Answer

Ethical issues for case managers include the client's right to select providers of resources.As a practical matter,nurses usually offer several choices so there is no suggestion of misconduct in pushing a particular provider.

Question 11

Which of the following best describes why health care institutions are unhappy beyond the fact that they are not receiving the previous high reimbursement for procedures from Medicaid or Medicare?

Accepted Answer

Although publication of quality measures is occurring,this is gradually being implemented.The Centers for Medicare and Medicaid (CMS)has established a value-based purchasing program for hospitals that was launched in 2013.The program links Medicare payments to quality performance on common,high-cost conditions such as cardiac,surgical,and pneumonia care.Thus,all reimbursement is not being linked to these quality measures.However,whatever the federal government does to hold down costs is usually quickly copied by insurance and other third-party payers.

Question 12

Which of the following best describes why nurses are increasingly becoming case managers when social workers have historically been so successful in the role?

Accepted Answer

Traditionally,case managers were social workers.Client health care needs became more complex,the need for ongoing patient assessment has emerged,and available resources have become more numerous and diverse.Therefore,nurses have become case managers.There is not a shortage of licensed social workers to fill these roles or a salary issue with social workers being in these roles.These roles are different than direct clinical care,but may not be considered to be an easier role for the nurse.

Question 13

Which of the following has the largest influence on the case manager's role?

Accepted Answer

The individual case manger's role will vary depending on the specific program's services.The criteria of program acceptance,location,and population served by the program will not have as large an influence on the case manager's role as do the specific services of the program.

Question 14

A client has been referred to a case management program.Which of the following actions would the nurse most likely take first?

Accepted Answer

All clients referred for case management must undergo screening to determine their appropriateness for inclusion in the program.Thus,this is the action the nurse must take first.Not all referred clients need the services of a nurse case manager.Often,a nurse can arrange community services or instruct the client and family in the most appropriate follow-up based on client need and program design.

Question 15

A nurse has been working as a case manager for the past 6 months and would like to become certified.Which of the following organizations should the nurse pursue certification through?

Accepted Answer

The only organization that offers a certification that this nurse is qualified to obtain is the Certified Case Manager (CCM)through the CMSA.The ANCC certification requires that the nurse has completed a minimum of 2000 clinical practice hours in case management nursing within the past year.Having worked only 6 months as a case manager,the nurse would not meet this minimum criterion.The ANA and CMS do not offer certification for case managers.

Question 16

A nurse is explaining case management to a client.Which of the following statements would be the most appropriate for the nurse to make?

Accepted Answer

There is no single definition of case management.But it is a collaborative process to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes.The response "with you" shows a collaborative approach to coordinating care for the best outcome.

Question 17

Which of the following best describes why utilization review departments are becoming case management units?

Accepted Answer

Case management programs evolved from utilization review departments when those departments demonstrated that monitoring service use alone is insufficient for managing patient populations with diverse resource needs.There is not readily available funding for case management responsibilities.Case management involves more than utilization review,so there is a changing role of the nurse associated with the change of the name of the department.Using nurse experts for case management is beneficial,but it is not the reason why these departments transitioned.

Question 18

Who first created the idea of a continuum of care,which later evolved into the term "case management"?

Accepted Answer

The concept of continuum of care originated after WWII to describe the long-term services required for discharged psychiatric patients.The term "case management" first appeared in social welfare literature during the early 1970s.Nightingale,Wald,and social workers were not involved in the creation of the idea of the continuum of care.

Question 19

Which of the following best describes the aftermath of the deinstitutionalization of mentally ill patients into the community during the 1970s?

Accepted Answer

Several problems resulted from deinstitutionalization of mentally ill patients,because there was no follow-up or monitoring.Many were readmitted to state hospitals.Many ended up homeless or in prison facilities,not in nursing homes or with their family members at home.Community health centers were created to provide care to these patients,but the deinstitutionalized were unable to meet their basic needs and receive proper follow-up and health care monitoring.Thus,they were readmitted to care.

Question 20

Which of the following clients may be eligible for hospital-based,disease-specific case management support? (Select all that apply.)

Accepted Answer

Case management services are often provided for individuals who are identified as having medical conditions that are high-cost or high-volume acute and chronic illnesses such as congestive heart failure.The goal is to keep these clients as healthy as possible and stable in their home environment.Doing so will decrease the frequency and length of hospital stays and therefore decrease health care costs.

Quiz 9: Case Management