Care Transitions Today Podcast

Case by Case: The Right Next Step

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association.

In this episode, returning experts Dr. Rebecca Severe and Dr. Sweta Singh are joined by special guest Dr. Ariana Peters of Mayo Clinic to discuss two real-world cases that illustrate the complexities of determining medical necessity throughout a patient's hospital stay.

The first case explores a patient who remained hospitalized after becoming medically stable because she wished to complete additional diagnostic testing before discharge. The panel examines the ethical and operational challenges of balancing patient preferences with appropriate resource utilization, highlighting when inpatient care is no longer medically necessary and how multidisciplinary teams can navigate these difficult conversations.

The second case follows a patient who required ongoing hospitalization despite limited treatment options, prompting discussion around discharge planning, patient appeals, and the physician advisor's role in supporting frontline clinicians. Throughout both cases, the panel emphasizes the importance of clear communication, thorough documentation, interdisciplinary collaboration, and maintaining a patient-centered approach while ensuring hospital resources are used appropriately.

The Association of Physician Leadership in Care Management (APLCM) was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on a collaborative model that brings together nurse case managers, social workers, and physicians in care management. ACMA has a rich 25-year history of supporting the case management field. APLCM is inclusive of all practice settings, and membership provides access to ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership offers valuable professional networking opportunities and resources. Visit ⁠www.aplcm.org⁠ to learn more.

For more information about the podcast, please visit ⁠www.acmaweb.org/podcast ⁠or contact us directly at ⁠podcast@acmaweb.org⁠ with questions, topic requests, or feedback.