This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this conversation, the physicians discuss two cases and whether they should be classified as inpatient or outpatient. The first case involves an 86-year-old patient with bilateral lower lobe pneumonia and hemoptysis. The team believes it meets the criteria for inpatient status, but the medical director denies the claim due to the lack of hypoxia. The consensus is to suggest appealing the denial and having a peer-to-peer discussion to present the case's complexity. In the second case, a six-month-old with short gut syndrome and a viral illness is admitted for observation and antibiotic treatment. The team calls it inpatient, but they anticipate potential denial due to the short length of stay. They emphasize the need to educate payers on the unique considerations for pediatric cases.

The Association of Physician Leadership in Care Management, or 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 the partnership and collaborative model of 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. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

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