Build a bigger hat rack: case managers' duties expand to outpatient care.

With the current national trend toward fully integrated health care systems, hospital-based case managers are becoming crucial to the expansion of acute care facilities into the outpatient arena. While many may still be getting used to juggling both clinical and financial duties, others--particularly at small, rural hospitals--are taking on even more responsibilities. While there are advantages to having inpatient case managers oversee outpatient and community care--including shortening inpatient length of stay in some cases--most inpatient/outpatient models have drawbacks as well. In particular, case managers are required to maintain a flexible outlook that encompasses the entire continuum, rather than just one slice of it. One potential result of the trend toward outpatient case management could be an increased willingness on the part of managed care organizations to subcontract work with hospital-based case management departments to handle outpatient programs.