My nursing colleagues and I often get into playful banter about healthcare issues. Frequently, the topic of care coordination or coordination of care comes up in our dialogues. My response? Follow the money.

If I’m being paid by the hospital, what are the chances that I’m really going to ‘stir the pot’ about a patient’s inpatient care? If my paycheck comes from an insurance company, how hard am I able to work on a complex patient’s case when I have multitudes of other patients I’m supposed to be in touch with? If a patient “meets criteria” at a rehab, but I know he’s not safe to go home, how much time can I put into advocating for that patient to remain before I have to discharge another patient?

Until our healthcare system recognizes care or case managers as the care coordinators who CAN keep the system moving (on behalf of the patient) AND gives them the appropriate POWER and TIME to advocate for patients and families, our system will never improve in a meaningful way.

The majority of nurses and social workers, the case managers ‘in the trenches,’ have only the patient’s best interests at heart, but economic, legal and bureaucratic forces prevent them from doing what’s best.

Just follow the money.