Post-Pandemic Case Management: What’s Changed, What Remains the Same, and How to Prepare for What’s Next

Workers’ compensation and case management are inextricable from the other. Medical management professionals involved in helping an employee travel the road to recovery and return safely to work hold two different—but not discrete—responsibilities: First, to the affected employee, and second to the patient’s employer.

Case managers have the vision to see who and what kind of information and resources are necessary to contribute to an employee’s rehabilitation plan. They also have the talent to know which resources will best support the employee’s return to work.

The modern workers’ compensation treatment management model (closely tied to the coordinated care model) serves employees not simply from the isolated physical diagnosis but from a broader, holistic approach to ultimately enable the employee to return to work in optimal condition.

Having one point of contact for each of the stakeholders in the treatment and recovery streamlines the process and boosts quality. That centralized tracking helps ensure exceptional care, avoid redundancies and omissions, and keeps the treatment care plan moving forward smoothly and effectively. It also ensures that information is relayed responsibly to the claims adjuster and the patient’s employer, to advocate for any requisite workers’ compensation or return-to-work plans.

What's Changed

It feels like everything in 2020 changed in an instant – even within case management, there were some significant innovations that took place rather quickly.

One upgrade to the industry that the pandemic pushed to the forefront was the increased reliance on technology to keep operations moving along. Quarantines and concerns around viral spread prevented many people from feeling comfortable visiting on-site medical facilities, and case managers were unable to meet with injured workers in-person to evaluate their individual claims. As with many others in all industries, workers’ compensation professionals inevitably found ways to expedite advancements that would have happened naturally over time

Medical and Life Care Consulting Medical Chart Reviews

Medical Chart Reviews and Chronologies: Seven Best Practices and Why They’re Important

Documentary evidence is a critical component of all litigious matters. Thinking specifically about retrospective chart reviews, also known as a medical record review, a thorough understanding of the information within medical records can make or break a case. In this month’s INSIGHTS article, we explore medical chart reviews and chronologies and share seven best practices for attorneys and paralegals when reviewing medical records, interpreting the information, and when to engage a medical professional for expert review and analysis.

What is a medical chart review, and what is a chronology?

Medical records include various components and documentation of patient history, clinical findings, diagnostic test results, preoperative care, operation notes, post-operative care, and daily notes of a patient’s progress and medications after an injury or illness.[i] “The medical record frequently is the most important document available in defending against or preventing legal actions, including but not limited to personal injury suits, criminal cases, workers’ compensation actions, disability determinations, and claims of negligent or improper healthcare (medical malpractice), and is generally admissible at a trial.”[ii] A medical record chronology organizes medical records, treatment history, and medication history from the injury or illness date to the present.

When should a medical chart review and chronology be completed?

A medical chart review and chronology is completed either before or after a lawsuit is initiated. Before filing a case,  a medical chart review and chronology is a great resource to reveal the story, gain a deeper understanding of the injury or illness, and determine whether liability is attributed to the opposing party. A medical chart review might also be completed after a lawsuit is filed by either the plaintiff or the defense. The complexities and long-term implications of an injury or illness, the necessary treatment, and the attorney’s experience generally inform whether a review and chronology is completed before or after initiating legal action.

To get the most from a medical chart review and chronology, we share seven best practices for reviewing and understanding medical records and the stories they tell.

  1. Understand the information you’re looking for and how it gets into the chart

A foundational understanding of who adds information to a medical record and how that information is added is paramount to completing a thorough medical chart review. Many health care providers can add information to an individual’s medical chart, including the medical transport team, physicians, nurses, laboratory technicians, physical therapists, and any other health care professional providing care. Consider an automobile accident with 12 months of post-injury treatment; at the very least, records should be reviewed from the accident’s scene or initiation of injury to the present time.  In this instance, records include those of the EMT team that assist the scene, emergency room records, in-patient acute hospital records, rehabilitation hospital records, and outpatient care and physician visit records. And each encounter with a professional may include the chief complaint, physical exam, history of present illness, an assessment and plan, lab or radiological orders, prescriptions, progress notes, and test results.

 

It is also essential to understand how the information gets into the record – is it dictated and transcribed, or handwritten, as the method used for charting can affect the accuracy of the information. According to Air Medical Journal, “…the process of dictation and transcription has been shown to introduce more inaccuracies into the medical record, such as in recording childhood immunizations.”[iii] Electronic health records add yet another layer of complexity and may be confusing for the untrained eye to review and understand.

  1. Ask Questions

The more questions you ask, the more information to factor into your case, including pre-existing injuries and illnesses, medications, and prior and current treatments. When interviewing your client, ask open-ended questions to learn as much as you can about the patient’s health history. The goal is to uncover any other illnesses or conditions and when they might have begun, medications they are presently taking or may have taken in the past, or any information which may factor into how the individual is healing.

References: 

[i] Medical records and issues in negligence

[ii] Legal Issues in the Medical Record | Effective Documentation for Physical Therapy Professionals

[iii] Performing chart review studies

Making the case for Employee Health & Wellness

Employers nationwide are paying close attention to the need for wellness programs and benefits. Historically, one of the main drawbacks to providing wellness benefits is that it costs money, and the return on that investment isn’t always clear-cut. However, as the labor market continues to fluctuate and health care costs continue to climb, employees are seeking out more benefits from their employers than ever before.

As more employers are investing in wellness, companies are shifting away from basic physical wellness initiatives. Instead, there’s been a shift to integrate total wellness, particularly with a focus on mental health and wellness.

In fact, employee mental health has become a top concern this year, as the COVID-19 pandemic has created immense uncertainty, change, and stress for employees across the country. According to a survey by FlexJobs, a telecommuting firm, employed workers are more than three times as likely to report poor mental health now versus before the COVID-19 pandemic.

Generally speaking, an increased focus on employee wellness can improve employee health and wellness. Happy and healthy employees translate into higher recruitment and retention results and employee engagement levels, as well as lowering a company’s overall healthcare costs. This Medical and Life Care Consulting white paper explains why employers should provide wellness benefits.

What are workplace wellness programs?

Traditionally, workplace wellness programs are initiatives that employers offer to encourage employees to lead healthier lives. According to the 2020 Employer Health Benefits Survey from the Kaiser Family Foundation (KFF), a nonprofit organization that focuses on U.S. health issues, 53% of small firms and 81% of large firms offer a program designed to help employees address health risks and unhealthy behaviors.

References: 

2020 Employer Health Benefits Survey. (2020, October 8). KFF. https://www.kff.org/health-costs/report/2020-employer-health-benefits-survey/

Bolden-Barrett, V. (2018, December 6). Fulfillment is the new standard for employee engagement. HR Dive. https://www.hrdive.com/news/fulfillment-is-the-new-standard-for-employee-engagement/543618/

Gallup. (2020, October 19). Q12 Employee Engagement Center. Gallup.Com. https://www.gallup.com/products/170969/q12-employee-engagement-center.aspx

Harter, B. J. (2020, November 11). Employee Engagement on the Rise in the U.S. Gallup.Com. https://news.gallup.com/poll/241649/employee-engagement-rise.aspx

Health and Economic Costs of Chronic Diseases | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved December 14, 2020, from https://www.cdc.gov/chronicdisease/about/costs/index.htm

Increase Productivity | Control Health Care Costs | Model | Workplace Health Promotion | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved December 14, 2020, from https://www.cdc.gov/workplacehealthpromotion/model/control-costs/benefits/productivity.html

Mental health in the workplace. (n.d.). World Health Organization. Retrieved December 14, 2020, from https://www.who.int/teams/mental-health-and-substance-use/mental-health-in-the-workplace#:%7E:text=A%20recent%20WHO%2Dled%20study,or%20getting%20work%20is%20protective.

Oss, M. E. (2020, May 7). Mental Health Spending Now & After The Pandemic. OPEN MINDS. https://openminds.com/market-intelligence/executive-briefings/mental-health-spending-now-after-the-pandemic/#:%7E:text=Mental%20health%20spending%20rose%20to,OPEN%20MINDS%20Market%20Intelligence%20Report

Reynolds, B. W. (2020, August 21). FlexJobs, Mental Health America Survey: Mental Health in the Workplace. FlexJobs Job Search Tips and Blog. https://www.flexjobs.com/blog/post/flexjobs-mha-mental-health-workplace-pandemic/

What about pain: Understand pain and options for managing pain within workers’ compensation claims

Each year millions of claims are submitted by workers who may have suffered a work-related injury or illness. The Bureau of Labor Statistics reported 2.8 million nonfatal workplace injuries and illnesses reported by private injury employers in 2019 alone. Of that figure, 888,220 nonfatal injuries and illnesses caused a private industry worker to miss at least one day of work, with 80% of injuries or illness being sprains, strains, tears, soreness, bruises, contusions, cuts, lacerations, punctures, and fractures – all, very likely, causing some degree of pain[i]. Ten to twenty percent of individuals who enter the workers’ compensation system due to physical trauma develop chronic pain from either the severity of the initial injury or the injury’s progression. [ii] Chronic pain, one of the most common reasons adults seek medical care, has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety, and depression, and poor perceived health or reduced quality of life.[iii]  This month’s INSIGHTS article explores pain, including pain management options, and how they may be used during an individual’s workers’ compensation rehabilitation.

The experience of pain from one individual to another is entirely unique. As one may imagine, pain is subjective and intertwined with two complementary aspects: a feeling of pain in a particular part of the body, and the other, an attempt to relieve or terminate the pain[iv].  Determining the best options for treating a worker’s pain is guided by understanding the source and history of the pain, the intensity, the duration, aggravating and relieving conditions, and the structures, or parts of the body, involved in causing the pain. Pain management is aimed at identifying the source of the problem and defining the optimal plan of treatment[v].

Options for pain management include:

  • Interventional procedures
  • Medication management
  • Physical therapy or chiropractic therapy
  • Psychological counseling and support
  • Alternative therapies
  • Referral to pain management specialists[vi]

Interventional pain procedures

Interventional pain management aims to relieve, reduce, or manage pain and improve a patient’s overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. As nurse case managers, facilitation of timely testing and ensuring the completion of treatments and procedures helps develop a clear picture of how the individual’s pain is being managed and its effectiveness in relieving or reducing the underlying pain.  The nurse case manager’s assessment skills are crucial in detailing pre-and post-procedure status, documentation of symptoms, the anticipated impact in everyday life, and the longevity of response.  This knowledge helps the health care provider determine the treatment’s long-term effectiveness and the resulting pain relief.

References: 

[i] Brown, Jeff – BLS. (2016). Employer-Reported Workplace Injuries and Illnesses — 2015. https://www.bls.gov/news.release/pdf/osh.pdf

[ii] MPR. (2015, September 10). Prescribing Pain Medications for Workers’ Compensation Patients – MPR. MPR. https://www.empr.com/home/mpr-first-report/painweek-2015/prescribing-pain-medications-for-workers-compensation-patients/

[iii] Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR. Morbidity and Mortality Weekly Report67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

[iv] Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior, Osterweis, M., Kleinman, A., & Mechanic, D. (2020). The Anatomy and Physiology of Pain. Nih.Gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK219252/#:~:text=At%20least%20four%20physiological%20mechanisms,primarily%20central%20nervous%20system%20mechanisms.

[v] Standiford Helm II, MD. (2016, September 6). Pain Management. MedicineNet; MedicineNet. https://www.medicinenet.com/pain_management/article.htm#how_is_pain_treatment_guided

[vi] DO, T. (2019). Interventional Pain Management: A Comprehensive Approach to Chronic Pain. SpineUniverse. https://www.spineuniverse.com/treatments/pain-management/interventional-pain-management-comprehensive-approach-chronic-pain

Supporting workers through Post-Coronavirus (COVID-19) Recovery

Workers are still feeling the effects of COVID-19: There is a new program to help!

In early September (2020), the United States surpassed 6 million[i] cases of COVID-19 reported to the Centers for Disease Control (CDC). Since March, the U.S. has witnessed the diagnosis exponentially increase around the country, some diagnosis resulting in death (approximately 200,000 nationwide[ii]), yet the vast majority of those diagnosed (nearly 97%) recover. Within the population of those who recover the effects of the virus on their body ranges from asymptomatic to a wide variety of lingering ailments. The American Association for the Advancement of Science, in their ‘Science’ journal report “Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain.[iii]

So, what’s next for those who return to work? In this INSIGHT article, we partner with Physical Therapist Nicole McManus, MSPT, OMT, FAAOMPT of Professional Physical Therapy (ProPT), a provider of outpatient therapy services with a passion and dedicated program for injured workers to examine the impact of reconditioning after being diagnosed with COVID. ProPT recently added a Post-COVID Reconditioning Program to their service line which is focused on systematically preparing the worker to tolerate the demands of their job.

Post-COVID effects include limited cardiovascular endurance, muscle weakness, low VO2 max (respiratory capacity) and in some cases, cognitive processing deficits and depression as a result of post-intensive care syndrome (PICS).  If a worker needs to be able to perform physically demanding tasks over the course of a normal work day, there is a strong possibility that without reconditioning, the worker will fail to meet the job requirements and may need to remain on restrictions.

Professional Physical Therapy uses a validated pulmonary conditioning protocol to address the adverse effects of COVID-19.  The worker is evaluated by a licensed physical therapist who not only assesses the impairments and functional deficits present but takes specific measurements regarding their pulmonary and cardiovascular function.  These key measurements are reassessed regularly to monitor progress and to compare their current abilities to the job requirements.  The benefit of a specific reconditioning program for the affected worker is that they can also see and feel their progress.  Injured workers who participate in this program have less anxiety or reservation when it is time to return to work as reconditioning allows them to practice their job tasks while consistently increasing their cardio-pulmonary endurance and capacity.

References: 

[i] CDC COVID Data Tracker, retrieved from https://covid.cdc.gov/covid-data-tracker/?utm_source=morning_brew#cases

[ii] COVID in the U.S.: Latest Map and Case Count, retrieved from https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

[iii] From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists, retrieved from https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists

Obesity within workers’ compensation case management

Strategies to help patients along the road to recovery and improve rehabilitation outcomes

The battle of the bulge has been a losing battle for many as the obesity rate for Americans has steadily increased to over 40%.[i] More and more of the population, as indicated, have problems with weight management due to a sedentary lifestyle and job duties. With increased weight, we also see an increase in related health issues, including diabetes and cardiovascular disease, which are among the leading causes of death in the United States. When we consider the impact of obesity on recovery and rehabilitation within workers’ compensation case management, the effect is even more significant. In this INSIGHT article, we explore obesity within workers’ compensation case management, and strategies nurse case managers can use to help their patients along the road to recovery and improve rehabilitation outcomes.

Medical and Life Care Consulting

In 2016, the Journal of Occupational and Environmental Medicine, an official publication of the American College of Occupational and Environmental Medicine (ACOEM), published a study comparing workers’ compensation costs and outcomes for obese, overweight, and normal-weight workers. The study found that for workers with major injuries, costs averaged about $470,000 for obese and $270,000 for overweight workers, compared to $180,000 for normal-weight workers.[ii] Now, as nurse case managers, our work is purely focused on the recovery and rehabilitation of the injured individual, but the financial data clearly demonstrates that weight can have a profound impact on the time and resources needed for the injured worker’s recovery. 

As nurse case managers, our approach to evaluating patients is very holistic, and we review all their diagnoses and comorbidities at the initial evaluation (meeting). In the patient’s initial meeting, comorbidities regarding weight are evaluated when taking the patient’s height, weight, and assessing their BMI. Obesity occurs when a BMI is over 30. When a nurse case manager is first meeting a patient addressing comorbidities is a very delicate discussion. Often, the conversation regarding their weight status is approached throughout the patient’s treatment plan as the treatment plan is an ever-evolving process, and evaluation of their response to the treatment is also evolving. With today’s typical lifestyles, patients’ weight can vary from being within normal BMI ranges to overweight, or the patient can be obese. Visual evaluation of the patient is usually sufficient to identify the patient’s BMI.

The diagnosis of obesity is a significant diagnosis in which we often do not see the ramifications until it’s become the standard in our life. While many people are obese but do not have any other health issues, the extra weight will eventually take a toll on their bodies and deteriorate other systems. For case management of work-related injuries, chronic illness, congenital or developmental issues, the diagnosis of obesity further complicates existing diagnoses – recoveries are delayed, and complications can occur.

Because the nurse case manager’s work is holistic, we cannot ignore the diagnosis of obesity, regardless of the work injury. We need to address it and assist in determining ways the patient can resolve this issue while we are also working on treating the primary diagnosis. 

Identify and Inform

As the patient’s advocate and trusted partner in their rehabilitation and recovery, the nurse case manager plays a crucial role in helping them improve their overall health. While the injury or illness of the claim is the number one concern, the patient’s weight can affect their recovery and should be identified in a respectful and nonjudgmental way. The National Institute of Diabetes and Digestive and Kidney Diseases suggest asking patients if you can talk with them about their general health, including their weight. Studies also show that patients prefer terms like “weight,” and “BMI” when talking about obesity, and dislike terms such as “fatness,” “excess fat,” and “obesity.” Don’t forget to be sensitive to medications that may contribute to their weight gain or challenges losing weight.

Inform the patient of not only the health risk and negative impacts of their weight, but more importantly, highlight the positive effects of losing weight during their recovery and their overall health. Working towards a positive outcome may be more motivating for the patient than trying to avoid a negative consequence of being overweight.

Spend some time learning about the patient beyond their medical records and charts to understand better their eating and drinking patterns and what they may enjoy doing for physical activity. The 2015-2020 Dietary Guidelines for Americans suggest questions like “What’s your family’s favorite dinner” “When you’re thirsty, what kind of drink do you reach for?” or “Does eating healthier seem hard or unrealistic?”.[iii]

Here are some additional resources:

  • Just Enough for You: About Food Portions– This resource is published by the National Institute of Diabetes and Digestive and Kidney Diseases and provides information on portions and servings, how much someone should eat, how to manage portions and eat well when money is tight and much more.
  • USDA’s ChooseMyPlate– This is a great resource to help with creating toolkits and integrating additional resources into the patient’s recovery and rehabilitation plan, including the MyPlate Plan which can be personalized based upon age, sex, height, weight, and physical activity level, and shows the patient’s food group targets – what and how much to eat within their calorie allowance.
  • Physical Activity Guidelines for Americans– Published by the U.S. Department of Health and Human Services, this guide is an essential resource for health professionals when designing physical activity programs. 

Set & Facilitate Goals

The goal for good health and wellbeing is for all to be within the appropriate weight scale for their body type. While helping a patient execute their recovery and rehabilitation treatment plan, help them integrate goals for achieving a healthy weight. The Mayo Clinic recommends focusing on process goals instead of outcomes goals. An outcome goal is the target result – lose X number of pounds. A process goal is how you will reach that outcome, for example, walking 30 minutes per day, or drinking water at every meal.[iv] 

References

[i]Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018, retrieved fromhttps://www.cdc.gov/nchs/products/databriefs/db360.htm

[ii]Study Links Obesity to Higher Workers’ Compensation Cost, retrieved fromhttps://www.insurancejournal.com/news/national/2016/09/30/427876.htm

[iii]Dietary Guidelines for Americans 2015-2020, Eighth Edition , For Professionals: Talk to Your Patients & Clients About Health Eating Patterns, retrieved fromhttps://health.gov/sites/default/files/2019-10/DGA_Conversation-Starters.pdf

[iv]Weight-loss goals: Set yourself up for success, retrieved fromhttps://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20048224

Planning for the future? Determine the type of vocational services your case needs

At Medical and Life Care Consulting, our work within medico-legal claims and life care planning often uncovers the need for additional resources such as the vocational consultant to provide an opinion on an individual’s ability to work and earn money. In this issue of INSIGHT, we’ve partnered with CRC Services’ vocational consultants, to explore the vocational rehabilitation field, the role of a vocational consultant, and examine how and when the expertise of the vocational consultant may intertwine within a case. In addition to this article, we invite you to learn more about vocational rehabilitation consulting and expert witness services in our upcoming webinar “The Rehabilitation Continuum: Working with a vocational consultant within your medico-legal case,” click here to learn more.

More than 10% of U.S. adults report a disability; slightly more than 20 million Americans between ages 18 and 64 report having a disability[i]. In 2004, the World Health Organization published that unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years.[ii] Disability-adjusted life years (DALYs) represent the total number of years lost to illness, disability, or premature death within a given population.[iii] When an individual is significantly injured, their lives are altered, and their road to recovery often extends beyond physiological aspects of healing and includes recovery and rehabilitation of how the individual works. The practice of vocational rehabilitation uncovers their abilities and helps develop a roadmap for returning to the workforce.

What is vocational rehabilitation?

According to the National Rehabilitation Information Center, vocational rehabilitation is made up of a series of services that are designed to facilitate the entrance into or a return to work for people with disabilities or by people who have recently acquired an injury or disability.

Medical and Life Care Consulting

Some of these services include vocational assessment and evaluation.  Following the vocational interview and administration of vocational testing, vocational consultants are uniquely qualified to create suitable vocational rehabilitation plans. Plans typically encompass suitable post-injury job matches, identification of short-term and/or long-term retraining programs and research of the programs to include cost, duration and accommodations needed, and the coordination and needs of public and/or private vocational rehabilitation professionals.  Vocational consultants also provide job seeking skills training (i.e., career counseling, resume and cover letter development, interviewing techniques, proper application completion, education and tips for proper disability disclosure), labor market research, employer and job development, analysis of any on-the-job accommodations and ancillary support services (e.g., job coach, transportation, nurse’s aide, among others).  Vocational consultants can work with individuals to provide various levels of exposure to the world of work such as informational interviews, job shadowing experiences, work readiness evaluations, internship/volunteer experiences, and paid employment.

Working with a vocational consultant within a medico-legal case

In a medico-legal case, there are instances where a vocational consultant and expert are required to provide an opinion on an individual’s ability to work and earn money. Through their expertise and professional services, clients become educated on the art and science of the private vocational rehabilitation field, vocational methodologies, nomenclature, and common treatises used. The services of the vocational consulting and expert may also include records review and preliminary vocational analysis, in-person vocational assessments including a vocational interview and administration of standardized testing (intelligence, memory & concentration, achievement, aptitude et al.), transferable skills analysis, pre-post injury analysis, and labor market research to determine the availability of suitable employment and associated wages; if applicable.  Vocational Consultants also assist attorneys with strategizing their cases by peer-reviewing the opposing vocational expert’s reports and/or opinions and discussing areas in which the attorney can develop the case (e.g., post-injury academic performance, post-injury work experience, among others). As a vocational consultant, or expert witness, the vocational rehabilitation consultant will address the plaintiff’s level of employability and wage-earning capacity pre- and post-accident. In catastrophic cases, future vocational rehabilitation needs may be addressed and as a component of a life care plan.

When the work of the Nurse Life Care Planner and the Vocational Expert Intertwine

Oftentimes, in catastrophic cases involving young adults, future work may be possible with significant supports. As a case example, imagine an 18-year-old injured in a motor vehicle accident and becoming a paraplegic. The individual received above-average grades in high school and was college-bound before the accident occurred. Cognitive testing demonstrated they possessed above average intelligence and college-level aptitudes (e.g., reading, spelling, math). In this case, in addition to providing an opinion with regard to the plaintiff’s pre-post injury level of employability and wage-earning capacity…

The content for this article was developed and published in coordination with CRC Services, LLC, and provided solely for informational and educational purposes. This article was not released as a means of endorsement or advertisement for either Medical and Life Care Consulting or CRC Services, LLC or constitute a formal partnership between each organization.

case management during coronavirus

Caring in the midst of a crisis: Re-examining workers’ compensation case management during COVID-19

In the wake of COVID-19 healthcare professionals worldwide are experiencing drastic changes in how they work and care for their patients – changes which not only impact hospital and acute care professionals,  but changes with rippling impacts to health care providers in varying fields including nurse case management. Whether facing a global pandemic, or an equally significant crisis, the ability to adapt is critical for patient recovery and care. After more than a month of shelter-in-place protocols, MLCC takes a moment to re-examine workers’ compensation nurse case management and how we’re ensuring our patients continue to receive the attention and care they need for recovery.

As workers’ compensation, or field nurse case managers, our primary role is not direct care. Instead we are commissioned to assess, plan, facilitate, coordinate care, evaluate and advocate options and services to meet an individual’s and family’s comprehensive health needs.[i] During a crisis, our mission does not change yet, how we deliver and manage our cases just might. Within workers’ compensation, we’re often treating individuals with emergent injuries or illnesses, and elective treatments may not appear critical in the face of those directly affected by the crisis. However, our goals remain focused on the improvement and healing of our patients, and here’s how we’re doing it:

1. Finding alternative methods of treatment

Our patients and the care they need is our priority. When customary modes of treatment are not available, nurse case managers must find alternative solutions such as replacing in-office provider visits with telehealth visits and video appointments. Physicians, physical and occupational therapist are still able to provide orders, update treatment plans, provide treatment, and more through video conferencing features of telehealth software platforms.

2. Finding alternative care providers and alternative methods of care delivery

As nurse case managers within workers’ compensation, finding alternative care providers and alternative methods of care delivery is something we do every day in practice.  When one door is closed there is always another that is open. At MLCC, once regional shelter-in-place and stay at home orders were executed we immediately developed an evolving list of providers that were open and confirmed the level of services they had available. If certain caregivers were closed and unavailable, alternative treatment sites and treatment providers were identified.

telehealth in workers' compensation case management

For our existing patients, we immediately reassessed diagnosis and whether any new complications or risk for complications were identified while continuing treatments put in place by their care providers through video appointments and telehealth conference calls.

When new patients were referred, with new or evolving injuries/illnesses, physicians were identified, and visits facilitated as needed. As with all patient visits during this time of crisis, appointments were completed in person with appropriate personal protective equipment (PPE) or through telehealth platforms and video conferencing until the pandemic is under control.

3. Exploring varying options for testing

During times of crisis usual and customary standards of care and case management may not be available. In the Northeast region we found that provider offices may be closed for patients, but open for specific services, or even transformed into COVID-19 testing centers. As case managers we rely on our relationships with our providers and are consistently exploring the varying options available to our patients.

Let’s consider an example case where a patient who has been diagnosed with a fracture and needs an evaluation of the injury. The evaluation has been delayed due to the shutdown of offices but can no longer be postponed. Even though the physician’s office is closed, their x-ray office may be open, and their treating physician is requesting an x-ray.

However, amid the current crisis the x-ray department is now a known COVID-19 evaluation and treatment center. That patient, who is severely compromised, may be put at risk in that center. An alternate site would be found, orders facilitated, and the treatment scheduled by the nurse case manager to decrease risk of the patient contracting COVID-19.

Having the ability to continue managing our cases and securing varying options is the responsibility of the nurse and by doing so decreases the anxiety the patient may have around their treatments and care.

4. Connecting patients with the appropriate resources

As health care professionals, our focus always includes the prevention of further complications, or contamination in the case of COVID-19, of patients and their families while getting them resources and services they need for recovery. In the wake of the current pandemic this includes nurses wearing appropriate PPE’s and taking precautions during patient visits, at therapy appointments, or out in the community.

personal protective equipment

It also means connecting our patients with protective equipment, masks and gloves, when attending appointments in their physician’s or provider’s office. Continuing to educate and provide supplies goes a long way in minimizing risk of possible contamination.

Managing hypertension as a co-morbidity in workers compensation

Hypertension and workers’ compensation case management: Three strategies for improving patient and claim outcomes

In January 2018, the American Heart Association published an estimate that 103 million U.S. adults have high blood pressure, which accounts for nearly half of all adults in the United States[i]. High blood pressure, also known as hypertension, can lead to severe health complications and increase the risk of heart disease, stroke and sometimes death. With such a high occurrence of U.S. adults having high blood pressure, it is not surprising that hypertension is the most prevalent comorbidity within workers’ compensation claims[ii]. In this issue of INSIGHT, we explore hypertension within workers’ compensation, and three nurse case management strategies to improve patient and claim outcomes.

When managing any type of diagnosis, a preexisting health condition has the potential to impede upon the individual’s recovery. Comorbidities can prolong the claim and have been known to increase the risk of complications. In a study by Harbor Health Systems it was found that “claims associated with comorbid conditions experienced longer claims duration, higher medical costs, more temporary total disability (TTD) days and increased litigation and surgery rates.[iii]

Given the prevalence of high blood pressure, it is important for nurse case managers to understand the underlying effect the condition has had on the individual’s body and develop a plan to reduce complications on the present injury or illness being treated. An effective approach to managing workers’ compensation patients with hypertension requires early identification, education to mitigate further complications, and consistent management.

Indentification

Hypertension in workers compensation

High blood pressure usually has no symptoms, and many adults are unaware they have the condition. The Centers for Disease Control reported that over 46% of adults worldwide don’t know they have hypertension[iv]. In workers’ compensation case management, it is critical that the nurse is skilled in identifying underlying comorbidities or other conditions which may interfere with the individual’s recovery.

When a patient presents with pain don’t assume the source of the pain is only the injury. Oftentimes symptoms of untreated or substandard treatment of high blood pressure produces symptoms which can mimic other conditions, such as headaches and migraines, pain, anxiety, and more. It is important that the nurse case manager includes an assessment of blood pressure to rule out high blood pressure as the underlying cause.

It’s is also important to consider the impact an individual’s emotions can have on their blood pressure. We frequently observe a patient’s blood pressure elevated by simply attending their doctor’s appointments.  The claimant may also have anxieties surrounding missed work or other life stressors resulting in higher than normal blood pressure. Appropriate identification and follow-up with the patient’s primary care provider is critical. Sometimes, something as simple as recommending the patient keep a blood pressure log to review and share with the primary care provider.

Mitigation through education

High blood pressure can quietly damage an individual’s body for years before being diagnosed. If the claimant was unaware that they had high blood pressure or don’t understand the impact high blood pressure can have on their injury or illness, proper treatment and patient education is key to mitigating further complications.

Education helps patients better understand their condition, the role of medication and lifestyle changes as well as increasing awareness about the progression of high blood pressure and complications.[v] Comorbidities such as hypertension are not compensable, yet poor treatment regimens, and out of control blood pressure can affect the compensable injury or illness of the claim.

References: 

[i] More than 100 million Americans have high blood pressure, AHA says. (2018). Www.Heart.Org. https://www.heart.org/en/news/2018/05/01/more-than-100-million-americans-have-high-blood-pressure-aha-says

[ii] Laws, C., & Colon, D. (2012). Comorbidities in Workers Compensation. https://www.ncci.com/Articles/Pages/II_research-brief-comorbidities-in-workers-compensation-2012.pdf

[iii] New Research Shows Impact of Underlying Conditions on Workers’ Compensation Claims. (2011). Harborhealthsystems.Com. https://harborhealthsystems.com/new-research-shows-impact-of-underlying-conditions-on-workers-compensation-claims/

[iv] Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and Control of Hypertension. Journal of the American College of Cardiology72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008

[v] Ribeiro, C. D., Resqueti, V. R., Lima, I., Dias, F. A. L., Glynn, L., & Fregonezi, G. A. F. (2015). Educational interventions for improving control of blood pressure in patients with hypertension: a systematic review protocol. BMJ Open5(3), e006583–e006583. https://doi.org/10.1136/bmjopen-2014-006583

What exactly is the practice of Nurse Life Care Planning and a Life Care Plan?

The formal practice of Nurse Life Care Planning, which is approximately twenty-years-old, is often misunderstood by industry partners including attorneys, fiduciaries, and even professionals within rehabilitation, insurance, and health care management. For individuals suffering from a catastrophic injury or illness, a life care plan informs private fiduciaries, legal professionals and case managers of the long-term resources required for the individual’s long-term care, health, and wellness.

A life care plan is typically developed by a nurse life care planner whose primary role is to develop a client-specific lifetime plan of care utilizing the nursing process. The plan contains an organized, comprehensive, and evidence-based approach that estimates current and future healthcare needs. A life care plan also includes the associated costs and frequencies of items and services needed for care and can be applied in various sectors including private, medical-legal and case management by serving as a valuable guide.

This white paper provides an overview of nurse life care planning, as a practice, the customary components of a life care plan, and aims to articulate the vital need for a life care plan when managing a medico-legal claim of an individual who’s been catastrophically injured or ill. Any information, sample tables, or opinions within this whitepaper are purely the opinions of Medical and Life Care Consulting Services, Inc. and should not be used as legal advice, counsel, or testimony of any nature.

Download the complete white paper today!

Nurse Life Care Planning

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