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

3 Things attorneys may not know about Medicare Set-Aside allocations

Cynthia Bourbeau, RN, CRRN, CCM, CNLCP®
Founder & President – Medical and Life Care Consulting Services, Inc.

The Centers for Medicare Services defines Medicare Set-Aside (MSA) allocations as financial agreements that allocate a portion of a workers’ compensation, medical malpractice or personal liability settlement to pay for future medical services related to the injury, illness or disease. These funds must be depleted before Medicare will pay for related treatment.

We work with attorneys to evaluate a person’s future medical needs and recommend an amount that should be set aside for future medical care. Once the government approves this amount, the administrator of the MSA fund uses the funds to pay for medical care related to the plaintiff’s injury. For example, if there is a settlement case for $6 million, and $2 million of that was approved for medical and care costs, that amount is put aside for future medical costs.

1. Medicare Set-Aside allocations not required in all states…yet

Medicare requires Medicare Set-Aside allocations in many states. The conditions under which an MSA is required vary by state, and attorneys need to be prepared. While an MSA is not required in all states, the federal government requires that Medicare’s interests are considered in all settlements for those people who are Medicare beneficiaries or likely to become a beneficiary in next 30 months.

MSAs have been used for years in workers’ compensation cases, and the government has extensive reporting and monitoring rules in place. MSA law is complicated and constantly changing, reinforcing the need for an experienced life care planner.

2. Who is responsible to ensure an MSA is completed?

When MSA allocations are mandated, it is the attorney who is responsible to ensure one is completed and the money is put aside. Medicare can collect against insurance carriers, the client, their legal counsel and their advisors—any counsel involved in a settlement—because of workers’ compensation, liability or no-fault settlements when the financial interests of Medicare are not protected with an MSA.

3. We will improve your MSA claims, settlement outcomes and trust arrangements

Our life care plans present concise standards of practice, data analysis, research, clear chronologies and evidence-based plans for current and future costs to maximize wellness throughout the patient’s lifetime.

We work with attorneys across the country to develop life care plans and MSAs, complete the Medicare paperwork, and make the necessary notifications. We offer best practices with a clinical approach for formulating MSA allocations to remain compliant with Medicare.

If you are an attorney specializing in medical malpractice, workers’ compensation or liability claims, contact us today to learn how we can help you plan for your client’s future.

Back to life, back to work: highlighting an invaluable profession during National Case Management Week

National-Case-Management

In the face of serious illness or injury, the idea of ever reclaiming a productive life can feel impossible. Fortunately, there is a set of compassionate professionals whose very role is to help turn that idea around—and make it a healthy and attainable goal.

It’s National Case Management Week (October 7–13), a time to join organizations everywhere in recognizing medical case managers and their invaluable impact. Here at Medical and Life Care Consulting (MLCC), we’ve made “back to life, back to work” a motto of sorts, as helping individuals return to optimal, active living is what we do every day.

“When the unexpected happens, it can be devastating and hard to see the light at the end of the tunnel,” said our president, Cynthia Bourbeau, who founded MLCC in 2001. “Our job is to work with patients, families, health-care providers and employers to develop a plan to reach that brighter place. Our case management professionals bring extensive training, expertise and sensitivity to every situation we encounter. Together, we lay out the smoothest path possible, in terms of the patient’s physical, emotional and social well-being, as well as financial and logistical considerations.”

Because research has shown that patients who stay active recover from their injuries more quickly and with fewer complications, we offer innovative stay-in-work programming as a component of our comprehensive employment-centered services. This allows for job modifications or light-duty job specifications for an individual when possible and indicated.

“We work with patients’ employers to develop customized plans,” Bourbeau said. “When individuals can stay on the job while still protecting their health and safety, it’s often the ideal scenario.”

Beyond our services within the employment realm, which also include workers’ compensation, short-term disability and long-term disability case management, our professionals provide major medical case management services within the community. In these cases, we work directly with patients and families as they navigate the challenges of catastrophic illness or injury, delivering services at a patient’s home or during acute hospitalization.

MLCC is proud of the role that we—and our fellow medical case managers nationwide—play in keeping individuals “in the game.” Learn more about our services, staff and story today. When the goal is getting back to life and work, we’re ready for the job.

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