Cheryl's Blogspot

There is a RIGHT way and a WRONG way to achieve our case management goals.  Unfortunately, some RN Case Managers have gone the wrong route all to try and steer treatment and medical opinions in the direction that would make their customer happy.  They committed the one deadly sin that I teach our JMS RNs to never commit...arguing with the treating physician. Now don't get me wrong, we MUST ask for clarifications of opinions, recommendations, etc., but you just don't argue with a  physician.  WHY?  because:  It won't do anything but make him/her mad - doubtful it will change their mind You will make it much more difficult for that physician to appropriately manage your patient. If it doesn't get you thrown out of and banned from the clinic, you will certainly have heck to pay the next time you need to work with that physician again.  And trust me, if you intend to stay in the case management field, you WILL have need to see that physician aga...

She's already done it twice this week - shut down a file with one Physician visit.  But this just goes to show how effective an onsite RN Case Manager can be!  She once got MMI and RTW on three files, on the first MD visit, all in one day.  We call her our One Hit Wonder.  You know, like artists that got a number one hit with one song that was amazing.  Steve Martin's King Tut still is an all time favorite one hit wonder!   Click Here to Play King Tut Video                    How does she do it?  Well, honestly most of the time it boils down to communication. Communication with the injured worker. Communication with the employer. Communication with the physician.  Nothing brings everyone together on the same page quite like onsite (field) case management.  Gathering pertinent information in a thorough intake assessment, and coming to the physician visit prepared with that info...

My blog is late in the week, for we all attended the Arkansas Workers Comp Commission Educational Conference this week.  As always, it was full of great presenters and information which I will be excited to share with you.  I cannot tell you how much we all look forward to this conference where we can visit with all our customers and long time friends in the WC arena.  We also love to have a little fun with competition while we're there.  This year we had a general attendee drawing for a lovely lantern, which went to Laura Hopper with AIG,  In addition, we had a very special VIP drawing for a VISA gift card that went to...well, watch and see! A heart felt thank you to everyone that stopped by our booth and especially our VIP drawing participants!

This time of year everyone is talking about football, and around here, our Arkansas Razorbacks.  My thoughts of football tend to revolve around the latest talk of permanent brain damage resulting from the game...but I digress;  The topic of this blog is really about having a game plan.  In Case Management, we work as a team with the injured worker, carrier, employer, and physician to get the injured worker rehabilitated and back to work.  That's the ultimate goal.  Sometimes it's an easy win, and other times it feels like reaching Super Bowl level.  Let me walk you through some of the play books we have going on. One of our senior CM team is currently working a catastrophic injury and I saw in an email today she has set forth her CM plan to the carrier for requesting a hand surgeon specialist.  The injured worker is likely still weeks away from restoring function to his hands, but early consultation and planning are essential to keeping the recov...

Today's post is from guest blogger, Jackie Cooper, RN, BSN. One of JMS Consulting's finest, Jackie is our NorthWest Arkansas Case Manager. Always keeping her eye out for the latest in treatment options, Jackie recently had lunch with two new providers in Fayetteville to learn more about their practice and new procedures they offer to patients.

The motto of the Case Manager is:  Plan for everything, but expect the unexpected!  An idiom from the famous novel  Of Mice and Men  says it best, "The best laid plans of mice and men often go awry."  As healthcare and Case Management becomes more evidence based, it becomes easier to guide WC providers to evaluate progress and base orders on objective findings.  Use of references such as the Official Disability Guides ensure evidence based practice.  So what can go wrong?   A few years ago we began working with a local provider who sought out WC business.  He let Case Managers help him learn to base orders on objective findings.  He'd done well and seemed to developed a predictable formula that effectively addressed related symptoms and never prolonged the treatment plan unnecessarily.  Many CM's began to flock to him. Then a JMS Case Manager brought him a patient that voiced a desire to get disability; on the f...

A referral came in yesterday prefaced by the label, "This is one of our frequent flyers!"  If you deal with workers compensation, you know what that means - an employee that has filed several work injury claims that many times are associated with bizarre, or routine circumstances that make us question validity versus some underlying motive.   As Case Managers, when we receive one of these referrals, there are 3 strategies that we will employ in our treatment plan.  The first and most important strategy is Choice of Physician .  In Arkansas, the employer has the right to first choice of physician.  We highly recommend employers take advantage of that and choose the best specialty fit for each injury on a case-by case basis.  In these situations, the physician should also be one that we know is willing to review all information presented - from the injured worker, from the employer, and any medical information from the case manager.   The seco...

Burn injuries are one of the most expensive injuries because of the specialty care involved and length of healing time.  It is also one of the most emotional injuries for the patient and their family.  We see all types of burns in our case management practice, but electrical burns can be the most devastating.  If - yes, "if" the injured worker survives, there are months of recovery hurdles ahead.  Rebecca Olson, RN is working an electrical burn injury that happened recently.   The first and most critical goal in management of a burn injury is  Assessment of the extent of injury . What makes assessment so critical is the fact burned or injured tissue will continue to necrose after the initial injury, revealing the depth of skin loss and whether or not skin grafting will be needed, the viability of blood vessels and the need for surgical amputation in some cases.  In an electrical injury, the path that the charge takes through the body - cross...

When I go shopping at my favorite clothing store and  purchase something fabulous on sale, I love to tell my husband how much money I saved him.  He usually rolls his eyes, not totally buying that he "made" money by my spending it.  He took this picture of me shopping while we were on vacation - he was bored. I have seen that same skeptical eye roll from claims managers when discussing the savings they can reap by using case management on their files. So let me tell you how just this week Stacy Mathis, RN saved one of our customers $75,000 with only 8 hours of case management services.   A file was referred with a date of MVA  October  2013. The claimant was driving a work vehicle and was rear ended.  He reported no injury at the scene and continued working regular duty.  In June 2014 he filed a work injury claim citing back pain  for several months  stemming from the MVA.  Case management received t...

In the 20+ years I've been a case manager, I've certainly seen employers grow to embrace the idea and benefit of light duty work.  In the 1990's the Safety Director at one factory used to say "if the employee can't lift more than 10-lbs., they can't open our door to get in - We don't have room to babysit!"   Staff changes have come and gone several times since then, and the mindset of the company has totally changed now to one of accommodating pretty much any restriction in order to avoid lost time as long as it is in the best interest of the injured worker.  Right now, Kelli Wells, RN has an injury case with that same company that demonstrates how light duty can benefit everyone involved.  The injured worker sustained a bump to his shin that he didn't think was significant.  Within a week, it became apparent the resulting wound was not healing adequately, and the IW was referred to a general practitioner, who recommended referral to a wound...

Yes, I know medical terms sound like another language to lay persons.  Sometimes we medical people get a good laugh out of patient's pronunciations.  My mother always called the "pharmist" to refill her meds.  My friend's mother said she needed "cadillac" (cataract) surgery.  One injured worker told me he was x-rated and sent home from the ER.  But the funniest was a lady talking about her "rotisserie cup" surgery - translated "rotator cuff". Medication names - particularly generic names, can be very confusing.  That's why I always recommend carrying a written list of medications in your wallet.  It's great to have in an emergency, or when you are filling out clinic history forms.  While we can laugh off some mispronunciations, medication names are very important NOT to get confused. Stacy Mathis, RN had a patient this week that is a perfect example.   An injured worker had been recommended to return to his psychologi...

Last weekend my college aged daughter was reminiscing playing the game of Clue as we used to do on family game nights – before teen social calendars became too busy.  Clue was one of our favorite games, where you play detective to solve a murder mystery by ruling out possible suspects and murder weapons.  During the course of the game, if you think you have solved the mystery, you can lay down your cards and make the accusation of the murderer, but if you’re wrong, you lose the game! Solving the source of an injured worker’s back pain is much like the game of Clue.  The physical exam, diagnostics, and conservative treatment measures including medications, therapy, and injections will hopefully alleviate the pain source.  The general public has a misconception that surgery will “fix” their back.  Injured workers many times don’t like it when a second surgical opinion is recommended; it feels like the insurance carrier is cheaping out and won’t let them get t...

Visit Our Website                                                          Connect with me on LinkedIn It’s kind of an inside joke around our office that I’ve been called “brilliant” by a physician for my interpretation of a lumbar MRI.  This story happened several years ago when Stacy Mathis, RN working with me in training, and was my witness!  This physician is known for his eccentric personality, and he went all out to make me feel as though my critical thinking skills really were brilliant!  I was attending a clinic visit for MMI and PPI assignment of a shoulder and lumbar injury.  The shoulder had been complicated by a postoperative infection, and was now healed.  The lumbar injury had been diagnosed as a strain, although an MRI had been obtained to rule out a disc herniation.  I was expecting a high ra...