Skip to main content

Winning One for the Team

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 recovery process moving forward with the best outcome.

Another RN on our CM team is working a lumbar spine injury that has not RTW since his injury.  The injured worker just had a follow up MD evaluation this week, and the physician indicated MMI and RTW are projected in 1-2 months, but he would order a FCE to determine RTW parameters.  Planning ahead, she isn't going to wait until the next month before scheduling the FCE.  She has already scheduled the FCE to be done the next day after the MD visit.  If MMI and FCE order are not achieved at that visit, the FCE can easily be cancelled, but she has planned ahead to avoid delay, and get the earliest RTW release.

And yet another RN CM has a shoulder injury patient that underwent surgery last Tuesday. Planning ahead, our CM obtained a work status prior to surgery for an appropriate LD RTW on the day following surgery.  If something happens in the operative course where that is not appropriate, restrictions can be revised.  But she didn't wait until the ten day post op visit to obtain a LD RTW, saving a week of TTD.

I could continue to name examples for all our nurses, because for all our cases we always have a case management plan, and a back up plan.   Kind of like the receiver getting the football from the quarterback (physician) and running with it.  Is your team color JMS Blue?





Comments

Popular posts from this blog

Case Management GPS

W The next time I purchase a new vehicle there are several features I have on my wish list.  For as much as we case managers travel, Navigation is high on the priority scale to make life easier.  Under the pressure of arriving at a physician appointment on time, it's never a good feeling to take a wrong turn or get lost. There are times our role as a case manager is much like a navigator. Deana Scott, RN had that experience just yesterday while attending a physician visit.  After three years of treatment for a work injury, the physician had nothing further to offer, and there appeared to be issues of malingering and symptom magnification.  There was a point at which the physician actually had a look in his eye of being lost as  far as how to bring the treatment course to an end.  Confusion centered around  the injured worker's return to work goals.   It's at times like this, a Case Manager is able to maintain focus and much like a navigato...

Slipping Under the Radar

A work injury is NO vacation!  Most of us would agree with that statement.  It's never fun to get hurt, yet it doesn't stop an injured worker from trying to turn recovery time into paid time off.  It is very common to have clients make requests to postpone procedures, therapy and return to work for personal reasons.  If this request is made to a physician under their group health insurance, it is not really an issue.  However when such a request is made during healing timeframe from a work injury, this is not an appropriate or reasonable request. As Case Managers, we must remind both the injured worker and providers that during recovery and rehabilitation time the injured worker's "job" is to heal and comply with appropriate treatment and work status.   Just this week, Deana Scott, RN had a client to request postponing her light duty return to work until she could finish outpatient therapy.  What Deana reminded her of, was that the activity of...

Working Both Sides of the Fence

Our Case Management role is so multifaceted.  While we are patient advocates to help injured workers obtain the best treatment on the road to healing, we also find ourselves working the other side of the fence - working just as hard to expose those defrauding the workers compensation system.   This week one of our RN case managers discovered in review of records that a patient had "chronic" back pain, when she had denied ANY pre-existing back pain or treatment for her reported work injury.  This patient DOES need treatment, but it should be on her health plan, NOT workers compensation.  On the other side of the fence, he has a patient that was discovered to have a serious underlying cancer causing what he thought was pain from a work incident.  He is working with the carrier to refer the patient to an appropriate provider. Case Management is such a rewarding field, and for so many reasons.  It's a great feeling when you've assisted someone to obtai...