Cheryl's Blogspot

Confession:  I always hated calculating savings dollars for case management.  I’ve been in work comp case management since 1990, and I always felt guilty – like I was given a free license to make up imaginary scenarios and inflated savings numbers.  Outside of negotiated discounts, that’s essentially what is seemed to be – if CM hadn’t been there, the treating MD might have recommended “X” and so I saved $__.   Therefore, for years, I didn’t address savings dollars in those terms.  Does case management result in managed care savings?  Yes it does!  RN Case Managers ·       identify pre-existing conditions confused with injuries, ·      keep treatment focused on the mechanism of injury, reducing wasted dollars ·   address appropriate physical abilities and limitations for work ·   propel cases forward, avoiding delays in treatment and approvals ·       And communicate, communicate, communicate! But how are these savings captured on a factual basis and not imagination?

A very special customer to JMS requested a small task in obtaining an impairment rating from a physician. There seemed to be some communication issues, between the adjuster and the physician.  The file initially did not have any case management services to help guide the treatment. and at the end of the process nearing file closure, there was a very high impairment rating assigned by the treating physician. Crystal Gilbert, RN got to work! Performing a file review, she found discrepancies with the past surgical history of the injured worker.  The injured worker had failed to give an accurate  medical history.  We gathered and provided the treating physician with medical records showing a prior WC injury to the same extremity and prior surgery to the same extremity of injury. Crystal was able to get a face to face meeting with the physician - because she's just that awesome - and review the medical records and providing documentation of the prior impairment rating from the prio

Stacy Mathis, RN Because JMS Consulting is the premier provider of case management services in Arkansas, we are approached frequently by out of state companies with a service request to work files under the guise of their namesake. As long as our business philosophy and standards align, we do this for a few companies. We recently parted ways with one such "national" company after they asked us to change wording in our reporting, as "the carrier might think we were advocating for the patient and not the customer" -- REALLY??? Of course, we were! At JMS, we believe in getting our patients the best treatment, with the best providers. Our professional networking and resourcefulness help fill in gaps of care and move things along to reduce the costs of recovery from a work injury. Today I read an article in CMSA Today on " Collaboration in Case Management " that deftly explains  the case manager's role in the managed care system; "A case mana

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 going to wo