Patient Advocacy

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 manager's primary obligation is to his or her patients, and with ideal collaborative practice, the positive patient outcomes of quality care will be achieved." Exactly! JMS Consulting holds high the Case Management Society of America's Standards of Practice in the realm of workers compensation claims. These standards bind us to put patient needs first.

While we do our best to give our customers excellence in service, we believe that we do that while working with all stakeholders to provide the best of care for the patient. In the end, positive patient outcomes are what ultimately bring file resolution -- and happy customers!

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At the Heart of Case Management

I have done presentations on The Benefits of Case Management to carriers, peers, and other health care professionals. Sometimes it sounds dry and philosophical to list benefits: access to care, best practice recovery, lowered cost expenditures. But who is the one that benefits? In our practice, is it the injured worker? the employer? the insurance carrier? From the Case Management Society of America, "It is the philosophy of case management that when health care is appropriately and efficiently provided, all parties benefit." Allow me to demonstrate for you the heart of case management from two of our case managers this week. One of our CM Team has a patient that was "swimming" amidst a work injury and numerous mis-diagnoses and was fearful this CM's job was to just "write him off." Our RN worked to find a physician that would clarify his diagnoses, even collaborating between his group health carrier and Work Comp carrier. At the conclusion of a...

The Head Bone's Connected to the Neck Bone...

My first test in college anatomy we were given a piece of paper with numbered lines, 1-206. Instructions were simple: Name the 206 bones in the body. I made 100% - thank you. Learning anatomy of all the body systems, and the physiology of how they interact is my love in the medical field. The science of it all fascinates me. There is a logical physiologic reaction to bodily injury, and a RN Case Manager's critical thinking skills help anticipate symptoms and complaints. If you hit your thumb hard with a hammer, we know you will have pain, and probably stiffness; and if you smashed it good enough, you could have "sympathetic" stiffness of adjoining fingers in the hand. That is a known physiologic response. Stacy Mathis, RN has a patient with multiple injuries has begun to relate all aches and pains to his MVA. The problem is, not all his complaints can be physiologically connected to the injury. This is quite common in catastrop...

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...

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