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!

Comments

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...

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