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