Skip to main content

Savings Analysis - Nonfiction Version

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?  Enter evidence-based guidelines.  These guidelines contain a dataset of actual claims to capture and categorize virtually any injury diagnosis along with other medical conditions, and the length of time it took for these claimants to return to work, and when the claim to be closed.  Utilizing ICD and CPT coding we can plug in all the factors of a claim we are working, and find out real savings dollars. Pretty cool.  For the last few years we have been utilizing these evidence-based guidelines to not only identify CM savings, but also to steer expectations of outcomes.

This week I’ve been working on savings reports for customers using evidence-based guidelines to “show them the money.”  With evidence based guidelines, we can now plug in all the factors of a claim and produce actual savings numbers.  Putting the proof in the pudding, so to speak. 

In this age of escalating medical costs, case management can be seen as an added expense to claim management when in actuality, case management is a savings tool. 


How much could case management be saving you on your claims?
Labels:

Comments

Post a Comment

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...
1 comment
Read more

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...
Post a Comment
Read more

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...
Post a Comment
Read more