Cheryl's Blogspot

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...

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...

Whether you know the song from the Madagascar movie or Apollo and Julianne's performance on Dancing with the Stars, this is such a catchy tune! And it came to mind when I read an email update from Stacy Mathis, RN just now.   Stacy's client just completed a progress evaluation with her surgeon, and is doing well, but additional healing and therapy time are needed before medical release.   One principle we adhere to at JMS is regular and timely intervals for physician follow up. Providers that don't understand WComp may suggest a 6 or 8 week follow up appointment.  Our CMs request monthly return visits, as too much can change for the better or worse during that time frame in the recovery process.  In this case, Stacy assured the return appointment was scheduled appropriately. Additional healing time may still be indicated, but work restrictions could likely be relaxed, helping out the employer, and actually contribute to the client's strengthening in prep...

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...

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...

When we are taking care of treatment arrangements and details, calling clients for updates and problem solving, attending physician visits with clients - sometimes with lengthy wait times, we establish a professional relationship with them.  From the client's perspective it can seem even "personal", although it's overwhelmingly a 1-sided sharing of information.  This is true not only in case management, but in every field of nursing, because nurses show empathy and compassion for others as we provide "care" for them. I caution adjusters and carriers not to think of case manager tasks as clerical, or messengers, or that our clinic wait time is a "waste" of time.  All our communications with clients are taking care of their needs - "medically" physical and emotional.  The results of our nursing can seen not only in the gathering of information, treatment planning, but also in improved patient compliance and understanding, and outcomes....