Discharge planning begins upon admission

A very wise nurse once told me they had a saying in the hospital she worked at:  "Discharge planning begins upon admission."  The goal of any admission at a hospital is to discharge the patient, hopefully in a better, healthier state than they were when they arrived.

This same adage applies to workers' compensation claims.  The goal of any claim representative should be to ensure the injured worker receives appropriate medical treatment that will help them recovery, return to work, and hopefully a state of wellness.  This doesn't just miraculously happen!  A well-thought plan is needed to coordinate a successful return to work, but particularly if we're aiming to help the injured worker get better.

What can you do to help plan for success?

Start having the return to work conversation as soon as possible.  Employers should proclaim it to be their goal to return the injured worker to work whenever a claim is reported involving lost time.  That means having return to work discussion in the absence of a modified duty release.  You might be asking, how can we bring someone back to work if they don't have a work note allowing them to come back?  Generally we have an idea as to why type of restrictions correspond with the type and severity of injury.  For example, a rotator cuff strain/sprain may result in no overhead lifting, one handed restrictions, or lifting no greater than 2 lbs. over counter level.  How can you plan for RTW when there is such a variance in possible restrictions?  Plan for the worst, hope for the best.  Anticipate the most restrictive work note and go from there.  If they can lift 2 lbs. with their injured arm and you planned for, and found, one-handed work, then you have work available that fits restrictions!

When you have an injured worker with a note that totally disables them from working, it's never too early to try to identify a modified duty opportunity.  Sending this modified duty option to the treating physician may facilitate an earlier release to return to work, or it may not, but it's worth an attempt.

Communicate your intentions to the injured worker as well.  They are probably very concerned about their job, their income, and how they are going to pay their bills if they are taken out of work.  Letting an injured worker know, at the appropriate time, that you will try to find work available will be one of the best things you can do to reassure them that you value them as an employee.  Just be sure to do it in a sensitive manner at an appropriate time.

Word of the Day: Return

Merriam-Webster defines return as "to restore to a former or to a normal state."

That's the promise we make when we say we're going to return someone to work or return them to wellness.  It's a tall order.  Telling someone you're going to return them to a former state is almost like telling someone to get the wrinkles out of a piece of balled-up aluminum foil.  Even with extreme measures, the likelihood of getting a smooth Hershey Kiss wrapper out of a pea-sized wad is nearly impossible.  I am in no way saying injured workers are like balled up scraps of aluminum -- but we cannot promise everyone the health and ability they may have experienced pre-injury.  Even without an injury my body has aged 24 hours more than it was the same time yesterday.  In the past 24 hour hours deterioration has occurred, plates of the earth's lithosphere have shifted ever so slightly, and maybe an ice cap has melted ever so slightly more today than yesterday. It is very unlikely, if not improbable that we'd be able to easily eliminate the effects of aging, prevent the earth's plates from shifting or restore the polar ice caps. 

The workers' compensation laws are designed to indemnify an injured worker, or to "make them whole."

For a larger proportion of work injuries, that’s likely the case -- the cut finger that doesn't leave a scar, the bee sting, the ankle sprain that has resolved.  We can't make the same promise for many, more severe injuries that require surgery, produce scars, or leave injured workers with permanent restrictions.  The law tries to indemnify injured workers for their loss of income, medical treatment and sometimes permanent impairment.  But the injured worker will never be the same as they were pre-injury -- it's impossible for me to be the same as I was a week ago.  The point is -- we cannot stop change, nor can we go back and prevent the future from happening.  That is, unless of course you're Marty McFly.

It sounds as if this goes against all that we promise -- Return to Wellness?

The Return to Wellness promise is alive and well.  I can't tell you that we can return everyone.  These cases demand a frank and honest discussion about what the injured worker's future looks like.  When there are likely permanent restrictions or impairment, how do we manage that going forward?  I'm not talking about mitigating losses, I'm talking about reconciling who you were before an injury occurred and who you are going to be in the future.  For that logger who is not going back into the woods, it can be devastating.  For the mason who has always taken great pride in their skilled work, it's like losing part of your identity. 

As soon as we recognize that this may be the outcome, the sooner we must discuss what the future looks like for that injured worker.  Yes, it may not involve chopping down trees or building stone walls, but it has to mean something else.   This is reality, albeit sometimes a harsh one.  Life goes on after the work injury and it goes on after the claims settlement.  Medical providers can only take an injured worker so far and they can't, unfortunately and in most cases, return you to where they were before the injury occurred.  All the more reason to work to get an injured worker the best possible outcome -- this is going to be their life and their future long after the claim closes.  We may be stepping out of the realm of statutory benefits, but we can never lose sight of the fact that these are peoples' lives that are impacted by work injuries.  We must do all that we can to minimize that impact.

 

References:

Return. (n.d.). Retrieved November 21, 2014, from http://www.merriam-webster.com/dictionary/return

One more reason to offer RTW: Stop giving injured workers a bad rap

So much for the 80/20 rule.

According to a study conducted by Harris Poll on behalf of Summit Pharmacy, Inc., 2 out of 5 Americans believe that people who are collecting workers' compensation benefit don't want to work.  Not surprisingly, roughly 35% of respondents agreed that "You need a PhD to complete all the necessary paperwork associated with a workers' compensation claim."  That last question was a bit leading, and a tad dramatic for my liking, but I digress.

You can read more about the survey here.

While the survey may not be free of bias, I think there are some opportunities for further discussion.  The survey fails to consider whether or not the employer offered modified work to the injured worker.  If someone is offered suitable work and refuses it, that's a different story.  If the employer has done nothing to offer an injured worker modified duty, or if the injured worker remains totally disabled, then they are likely justified in remaining out of work.  I understand I'm arguing against a stereotype, but the stigma and stereotypes cannot be ignored.

In previous posts, I've written about injured workers who start to feel that they have to prove how disabled they are to justify their injury to people.  In an environment where a good portion of the American population thinks injured workers are just lazy, I can't imagine that makes anyone feel too good about being out of work.  It may even lead to them citing limitations and disabilities to demonstrate that they're not "faking" their injury. 

Conversely, when an injured worker is in a supported environment where they can trust that people surrounding them (including their employer and coworkers) believe their injury occurred and the subsequent pain is real, I'd venture to guess that they'd be less likely to point to their inabilities as they have nothing to "prove."

One thing we can do to fight this stigma (aside from preventing injuries from happening in the first place), is to offer modified duty to injured workers.  If they unjustifiably refuse the work, i.e., they really don't "want to work," then their benefits may be suspended and everyone can loosely conclude that they really don't want to work.  I'd like to see a survey that focuses on that.

We can also do a better job of helping injured workers fill out claim paperwork.  It may not require a PhD, but it is filled with jargon and legalese that those outside the WC industry have a difficult time understanding. A word of advice -- if you know the form you're about to mail out causes outrage or panic in injured workers -- give them a head's up that it's coming and what it means.  The wording on the forms typically makes it sound worse than it really is.

The Importance of an Ordinary Day at Work

In a recent meeting, I was encouraged, as I'm sure many others were, by a very simple, poignant observation.

We often wish away the ordinary days -- we pine to be on vacation, experiencing something exciting or adventurous, but when something happens to us or one of our loved ones, someone gets sick or injured, the one thing that we all long for are the ordinary days. We'd give nearly anything to have an ordinary day.

I've always believed that every day is a gift, and your health is a gift -- both of which we shouldn't take for granted.  It's unrealistic to spend every minute of every day focusing on how lucky we are to be alive and well, but as soon as something impedes our health or normal lives, we realize how fortunate we were.

I believe this is the case for most of us.  I also believe that is the case for most injured workers and employers of injured workers -- we all want the same thing.  We want to get back to the way things were.  We want things to be "normal" again.  Yesterday (Tuesday after Labor Day) was probably tough for most people -- getting back to work after a long weekend can be challenging.  Many people probably thought, why can't I win the lottery and get to stay home forever?! 

Work plays such an important role in our lives -- how we define ourselves, it is from what we derive our value, it shows what we can contribute to the world.  Think about the last time you met someone new.  After introducing yourself, the next thing you probably moved on to discuss was where you worked or what you did for a living.

Our job as workers' compensation professionals is to do what we can to restore injured workers to wellness.  To provide the appropriate medical treatment, guidance, and assistance to help achieve that sense of normalcy.  While it is true that not everyone will return to that old "normal," getting back to a state of wellness and productivity is our aim. 

We are creatures of habit.  We crave consistency.  We like routine and predictability.  Any disruption can cause us a great deal of strain and stress.  Think about the last unanticipated road construction detour you were faced with on your way to an appointment? 

Think about your morning routine.  You wake up, maybe you stop at the usual place to grab your coffee on your way to work, exchange some daily banter with the cashier, and continue on your way to work.  The average person spends 90,000 hours at work during their lifetime.  That's over 10 years, 24 hours per day.

Sure we all have our days we wish we'd win the lottery -- some more than others.  Those things that we'd rather be doing than working are probably also the same reasons we go to work.  There are probably aspects of everyone's job that would rather not have to do-- but that's why it's called work, right? 

When the ability to participate in work every day is taken from someone due to an injury or illness I'm confident in saying that what that person would like most is an ordinary day at work.  Employers have an opportunity to give the gift of ordinary days. 

Nurse Case Managers are NOT the Claims Police

This week's post comes to us from Eastern's own Director of Medical Cost Management, Nancy Crago, RN, BS, CCIM, AIC.  Nancy has over 35 years of nursing experience as well as 16 years of insurance experience.  She has had the opportunity to work directly in many areas of workers' compensation claims ranging from telephonic case management, claims adjusting, and supervision of adjusters and case management teams.  

What is a case manager?

The Case Management Society of America defines a case manager as a health care professional who is responsible for utilizing the case management process for individuals with health-related needs, with the goal of maximizing their wellness, autonomy and appropriate use of resources.  

What experience do case managers have?
Nurse Case Managers are registered nurses with at least 10 years of nursing experience.  Many nurses have advanced degrees and have specialized clinical skills and knowledge.  In addition, many nurses have national certification from organizations which focus on case management.  These include CCM, CRRN, and CDMS.  Continuing education is required to maintain professional licenses and national certifications.

Nurse Case Managers who work in the workers’ compensation environment generally have backgrounds in orthopedics, neurology, critical care, emergency trauma, general surgery, rehabilitation, or occupational health.  

Exactly what is it that nurse case managers do?
Case Managers have several roles – they are advocates, facilitators, coordinators and educators.  The foremost role is advocate.  Whenever a case manager works with an injured worker, the nurse establishes a relationship with that person.  The case manager and injured worker establish goals and plans to meet those goals.  While working as a case manager in workers’ comp it is essential that the case manager inform the injured workers that any information related to the claim and its outcome will be shared with the physician(s), claims representative, and employer.

How can employers maximize the benefits of case managers?
Collaboration is the key to a successful outcome with a case manager.  Case managers are looking for a win-win situation – the injured workers returns to wellness and the employer regains a productive employee.  Although the case manager will be an expert about the injury and treatment, he or she may not be an expert about the injured worker’s job and specific requirements.  Share a detailed job description with the case manager.  This will foster understanding about your business.  This knowledge and a written job description helps the case manager to clearly discuss how the injured worker can safely return to work during recovery from the work injury.   Use the case manager’s medical knowledge to help design a job around any restrictions the physician may order.  Ask questions about the treatment plan – how long will treatment last, are there other effective treatments. 

Case managers are NOT the "claims police"
Injured workers (and some mistaken employers) may think that the case manager is assigned as a policeman.  Nothing can be further from the truth.  Medical care is becoming more and more complex.  The case manager will assist the injured worker to understand the treatment plan, medications, and why early return to work is essential for a full recovery. 

Because the case manager brings medical expertise to the claim, he or she will always be pushing toward the next outcome and goal.  Expect the case manager to provide suggestions and recommendations for next steps.

Through education and experience, a case manager brings medical expertise to the claim.  A case manager also helps to coordinate care with a variety of healthcare providers—physicians, therapists, pharmacists, etc.   Case Managers are not “claims police”.  Their only focus is on returning injured workers to wellness through appropriate medical care.  As nurses, case managers are advocates for the injured worker, which benefits the injured worker and the employer. 

Thank you to Nancy for sharing her experience and insight on some of the many aspects of case management!