Informed case manager will improve care

Communication key to success

By Maria Bristow, RN, BSN

Medical Case Manager

Brentwood (TN) Services Administrators

Including a case manager in the care of a workers' compensation patient sometimes poses a challenge to occupational health providers who are more used to being solely responsible for coordinating the patient's care. How do you work with a case manager to everyone's benefit?

Like many professional situations, the answer involves good communication. The case manager should be considered another member of the team working to care for the patient. To get the most out of the case manager's work, the rest of the team must communicate well. As a case manager, I hope to provide a few tips in this column on how to communicate the information that will be of most use to a case manager.

First, it is vital that the physician and rest of the health care team be familiar with state laws governing workers' compensation. In Tennessee, where I am located, this information can be obtained easily from the state department of labor, the governing agency for workers' compensation. The information is available from similar agencies in other states.

Not all injured employees will be assigned a case manager, and the criteria for assigning a case manager vary from state to state. In Tennessee, these three thresholds are applied to determine if a case manager is needed: inpatient hospitalization; medical costs of $10,000 or more; and eight weeks or more of lost time.

A case manager is a licensed professional, usually a registered nurse or vocational rehabilitation specialist, who is assigned to follow closely the medical progress of the injured employee through communication with the patient, family, physician, and other health care providers.

The medical progress of the injured employee is communicated to the claims representative and employer through the case manager, and decisions are made regarding treatment and return to work based on the physician's restrictions and recommendations. If a physician thoroughly understands the role of the case manager in the treatment of his or her patients, there should be no hesitation to share medical information and opinions with the case manager, as well as the claims representative. Like most state regulations, Tennessee state law requires health care providers to be forthcoming in the release of medical information and medical records to the assigned case manager, employer, and insurance representatives pertaining to the specific work injury.

Many orthopedic and neurosurgical offices, which routinely treat work-related injuries, have a workers' compensation specialist on staff to handle the administrative duties pertaining to that specific patient population. As a case manager, I have found these staff members invaluable in obtaining needed medical information and in making referrals to the physician. I would recommend this addition to the office staff of any physician involved in treating work-related injuries. In a smaller office, the nurse or physician's secretary can carry out the same duties, and that person should be educated on the workers' compensation system and laws.

Regardless of size, an occupational health provider should make a practice of routinely faxing a copy of the work release and physician's office note to the employer, claims representative, and case manager as soon as they are available. This practice increases the efficiency of handling a workers' compensation case. Several of the physicians with whom I work do this, saving the case manager the time of calling the physician's office to request these documents each time the patient sees the physician.

Be specific in describing limitations, needs

Return to work is a major issue in workers' compensation cases, and the occupational health physician plays a major role in determining how soon the patient returns. From a case management perspective, it is extremely helpful if the doctor addresses this issue from the very first time the physician sees the patient.

Even if a long recovery process is foreseen for the patient, case management will be improved if the physician immediately discusses return-to-work expectations and any need for work restrictions. When addressing work restrictions, the physician should provide a written statement on work restrictions at each office visit. The physician should be as specific as possible, such as writing "no lifting more than 20 lbs.," instead of "no heavy lifting" or "light duty only." The restrictions need to be measurable so that the employer can be certain the employee is working within the restrictions. If physical therapy is required, the physician should state clearly what the goals for the therapy are.

It also is helpful to the employer and the insurance carrier for the physician to project an anticipated return-to-work date, since the injured employee is paid a reduced salary from workers' compensation funds while he or she is disabled. This information is useful in determining the amount of reserves needed on the claim.

Throughout the entire process, remember that working closely with a case manager is worth the effort. Everyone benefits - the patient, the health care provider, the employer, and the insurer. Our experience at Brentwood Services Administrators has shown that working with a case manager can cut workers' compensation claim costs by 35%.

Maria Bristow, Brentwood Services Administrators, 5121 Maryland Way, Suite 300, P.O. Box 1125, Brentwood, TN 37024-1125. Telephone: (615) 371-9211.