Case managers produce long-term, positive effect March 1, 2020 No Comments Reprints Facebook Twitter Linkedin Share Share Related Articles Workers\u2019 Comp Case Managers Juggle Many Skills for Clients ODG Guidelines Improve Care for Injured Workers What Does Population Health Really Mean for Case Managers and Social Workers? Related Products Nurse Case Managers & Social Workers: Relationship Best Practices \u2014 Series Nurse Case Managers & Social Workers: Relationship Best Practices Part 1 EXECUTIVE SUMMARY Workers\u2019 compensation case managers can help injured workers return to work much faster than they would without case management services and monitoring. \u2022 Nurse case managers can start handling a workers\u2019 compensation case while the injured or ill worker is still in the ED, getting the process rolling quickly to ensure the person receives all necessary help. \u2022 The workers\u2019 compensation industry largely follows occupational disability guidelines, which include evidence-based and data-driven methods to help employees return to work after an injury or incident. \u2022 Without case management, an injured worker could become addicted to opioids and languish for weeks before returning to work \u2014 sometimes never regaining their previous activities of daily living. Case managers can make a big difference on the long-term health and economic impact related to workers\u2019 injuries on the job, even when the injury is less serious. \u201cThe unique situation of workers\u2019 comp is we are able, as case managers of workers\u2019 comp, to have an impact and stay in contact with patients from beginning to end,\u201d says Barbara DeGray, RN-BC, CRRN, vice president of case management at Managed Care Advisors in Bethesda, MD. Case management in other areas are focused on the setting, handing off a patient from one place to the next. \u201cWe are helping case managers manage across the continuum of care,\u201d DeGray says. \u201cIn workers\u2019 comp, generally, a nurse case manager is assigned soon after an incident, often the same day,\u201d she explains. \u201cThat starts the process \u2014 identifying that someone has been injured at work, exposed to illness at work, or has a situation where symptoms have developed.\u201d The industry standard is called occupational disability guidelines (ODG), which also is the name of a company that has extensively studied cases of injured workers and how long it takes them to recover and return to work. ODG employs evidence-based and data-driven guidelines that are used by payers, providers, workers\u2019 compensation, and others. (For more information, see related story in this issue.) Best and Worst Cases Workers\u2019 comp case managers are helpful with all injured or ill workers, but sometimes achieve the most striking results when working with employees who suffered a minor injury on the job, she notes. \u201cSometimes, it\u2019s the minor injuries that cause more delay [in return to work],\u201d DeGray says. \u201cWe pay attention to all injuries and all conditions.\u201d DeGray offers these two scenarios: \u2022 Worst-case scenario: A worker twists his back at work while lifting and moving a heavy piece of equipment. He is sent to the ED, where he receives muscle relaxers and pain medication, including opioids, since he reported severe pain. They told him to rest, so the man returned home, took his medication, and stayed off work for a day. \u201cHe tries to return to work, but he is in too much pain, so he went home again,\u201d DeGray says. The worker then stays in bed or on the couch, takes his pain medication, stops paying attention to what he eats, and becomes deconditioned. \u201cHis back now causes him more problems because he\u2019s spending time lying down, and he starts to become depressed because he is not contributing to his family and is not involved, and he begins to present as a disabled person,\u201d DeGray says. \u201cAfter two weeks, he has the potential to go down the opioid addiction track.\u201d The man visits a doctor for his continued back pain and inflammation, and he receives more opioids. The man does not return to work, and has fallen into a disabled life only one month since he was injured, she adds. Eventually, a case manager will see the man because of his chronic pain, but it is too late to prevent the downward escalation of his health. \u201cThis is a bad path. Unfortunately, we have seen it happen where no was intervening; no one was checking on them,\u201d DeGray says. \u201cThe hospital or ED were not checking on him. He wasn\u2019t referred to home health because that wasn\u2019t appropriate.\u201d \u2022 Best-case scenario: Another worker also twists his back at work. His injury is identical to the first case, but what happens next is much different. Workers\u2019 compensation assigns a case manager while the man is in the ED, DeGray says. \u201cWe contact the ED and find out what their instructions are,\u201d she says. \u201cWe have to get something from the ED to justify why they\u2019re out of work. The injured worker has to provide some kind of paperwork to the employer.\u201d The doctor gives the case manager the discharge information, and the case manager calls the patient after he is discharged to educate him about the use of medication and about how occupational medicine is a specialty area that could help him recover more quickly. \u201cWe direct him into follow-up care with an occupational medicine doctor, who will see him every two weeks,\u201d DeGray says. \u201cThen, the occupational medicine doctor gives him a treatment plan, saying, \u2018You can take the opioids, but only take them for a week, and then I want to see you again in a week to see how you\u2019re doing.\u2019\u201d The occupational medicine doctor advises the patient to use heat and ice, and the doctor writes a treatment plan that is shared with the case manager. The workers\u2019 comp case manager calls the patient after the occupational medicine clinic visit and explains how to comply with the physician\u2019s instructions and integrate these into his daily life. The case manager also helps the patient set goals and adjust expectations. \u201cWe ask the injured worker patient, \u2018What is your expectation? What do you think will happen?\u2019\u201d DeGray says. \u201cWe say, \u2018Studies about your type of injury and diagnosis show that most people are able to get back to work within six weeks, maybe doing modified work within four weeks, and it\u2019s going to be tough.\u2019\u201d The case manager emphasizes that the patient should take his pain medication but expect to be taking different types of pain treatment after a couple of weeks. \u201cWe set expectations for the injured worker, employer, and healthcare providers,\u201d DeGray says. For instance, the physician wants the patient to walk, stand, and perform as many activities of daily living as possible. He is supposed to modify his activities to prevent further injury to his back. The man can wash the dishes, but he should avoid bending over to put dishes in the dishwasher, DeGray says. The treatment plan includes reducing pain medication over time, and encourages the patient to try different pain control methods. The plan refers him to physical therapy several times a week, which has a secondary benefit of helping the worker set a habit of getting dressed and leaving his home, a step toward a return to his prior habits. \u201cWe\u2019re helping him maintain a routine of getting up, getting dressed, and moving out of the house,\u201d DeGray says. At the patient\u2019s next doctor\u2019s visit, he learns that he is progressing well, and can go back to work. At first, he will return to work with limitations, including not lifting more than 10 pounds. The providers and case manager find the worker\u2019s back pain is better, so the patient is prescribed nonsteroidal pain medication. Eventually, he can lift up to 20 pounds. Within six to eight weeks of his injury, he is back to his regular work duties. Return to work within six weeks is the best-case scenario. Eight weeks is average, and workers who recover more slowly might not return for months, DeGray says. With many workers\u2019 compensation cases, case managers stay involved even after the patient returns to work. \u201cCase managers help them keep on moving along the path of recovery, so they will have all of their symptoms resolved,\u201d she says. \u201cThey\u2019re on track to having a productive life. They may need to take anti-inflammatories for the rest of their life, or add some physical exercise they didn\u2019t have before.\u201d Case managers set patients on a path to where they no longer will need case management. \u201cWe\u2019re preventing disability, or minimizing disability by maintaining contact with the patient,\u201d DeGray says. \u201cThe idea is to see the whole picture, the whole person, see what is happening, and how to help the person become productive.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"