Challenged by continuing increases in workers' compensation medical and indemnity costs, employers are trying new loss control approaches, one of which is the use of a nurse call center to coordinate care and get the injured employee back to work.

The nurse call centers offer a number of advantages, including the ability:

o To facilitate timely, accurate reporting of injuries.

o To triage injuries to the best, most appropriate level of care.

o To improve return-to-work outcomes through suitable modified-duty assignments.

When risk management professionals think of a nurse's involvement with workers' comp injuries, they typically think of nurse case managers. However, “triage” nurses get involved much sooner in the process–basically at the point of injury to assist employees in obtaining quality medical care.

When an injury is reported, the nurse provides an objective medical assessment and channels the employee to the best, most cost-effective care.

Group health plans have long used toll-free nurse hotlines to provide members with medical advice and to triage patients to the most appropriate level of care. By using nurse call centers, health plans have fostered proper utilization of health care services, thereby saving significant costs.

Today, workers' comp programs are leveraging this same strategy to reap similar benefits and savings.

The first and primary benefit is improved medical care for employees. Triage nurses are highly compassionate medical professionals who listen closely to the details of each injury and provide personalized attention to each employee, focusing on unique medical needs.

Employees, as a result, have an overwhelmingly positive experience in the workers' comp process. Employers that provide this type of service send a clear message–that they care about their employees' health, safety and well-being. In addition, these organizations benefit from increased employee satisfaction and a consequent decrease in litigation.

The second benefit is a consistent, well-managed injury reporting process. Although it is commonly understood that prompt reporting of injuries leads to improved claims costs and outcomes, there are still many delays and obstacles to compliance.

An injured employee may wait to report an injury until it becomes worse and requires serious medical attention. Supervisors may be delayed in filing the proper claims form. Even when claims are reported on time, they often lack complete information. As a result, claims adjusters often spend several days trying to track down additional details.

By using a nurse triage program, the employee or supervisor calls a toll-free hotline to report an injury any time of day.

Nurses are trained to perform thorough questioning to gather comprehensive injury information, which assists in claims management. The triage nurse handles all the required paperwork. Within minutes of the call, the nurse sends the first report of injury via e-mail or fax to all the appropriate stakeholders, including the employer, supervisor, physician and claims administrator.

Immediate dissemination of the injury report allows each stakeholder to initiate their respective roles in the workers' comp process, allowing each individual to optimally impact the claim's outcome.

Beyond timely reporting, the third benefit is ensuring that every injury receives the care and treatment appropriate to its level of medical severity.

In the past, employers would often train supervisors to respond to worksite injuries. But these managers are not trained medical professionals and would often err on the side of caution, sending employees–even those with minor injuries–to the emergency room.

Using treatment protocols and sophisticated algorithms, the triage nurse systematically identifies the right course of treatment. In severe cases, a nurse will advise emergency care. With minor injuries, the nurse may provide simple first aid or self care guidelines over the phone, or send the patient to an occupational clinic in the employer's preferred provider network.

After speaking with a nurse, many injured employees do not require or request additional medical services. As a result, 20-to-40 percent of all calls result in “report only” or simple “first aid” injuries, which do not require compensation. As a result, many organizations have reduced claims by 20-to-30 percent.

The fourth benefit is improved return-to-work results. Organizations are now integrating their RTW program to operate in concert with injury triage.

Triage nurses send an injury report to the RTW coordinator, who immediately initiates communication with the employee and physician to facilitate an early and safe return-to-work outcome.

When appropriate, the coordinator will provide a modified duty assignment to accommodate work restrictions. At the core of this strategy is establishing an online database of essential job descriptions and transitional work assignments, which stand ready to utilize when an injury occurs.

By closely integrating RTW with injury management, organizations have reduced lost days, indemnity costs, disability expenses and temporary labor expenditures.

Ultimately, workers' comp losses impact an organization's bottom line, so containing these costs is critical.

By enabling optimal injury management and quality medical care, employers often reduce health care costs by as much as 20 percent, and by integrating a structured RTW program, injured employees recover and return to work sooner–reducing lost time by 50 percent.

All these benefits have enabled employers to decrease overall workers' comp costs by 10-to-30 percent. For organizations that already experience excellent program results, improvements may be more modest, but even single-digit reductions help in light of ever-increasing medical and indemnity costs.

Paul Binsfeld is the CEO of Company Nurse, a firm specializing in workers' compensation injury triage and management. For more information, e-mail paulb@companynurse.com, or go to www.companynurse.com

Special Reports /

Triage Nurses Can Help Risk Managers Contain Workers' Comp Medical Costs

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