There is no arguing that nurses are an extremely valuable resource to the workers' compensation process. Serving as patient advocates, nurse case managers (NCMs) help to ensure that injured workers receive the quality medical services they need to make the best possible recovery.
In this role, NCMs work with medical providers, employers, and injured workers to facilitate appropriate medical services, identify potential obstacles to recovery, and ultimately focus on returning injured employees back to work.
To help control medical costs, NCMs also work with managed care services, such as provider networks and utilization review. If a diagnosis or treatment is inappropriate, NCMs will help to get the employee's treatment plan back on track by working with providers and claims adjusters.
However, NCMs must navigate both the health care and workers' compensation systems, and in recent years both have grown increasingly complex, making the jobs of NCMs more challenging and demanding. NCMs have expressed three key needs to help them do their jobs better and more efficiently. As National Nurses Week approaches (May 6-12) we examine those needs, and the solutions available through today's diagnostic specialty networks.
1. Help me identify quality providers.
Many work-related injuries seem simple in nature, but they have the potential to become long and costly if complications are not addressed early. In addition, injuries may require diverse medical services from various types of providers.
In these scenarios, NCMs want an easy and effective way to identify the best providers in various areas of medicine. Although NCMs may have access to large general networks, it may be difficult to identify the quality doctors in a given field. When good physicians have been identified, nurses are still tasked with the process of scheduling appointments and coordinating an appropriate time and location with the patient.
A diagnostic specialty network specializes in providing assistance for scheduling various types of diagnostic tests. It has established a network of quality providers for both advanced radiology and electrodiagnostic services. If payers partner with a diagnostic specialty network, their nurses can offload the entire diagnostic referral process — no longer having to worry about identifying a provider, scheduling an appointment, or following up on the medical report or bill. The diagnostic network handles the whole process, offering online tools to streamline the process even further.
2. Help me return injured employees back to work.
Today, many nurse case managers are being held accountable for returning employees to work as soon as possible. Working with providers, NCMs develop a return-to-work (RTW) plan that takes the employee's job responsibilities and work restrictions into account.
To do this effectively, nurses rely on accurate diagnostic information to guide an appropriate and effective treatment plan, which aids in a speedy recovery and RTW. However, studies show that key diagnostic exams, known as Electromyography (EMG) and Nerve Conduction Studies (NCS), are often performed by unqualified providers. As a result, as much as 68 percent of these tests may not be medically useful. A poorly performed test or inaccurate test interpretation can derail a patient's entire treatment plan, leading to unnecessary or inappropriate medical services, delays in recovery, and extended disability.
To address this issue, a diagnostic specialty network must help to identify qualified EMG and NCS providers (neurologists and physiatrists exclusively), selected and credentialed using AANEM quality guidelines and an evidence-based approach that continually monitors the quality of its providers.
3. Help me to obtain additional education and CEUs.
Most states require that nurse case managers receive licensed certification to practice, as well as a certain number of continuing education units (CEU) each year to maintain their license. In addition, NCMs must be knowledgeable about workers' compensation laws in the states they serve, as this expertise helps them to appropriately manage a claimant's medical care and RTW outcomes in a manner compliant with statutory requirements.
By offering courses, payers can provide NCMs with a valuable opportunity to upgrade their skills and expertise, while also assisting them in meeting state-mandated CEU requirements.
To address these needs, some diagnostic specialty networks, like One Call Medical, have launched a series of free online webinars and CEUs that help NCMs understand today's complex medical, diagnostic, and workers' compensation issues.
Give Nurses What They Need
NCMs are adept at collaboration and multi-taking. On a daily basis, they communicate workers' compensation objectives and expectations to a large number of stakeholders. Today, they are under intense pressure to manage the timeframe in which injured workers receive medical treatment, recover, and return to work. In this process, they juggle multiple objectives in terms of patient advocacy, cost control, and quality care.
They do it all with a compassionate and proactive approach, understanding that if the patient wins, we all win. With this growing plate of responsibilities, however, it is vital to provide NCMs with the services, tools, and education they need to perform their jobs to an optimal level of success.
Bill Colacurcio is the director of OCM University at One Call Medical (www.onecallmedical.com). He may be reached at bill_colacurcio@onecallmedical.com.
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