Critcal Path Network: Case manager coordinates care for injured workers
Critical Path Network
Case manager coordinates care for injured workers
She is liaison between employee, employer, insurer
When injured workers come into Detroit Receiving Hospital's Level 1 trauma center at the Detroit Medical Center, their care is coordinated by a dedicated occupational health case coordinator who acts as a liaison between the emergency department's medical care team, the employee, the employer, and the workers' compensation carrier.
"A lot of injured workers have never had a work-related injury and don't understand how workers' compensation works in Michigan. I'm someone who the injured worker can contact if they have questions and concerns throughout their treatment and recuperation. It's much easier when workers and employers have one person to contact," says Wanda Vesey, RN, occupational health case coordinator for Detroit Medical Center's occupational health services department's fast-track program.
Vesey monitors the care of all injured workers who come through the emergency department as well as those who are referred for follow-up care at the hospital's occupational health services clinic.
Hospital contracts to treat workers
The hospital has contracts with major Detroit employers to treat workers injured on the job and to provide pre-planned assessments, drug and alcohol testing, and international travel health services. Smaller companies, which do not have a contract with the hospital, also refer their injured workers to Detroit Receiving Hospital's emergency department.
The occupational health services clinic sees an average of 75 patients a day. In addition, Vesey monitors and facilitates the care of an average of five to eight patients who are treated in the emergency department.
The key to the fast-track program for injured workers is having a dedicated case manager who works exclusively with injured workers. This helps move them smoothly through the continuum of care and get them back to work as quickly as possible while keeping the employers and third-party administrators or workers' compensation insurance carriers informed, Vesey says.
She coordinates the care of the workers from the time they reach the emergency department until they are discharged or admitted to an inpatient unit. She arranges for other outpatient services, such as physical therapy and MRIs, or follow-up appointments with specialists and gets authorization for the visits in advance.
Being in the know
Having someone who is familiar with Michigan's workers' compensation administrative rules and regulations is helpful since the paperwork requirements and regulations are different from those commercial insurers, Vesey says.
For instance, any follow-up care has to be authorized by the employee, a requirement that can be confusing.
"Many injured workers don't understand, in our state, the employer directs who provides medical care for the first 10 days following the injury. I find out where the employer wants them to go, whether it's to our clinic or another provider clinic. I educate the employees about the process and continue to be a liaison between the employer and employee during the recuperative period," she says.
Vesey is notified whenever an injured worker comes into the emergency department by way of an automated notification system that is linked to the hospital's registration system and electronic medical record. She also responds to calls or pages from the emergency department registration office.
"I meet the clients and occasionally their families in the emergency department, give them my card, and let them know that someone is here to answer their questions and help them navigate the process," Vesey explains.
She contacts the human resources department at the patient's place of work, alerts them that the worker is being treated, and gets information about the workers' compensation carrier. She finds out what information the insurer wants, compiles it, and faxes or e-mails the information to them.
"Sometimes an injured worker hasn't filled out an incident report. I get them to do so and forward the information to employer or the third-party payer if they want the information," Vesey says.
She obtains authorization for follow-up treatment from the workers' compensation carrier, gets information on billing and where the medical records should be sent, and passes the information on to the emergency department registration officer.
"I keep the employer informed about the status of the patient and provide ongoing reports to all of the parties," Vesey says.
Coordinating transfers
Because Detroit Receiving is a Level 1 trauma center, injured workers may be transferred from other hospitals, particularly those with head injuries or those who need to be treated in the burn unit. In those cases, Vesey makes sure that Detroit Receiving Hospital has all the medical records from the transferring facilities.
When she arrives for work each day, Vesey picks up a printout of all workers' compensation clients who came to the hospital the previous day and checks their status.
If the worker came to the emergency department after hours, Vesey contracts the employer and verifies that the injury was work-related, then notifies the workers' compensation carrier.
If patients have been treated and released, she follows up to make sure they keep their follow-up appointments and informs the employer of any work restrictions.
"I contact the employer and the employee and get whatever authorization is needed for any follow-up visits or consultations with specialists," she says.
Post-discharge care
If the workers don't have an occupational health clinic at their place of employment, Vesey arranges for them to go to the Detroit Receiving Hospital occupational health clinic for follow-up.
"When I contact employers and third-party payers about follow-up visits, I send a marketing packet about our services if they don't have an occupational health clinic on site at the company," she says.
When injured employees are admitted to the hospital, Vesey passes on all the information she has collected, such as contact information for the insurance carrier, to the trauma care case managers.
"We work as a team. At our hospital, discharge planning starts on the first day. I get as much information as I can to help the case managers on the unit start immediately to take care of the patient's needs," she says.
Vesey then notifies the employer about the hospitalization and the unit on which the worker has been admitted.
Vesey keeps the employer apprised of the worker's return-to-work status. She sets up any referrals for additional services, such as an MRI or a physical therapy consultation.
"I get an authorization letter ahead of time and gather any other information the patient needs for the specialist visit. I alert the employer so that the worker can get time off to go to the appointment," she says.
When injured workers come into Detroit Receiving Hospital's Level 1 trauma center at the Detroit Medical Center, their care is coordinated by a dedicated occupational health case coordinator who acts as a liaison between the emergency department's medical care team, the employee, the employer, and the workers' compensation carrier.Subscribe Now for Access
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