Phone triage program cuts comp costs
Phone triage program cuts comp costs
Nurses help workers decide when to seek care
Phoenix-based Compensation Value Alliance (CVA) has reduced workers’ compensation costs by $100,000 annually for a restaurant client through its Company Nurse telephone triage program. Romulus, which owns and operates 11 Interna tional House of Pancakes in Arizona and employs some 850 employees, says the telephone triage system is well-suited to the strains, sprains, cuts, and burns that make up the majority of its workers’ comp claims.
"The Company Nurse program gives employees a level of comfort," says Chris Milisci, president of Phoenix-based Romulus. "How many times have you been hurt or sick and not known whether to go in to see the doctor or not? Do you make an appointment, or do you talk to the doctor or the nurse first? I think employees don’t necessarily want to rush to the emergency room when they’ve been injured, but sometimes they’re not sure whether they need to or not. The Company Nurse helps them make the decision about whether or not to be seen by a doctor, and the nurses always err on the side of caution, so there’s little risk that an injury will not be properly treated."
Romulus employees call the Company Nurse hotline and speak with a CVA nurse or paramedic, who gathers information on the injury and helps the worker decide whether to seek care and, if care is needed, where to obtain it. "In the past when someone was injured, the manager was notified immediately, and if it seemed severe enough that the person needed medical attention, we would immediately take the employee to the hospital," says Milisci. "We didn’t want our managers making decisions about employee medical care, so a lot of people ended up being sent to the emergency room that may not have needed more than a bandage."
Employees can speak privately with the nurse or paramedic at CVA. "The employee and the nurse make a decision about whether to seek medical care together," Milisci explains. "The system brings a level of comfort to managers and employ ees. The nurse or paramedic can help dissuade the injured employee from seeking unnecessary care, yet the employee at any point can say, I want to see the doctor.’"
Romulus’ employees are now comfortable with the Company Nurse program, but there was some dissatisfaction in the early days of the program, notes Milisci. "Initially, there were some long hold times when employees called the hotline. It’s no different from the hospital emergency room. When you go to the emergency room, you think you are the most important patient there. When employees called the hotline, they thought they were the most important caller, and they didn’t like being placed on hold." Once the hold time issue was resolved, employees started using the triage program more frequently.
"Any snags that might exist when you implement a new program occur almost exclusively upon start-up when new procedures are being put in place," says Steve Williams, chief executive officer of CVA. "It is vital that supervisors and human resources personnel receive training on how the service works — trainers must clearly explain the program in a simple as 1-2-3 manner and support the training with instructional posters in the workplace."
Romulus has been very pleased with the program’s results. In general, 23% of all injuries are referred for home care or first aid. Another 73% of injuries are referred to occupational or primary care physicians. Only 4% of injuries are referred to hospital emergency rooms.
A year of results
Between Sept. 1, 1998, and Sept. 1, 1999, CVA’s Company Nurse handled 113 employee injuries for Romulus with these results:
• 39 required first aid or home care and never became workers’ comp claims.
• Only four claims, or 3.5%, incurred indemnity expenses, compared to a state average of 18.2%.
• Romulus’ annual workers’ comp costs dropped from $170,000 annually to $70,000 annually. (For a national study of the top cost-control methods in workers’ comp, see p. 46.)
"Technology advancing almost daily enables instant communication. Nowhere is the time is money’ adage more relevant than when first report of injury, triage, and claim processing are instantaneously synchronized," notes Williams. "A case in point, industry statistics reveal that, typically, a six-day lapse exists between the time an injured worker is sent to the doctor and the employer collects and reports claim information, followed by up to 30 days for the adjuster to gather information from the employer, employee, and doctor. Compare that with our experience: report of injury, workers channeled to doctor, and the provider, employer, and adjuster notified all within an average of one hour and 11 minutes."
In addition, Williams notes that industry figures show that claims costs escalate 48% when reporting is delayed 10 to 30 days. "Apart from time efficiency, a key cost-saving factor is the identification of injuries that need not become claims."
Telephone triage systems also support case management by providing quality information quickly. "Having quality information quickly is the most important requirement in proper case management. Whatever that takes should be employed."
Williams notes that telephone triage is "injury management, not case management" but is designed to perform the following two functions that support case management and reduce workers’ comp costs:
• Identify and manage injuries that don’t need a physician’s attention.
• Maximize the information provided to claim professionals and employers while minimizing the time it takes to disseminate it.
"Telephone triage is not designed to replace physicians or case managers. On the contrary, it is designed to help make their jobs easier and more efficient," says Williams.
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