By Paul Binsfeld, CEO, Company Nurse
As discussed in last week’s article, a nurse hotline can serve as a centralized communication hub to initiate an “early intervention” approach, as it enables organizations to promptly report injuries and set claims down an optimal path, right from the start.
In general, early intervention aims at interceding on a work-related injury immediately and getting all relevant stakeholders involved as soon as possible to manage the injury and claim toward the best-possible outcome.
Over the years, organizations have implemented various early intervention strategies, such as return-to-work (RTW) programs, injury prevention, data management, and accident investigations. However, these initiatives often operate in silos within an organization. Comprehensive early intervention combines all strategies into one integrated approach, so initiatives interact with one another for optimal success.
Without structured processes and a managed approach, the claims process can become highly reactive. Early intervention is designed to initiate a proactive and coordinated response at the earliest, most critical point at which an organization can control medical care, claims costs, RTW outcomes, and employee satisfaction. In this week’s article, we discuss early intervention strategies that can be integrated with a nurse hotline’s injury triage service for greater success.
1. Foster a RTW Culture
Organizations are striving to cultivate an appropriate RTW culture as part of their early intervention approach. In the past, organizations may have had an all-or-nothing attitude with an injured employee classified as either “off work” or released to “full duty.” Today, they are re-envisioning a RTW culture that embraces the concept of temporary work assignments to accommodate injuries and work restrictions. Many organizations have already established a RTW program, but they must continually foster awareness of RTW objectives among supervisors and employees.
2. RTW Database
Online RTW databases enable workers’ compensation programs to improve results. With regard to RTW, the road of least resistance is usually the one most travelled. Physicians often rely on injured employees to describe their job duties during a visit. In these situations, employees may inadvertently overstate responsibilities and if those functions fall outside an injured employee’s current capabilities, the physician will prescribe time off from work, which inevitably leads to lost time and indemnity costs. Treating physicians do not have a convenient way to verify a job description. However, with an online database, organizations have essential job descriptions and transitional work assignments that have been pre-approved by departments and stand ready to use when injuries occur. Information from the RTW database can easily be sent to a physician’s office when work restrictions exist.
3. RTW Coordinator
Many organizations that have a RTW program want to achieve even better adherence to program standards. They often find that a missing factor is centralized coordination to facilitate a systematic process. To address this, some organizations have chosen to employ or designate a RTW coordinator, a specialized professional who assists in ensuring optimal RTW results for each and every claim.
The coordinator primarily serves as a RTW advocate, communicating with the treating physician, injured worker, and employer to establish a RTW plan that meets everyone’s needs and objectives. In addition, the coordinator provides a greater level of accountability and oversight for the program.
With a nurse injury hotline on the front-end, the RTW coordinator will receive an injury report and additional information to immediately initiate the RTW process. Utilizing an integration of early intervention strategies, the coordinator can use the online RTW database to track and report on RTW progress, as well as send job descriptions and temporary work assignments to a treating physician. This can often occur while the injured employee is still at the provider’s office. The doctor can then use this information to make a more informed and accurate RTW decision.
4. Data Management
In an early intervention program, the collection, management, and dissemination of injury information begins with an incoming call to the nurse hotline. Using advanced technology, a nurse hotline has the ability to instantaneously and seamlessly send injury reports and related data to employers and other entities, such as regulatory agencies, medical providers, third-party administrators, insurance companies, and brokers. It’s important that the nurse line utilize the latest web-based capabilities and state-of-the-art infrastructure to transfer data at a level of speed, reliability, and transparency that’s expected in today’s e-commerce society.
Data flexibility is also important in meeting the specific needs of various entities. For example, organizations may want information in a variety of data formats, a “first report of injury” (FROI) service to meet different state-reporting mandates, and summary reports based on unique requirements. With a flexible IT platform, a nurse hotline can easily add or modify fields, as well as reports. Data feeds are also made available, so organizations can pull data into their own systems for further analysis, benchmarking, and forecasting.
5. Safety Initiatives
In addition to the initiatives above, organizations take safety and injury prevention very seriously. With a nurse hotline collecting extensive injury information, employers can leverage this data to identify and address injury-prone areas. In addition, data can be mapped to auto-populate into an organization’s unique forms, such as an incident report or accident investigation form, to optimize efficiency. Some employers have formed a safety review board to discuss each accident, how it happened, and what can be done to prevent similar incidents in the future. The board also analyzes quarterly and annual reports to identify new and emerging trends, which it can then target with safety and injury prevention initiatives.
6. Training & Promotion
To ensure optimal adoption of early intervention strategies, including safety and injury prevention initiatives, supervisors and employees must receive adequate instruction and training. With today’s technological advances, there are many convenient training options, such as online self-paced learning, education via teleconference, and web-based training via service providers such as WebEx. Distributing and posting promotional material—such as posters, wallet cards, and stickers—also helps to remind supervisors and employers of early intervention strategies, such as reporting injuries to the toll-free nurse hotline. Together, training and promotion ensure a greater likelihood of adoption and integration of programs.
7. Ongoing Provider Communication
Many organizations have developed a list of preferred providers, but they should also plan to perform ongoing outreach to ensure providers understand program objectives and are engaged as partners in helping achieve best-possible results. For example, organizations can make physicians aware of the availability of modified duty assignments to accommodate work restrictions, and introduce them to key program stakeholders, such as the workers’ compensation program manager, HR representative, or RTW coordinator. In the absence of this type of targeted communication, medical providers will often take a conservative approach, allowing injured employees to return to work when they feel ready. Many organizations reach out to their preferred providers on a regular basis—often once a quarter—to make them aware of any changes and to discuss and review program objectives, performance, and patient satisfaction.
8. Stakeholder Synchronization
People—such as supervisors, claims adjusters, physicians, and nurses—provide the all-important personal touch in the workers’ compensation process. To synchronize stakeholders, organizations must facilitate a seamless hand-off of information and tasks, so each person can focus on the activities, claims, and injuries that require their attention and specialized expertise, at the most optimal time in the claims process. For example, claims adjusters must be able to launch an immediate and thorough investigation regarding the mechanics of an injury (e.g. how the injury occurred, what body parts were affected, etc.), and witnesses must be identified and interviewed early. Ultimately, coordinating tasks and sharing information so stakeholders are “in the know” and on the same page helps to mitigate adverse loss development, particularly if the claim is disputed and an attorney becomes involved.
9. Fraud Prevention
Workers’ compensation has become increasingly vulnerable to claimant fraud, particularly in today’s difficult economy. Obviously, prevention must begin with early intervention. When injuries are reported late, lag times leave the door open for inconsistent accounts of the nature and severity of an injury. Although a nurse hotline was designed to provide immediate response to injured employees, it has the added benefit of assisting with fraud prevention. Later in the life of the claim, a nurse’s careful documentation can help claims staff to monitor for inconsistencies with the original injury report—often an indicator for fraud and abuse.
In addition, when suspicious cases are identified early, organizations can take steps to discourage claimants from further taking advantage of the system. For example, the sooner injuries are reported; the sooner organizations can begin the investigation. If suspicious cases are identified early—within one or two weeks of a claim being filed—then with diligent and rigorous inquiry, claimants realize someone is watching. They understand that they’ll be held accountable to their stories, and further abuse of the system will likely be deterred.
Integrated Early Intervention for Future Success
By using an early intervention approach, organizations proactively engage injury management, quality care, and optimal RTW coordination to achieve improved outcomes. Ultimately, organizations want to provide prompt, appropriate, and cost-effective care that brings employees back to work quickly and safely. Many organizations utilize modified duty to enable workers to stay productive as they recover on the job, so there’s a greater likelihood that these employees will return to full duty.
Success in early intervention cannot be achieved overnight, but gradual adoption and transformation with ongoing efforts to educate stakeholders about the need and value of this approach is attainable. As organizations start to achieve results, they should use their success stories to illustrate the benefits to other remaining departments that have yet to reap the advantage of fully adopting and embracing these initiatives.
About Paul Binsfeld
Paul Binsfeld is CEO of Company Nurse, a firm specializing in injury management for workers’ compensation. He has over 20 years of experience in the workers’ compensation industry. By consulting with many different employers, Paul saw that injuries were often reported late, and employees did not receive appropriate medical care. He identified the common need for early intervention in the injury reporting, injury triage, and injury management processes. Paul has written articles for many insurance and workers’ compensation publications, such as The Journal of Workers’ Compensation, Public Risk, Risk & Insurance, National Underwriter, and Employee Benefit News. In addition, his company was recognized as an Arizona “Company to Watch,” based on its growth and entrepreneurial leadership. For more information, email [email protected]
About Company Nurse
The Company Nurse Injury Hotline enables organizations to make the “Right Call” for workplace injuries. As an independent facility, Company Nurse trains its triage nurses to be compassionate and objective when assessing employee injuries and medical needs. Our injury-triage process is founded on three important elements for workers’ compensation success: 1) Right Time – we respond on the Day of Injury, the earliest point at which to influence costs, outcomes, and employee satisfaction; 2) Right Care – our nurses refer employees to an appropriate level of care, whether first aid, clinic or ER; 3) Right Results – clients reap optimal savings and a return on investment, while employees benefit from a prompt, appropriate response to their workplace injuries. For more information, go to www.companynurse.com or call (888) 817-9282.