By Leanne Bronold, Clinical Guidelines Manager, Genex Services
In recent weeks, health care professionals have looked to the CDC and WHO for guidance on how to best treat the evolving coronavirus pandemic. However, for workers’ comp professionals, few standards are available that focus on issues most pertinent to their industry and the needs of injured employees.
Developing a COVID-19 clinical guideline specifically designed for workers’ compensation, that incorporates extensive materials from expert sources such as the CDC and WHO, provides case managers and other care providers with complete diagnostic and treatment protocols, duration of treatment timelines, DME suggestions and red flags to look for that may delay return to work.
This is a process that Genex undertook shortly after the WHO declared COVID-19 a pandemic in January, as we recognized the urgent need for a comprehensive tool to enable care providers to deliver the most informed and appropriate care to successfully return claimants to health and back to work.
Content for a comprehensive guideline needs to be built through a thorough, ongoing medical literature review based on recognized medical evidence, giving preference to evidence-based studies, randomized control trials, and meta-analysis content. This includes sources from recognized professional organizations such as the American Medical Association, Infectious Diseases Society of America, CDC, FDA and WHO. When developing Genex’s COVID-19 guidelines, we sent them for review by the medical director and physician advisory team and then for a final look by infectious disease and pulmonary specialists, who offered practical feedback to be used for professionals.
A guideline for a new infectious virus or disease such as COVID-19 is only effective if it remains current. This means the tool should be a “living document” that adapts to changes in treatment protocols and disease-related information from the CDC, WHO, and other federal and state health organizations. It includes medication recommendations and testing as well as necessary precautions including glove and mask use. Updating guidelines means continually scouring available clinical studies to provide workers’ comp professionals with an up-to-date, accurate overview of this ever-evolving illness and ensure their understanding of prevention, diagnostics, and treatment recommendations.
Aside from diagnostic information, practitioners can follow a formula based on CDC guidance that allows them to more accurately reassess return-to-work dates should infection occur. This includes information based on varying degrees of infection with or without hospitalization. Red flag indicators help providers and case managers signify the presence of one or more conditions that may prolong disability and require case management efforts to address them.
Along with the guideline itself, direct links to the CDC on specific information for a variety of occupational groups who are most susceptible to COVID-19 such as airline crews, first responders and health care workers can prove helpful. This allows providers to go directly to these sources with minimal time and effort.
Who uses the guideline?
The Genex COVID-19 guideline has been used by professional clinical staff to have the necessary tools to optimize their performance and improve patient outcomes, especially through case management and utilization management services. It can also be used by utilization management nurses and physicians as a secondary resource, particularly when there’s a lack of clinical information on a medical topic in other guidelines. Medical terms are explained in detail, allowing for easy use by claims examiners to better understand recovery times for injured employees.
Case managers use the guideline to proactively familiarize themselves with information on subjective and objective signs and symptoms so they can be prepared for the initial evaluation process. The diagnostic testing section contains information on radiology and laboratory testing. and appropriate time frames for the testing. It includes treatment and return-to-work guidance so case managers can establish goals and anticipate recovery needs. There is information focusing on complete diagnostic and treatment protocols, duration of treatment timelines, DME suggestions and red flags to look for that may delay return to work.
During this pandemic, a COVID-19 workers’ comp guideline should be referenced often during case manager-injured employee interaction. Case managers should use it to educate injured employees on how best to protect themselves while attending provider appointments or carrying on activities of daily living. This includes offering guidance on how to best maintain social distance in waiting rooms, such as calling the front desk upon arrival in the parking lot and asking them to call when the provider is ready to see them so they can stay in their car to avoid possible exposure.
And, of course, the safety of health care providers who are on the front line in treating injured employees during this pandemic is crucial. This guideline has been instrumental in giving nurses and physicians practical information to protect themselves and their patients.
As new illnesses or injures arise such as COVID-19, it is important that the workers’ comp industry is armed with comprehensive, evidence-based information to ensure injured employees receive the best care to help them not only return to work, but remain healthy during this or any crisis.
About Leanne Bronold
Leanne Bronold, RN, BSN, is the clinical guidelines manager at Genex Services, Wayne, Pa. Bronold has served the company for more than 30 years, first working as a field case manager, moving on to branch manager, and now leads the clinical guidelines team.
About Genex Services
Genex Services provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top under-writers of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems. Genex Services and Mitchell International merged recently to create the broadest continuum of technology and products servicing the auto, workers’ compensation, and disability markets.
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This is not a paid placement.