By Anita Jovic, RN, BSN, MBA, Vice President of Clinical Operations, HomeCare Connect
More than 22,600 burn injuries requiring employees to take time off work occurred in 2019, according to the US Bureau Labor Statistics. The type of burns involving lost time tend to be second to fourth degree burns.
Second degree burns range from mild to serious, with some causing scarring. Third degree burns usually involve skin grafting and hospitalization. The most serious are fourth degree burns, which affect muscles, tendons, and ligaments and even lead to amputations.
Although more than half of all workers’ comp burn claims have less than $550 in medical spend, a single injured employee with severe burns can have more than $10 million in medical payments. This is according to the June 2021 NCCI Research Brief Workers Compensation Burn Injuries Catastrophic Claim Management – What’s New.
The National Council on Compensation Insurance (NCCI) collaborated with Paradigm on this study that examined various cost drivers. Not surprisingly, the length of time spent in hospitals, the level of services provided there, and medical innovations in the form of skin substitutes and new treatments account for most of the costs.
These innovations have led to higher survival rates, even among older workers. Additionally, Paradigm’s data showed that nearly 80 percent of injured workers suffering severe burns obtained approval from treating physicians to be released to return to work.
Recognizing the costs will be high for severely burned employees, what can claim representatives do to set reserves and contain costs while facilitating the highest quality care after the initial acute phase?
Managing an injured employee with this kind of injury is a long process that addresses the burn wound itself along with systemic and psychosocial impacts.
A severely burned employee and their family go through a horrific, life changing experience. The payer’s claim representative and the vendor partner that will ultimately manage home healthcare services need to clearly, compassionately, and frequently communicate with them, starting as soon as possible after the injury.
It’s important to first find out how the employee and family want to communicate. Texting has become increasingly popular. It’s convenient and leaves an electronic trail for easy reference, and it prevents annoying phone tag.
Employees and families need to know what to expect in terms of the care they’ll receive. Small hospitals usually stabilize severely burned patients and transfer them to burn centers in larger facilities. Later, some injured workers move to skilled nursing centers for wound care and rehabilitation before their transition home.
These centers are not always conveniently located near the injured person’s home. It’s essential that the employee and relatives understand why the facilities are selected and the quality of care they provide. Traveling to visit their loved one or being separated during this critical time causes huge financial and emotional strain on families at a stressful time.
Most importantly, families and injured employees need a person who can patiently and compassionately answer their questions. Assigning a person or team to communicate with them up front can avoid all kinds of confusion, conflict, and frustration on the back end.
Managing the Quality of Care
Of all traumatic injuries, burns rank among the most complex and difficult to treat. Treatment needs to address the burn area and the systemic and psychosocial aspects of the injury, which are considerable. Psychological support to the employee and the family should begin as soon as possible.
Gaps in both care and cost management can easily occur when injured workers transfer between facilities. A clinical team should coordinate discharges and admissions, providing a detailed treatment plan to the post-acute care (PAC) facility, usually a skilled nursing center.
PACs are where payers can lose control over costs, and where some home healthcare ancillary providers can provide significant savings.
Skilled nursing facilities tend to bundle bills and they may include equipment and services not specified in the treatment plan, thus adding unnecessary costs to the claim. Home health managed care partners specializing in workers’ compensation usually have networks of durable medical equipment (DME) providers and can obtain it at lower prices than the facility will charge.
In addition, some home healthcare ancillary providers have created networks of post-acute care facilities with pre-negotiated per-diem pricing to further contain costs. This is important because for the most part this portion of the healthcare system lacks fee schedules. A PAC may quote a daily rate based on its current occupancy, making it difficult for a payer to budget reserves.
Having the partner manage the hospital-to-PAC and the PAC-to-home transitions enables the partner to monitor the injured employee’s progress and anticipate their readiness for discharge. Then any home modifications can be completed and all nursing services, supplies, and any additional DME can be in place the minute the employee comes home.
Not only can this proactive approach reduce claims costs by thousands by ensuring no extra days are spent in a facility, but it also relieves the family and injured employee of the anxiety, stress, and cost of being separated from their loved ones.
Next week, I’ll discuss the types of wound care and other nursing services, DME, supplies, and psychosocial treatment workers’ compensation burn patients need once they come home.
About Anita Jovic
Anita Jovic is the Vice President of Clinical Operations for HomeCare Connect, overseeing all clinical operations, including catastrophic care. She also conducts continuing education programs on a variety of home health clinical topics, including wound care, catastrophic care, and clinically driven home modification and durable medical equipment programs.
Anita has more than 26 years of nursing experience, encompassing workers’ compensation, catastrophic care, and home health. Before joining HomeCare Connect in 2015, Anita was responsible for one of the largest workers’ compensation catastrophic care programs in Florida. She previously served as Chief Nursing Officer for a home health agency and as Chief Executive Nursing Officer for a consulting firm that established a respiratory recovery program with several South Florida hospitals. Earlier, Anita was a nurse case manager, a hospice nurse, and a nurse manager for Lexington Cancer Center in Kentucky. She started her nursing career at Orlando Regional Hospital in Florida.
She earned her bachelor’s degree in nursing from Eastern Kentucky University and her Master of Business Administration degree from Nova Southeastern University in South Florida.
About HomeCare Connect
Specializing in catastrophic care management, HomeCare Connect manages the quality and cost of post-acute care, home health care, durable medical equipment and supplies, and home modifications along with prosthetics and orthotics for workers’ compensation payers. Its service standards ensure that injured workers receive excellent care in the fastest time frames at the most affordable prices. For the past several years, the Orlando Business Journal’s lists of fast-growing, privately held companies have captured its rapid growth. Based in Winter Park, Florida, the privately held company serves clients nationally and can be reached at www.homecareconnect.com or 855-223-2228.
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This is NOT a paid placement.