By Anita Jovic, RN, BSN, MBA, Vice President of Clinical Operations, HomeCare Connect
Claims for injured workers with severe burns can cost as much as $10 to $15 million, according to NCCI. Understandably, most costs occur in the hospital setting, but there are still opportunities to clinically manage costs once the injured employee comes home.
Planning & Preparation
The first step is to ensure the home is ready when the injured employee returns. While not common, home modifications may be needed to accommodate durable medical equipment (DME) and facilitate the worker’s independence, mobility, and activities of daily living. Renovations should be finished to prevent unnecessary days stay in a facility. For the same reason, the home health managed care company should have appropriate nursing services, DME, and supplies in place in advance of discharge and manage the transition into the home.
Careful wound management is key to recovery and cost containment. A wound that causes a patient to be hospitalized can add thousands, even a hundred thousand dollars to a claim.
Nurses who are certified/credentialed in wound care should work with wound care physicians to manage the worker’s in-home care. Depending on the severity of a wound, a wound vac may be applied in the hospital or in the home and is typically changed two or three times a week.
With today’s telehealth technologies, if a wound isn’t healing properly or looks odd, a field nurse can show it to the doctor or other clinician and modify treatment immediately. A telehealth session like this can spare the burned employee days of suffering and avert a $100,000 hospital visit.
DME will likely include a wheelchair with special cushions and an air-fluidized therapy bed or a hospital bed with an alternating pressure, low-air loss mattresses.
Most seriously burned employees also need compression garments, made from thick elastic material that look like scuba diving material. Worn 23 hours a day and removed only for bathing and dressings, these garments protect burned areas from fabric friction, prevent swelling, decrease itching, and protect the skin. They minimize scarring, especially the development of hard scars. Compression garments also improve circulation and reduce pain to the extremities through vascular support.
Costs vary depending on the wound, the burned body parts, how thick the garment needs to be, and how quickly the elasticity wears out and garments need to be replaced. If the injured employee can use an “off-the-shelf” arm sleeve, for example, the cost could be around $200 per sleeve, but a larger chest area requiring a custom design could run into thousands.
Wound care requires a wide range of supplies, such antimicrobial dressings, non-adherent dressings, petroleum gauze dressings, topical creams, ointments, medihoney gels, and gauze. Making sure the worker receives what they need when they need it in the right amount so that there is no delay of care, while also ensuring there is no waste is a way to contain costs.
In some cases, these burned workers undergo amputations and need prosthetics, which bring a unique set of cost drivers. My colleague Jan Saunders has covered these in a previous Leaders Speak article.
Depending on the burn, in-home physical therapy may be prescribed. Scar treatment, nutritional support, cryotherapy, pain management, and respiratory care are among the other home health services the injured worker may need.
Reconstructive surgery may also occur. When setting reserves for this, consider the body parts burned. The face, head, neck, and hands require more delicate and expensive reconstructive surgeries.
Psychosocial Factors & Support
Among the chronic conditions listed in the NCCI Research Brief on severe burns were depression, altered self-image, chronic pain, and post-traumatic stress syndrome (PTSD). The Overview of the Management of Severely Burned Patients article published in UptoDate, says “psychiatric/psychologic support of the burn patient should be an early and routine component of management.”
Depression and PTSD are the most common psychosocial factors among burned injured workers, but some develop significant issues such as somatization (the conversion of anxiety into physical symptoms) and phobic anxiety.
Interventions will focus on social adjustment, with return to work in mind. Treatment might be geared toward specific conditions, such as PTSD or anxiety, and exercise will be encouraged to improve overall quality of life.
Keep in mind that the family also needs mental health support, especially if there is a major disfigurement or amputation. Family dynamics is one of the psychosocial factors that affects recovery.
Some home healthcare ancillary providers have licensed clinical social workers or mental health social workers who can assess the injured worker and their family, provide counseling, and/or help the family, employee, and claims representatives identify appropriate resources.
Home healthcare should never be ad hoc or reactive. With catastrophic burn cases, especially, a clinical coordinator should be responsible for the case. A delay in care can result in serious issues, such as a bacterial infection, septicemia, and even sepsis. It is imperative to avoid any delay of care with burn injuries.
Ideally this point person knows everything happening on the case, discusses it with other clinicians in case roundtables where they can gather insights and ideas, and seeks the opinions medical directors and treating physicians when necessary. By carefully monitoring the case, the clinical coordinator anticipates next steps, prepares, and keeps the claims rep informed and ready to authorize any needed services. For example, if reconstructive surgery is scheduled, the coordinator should ensure the claim is staffed appropriate nursing and DME services.
In short, a home healthcare ancillary provider should clinically manage burn cases to avoid problems that can be avoided. Things like not having the right supplies, DME or medications when they’re needed, infected wounds, and undetected psychosocial factors create larger physiological problems and higher claims costs.
Return to Work
In a retrospective review referenced in the UptoDate article, 90 percent of patients returned to work within two years post injury. Reintroducing severely burned employees into society is the first step. Something as simple as determining the earliest time to transition from in-home to in-clinic physical therapy helps the injured person acclimate to the outside world.
Severe burns are catastrophic – certainly for the employee and their family – and for employers. Those of us charged with managing these claims do well if we:
- Communicate compassionately, clearly, and frequently with all stakeholders, especially the injured person and their family.
- Introduce mental health support early and maintain it throughout the claim
- Manage the transition between facilities and into the home.
- Deliver the highest quality of care, with no delays.
- Set positive, realistic expectations for recovery
We should also look for ways, even seemingly small ones, to manage costs without compromising this care.
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.