Urgent message: A loss management/injury management product line will further broaden a practice’s range of services (and revenue sources) while also creating a platform for referral of new patients.
Donna Lee Gardner, RN, MS, MBA
As discussed previously in JUCM, a clinic that seeks to broaden its clinical services—and, thus, its revenue streams—by offering comprehensive urgent care occupational medicine (UCOM) services will provide access to five distinct, but complementary, product lines:
• health surveillance
• injury/loss management
• prevention services
• on-site services
This article will focus on injury/loss management and rehabilitation.
Loss Management/Injury Management
A loss management and injury management product line allows UCOM practices to enter into contracts with employers who agree to send their work-related injuries to the UCOM facility for injury care.
Before treating any injured workers, however, the UCOM practice must establish a client company profile based on the company’s specific requirements.
In addition, conducting an onsite analysis will provide information about the work environment, such as specific hazards, functional job requirements, restricted duty opportunities, the com- pany’s safety program, the designated company contact for feedback on work-related in- juries, and other data identifying specific requirements for reporting and billing.
Injury management focuses on the immediate care of the injured worker and establishes the causality of the injury. Care is provided, and specific written guidelines are provided for the injured worker’s return to work.
Loss management provides an additional focus on preventing further injuries by evaluating the causality of the injury, providing specific recommendations for prevention by worksite redesign, education of employees, or additional prior-to-hire screenings to ensure that prospective employees have specific physical capacity to perform job tasks.
This component establishes a partnership between the UCOM practice and the client company, in which the two parties work together toward a safe work environment. A contract is negotiated and signed, with the client company paying administrative fees to the UCOM above the cost of any care provided to injured workers.
The goal of this approach is to provide fast, efficient, urgent care. While knowledgeable physicians and professional staff provide the hands-on care for the injured worker, the broader UCOM program develops treatment standards to ensure injury management is standardized to provide emergency care, follow-up referrals, and company feedback for injured workers’ med- ical data.
Outcomes are defined in conjunction with the standards for monitoring and documentation of value to the client company. A UCOM provider (typically, a nurse practitioner or physician assistant) should be identified as the primary treating clinician in the treatment facilities; this facili- tates fast tracking of all injured workers through the system in less than 45 minutes. A customer service orientation of all personnel that interact with the injured worker will assure a positive experience for the worker. This approach creates an excellent opportunity for the UCOM practice to increase its referral base.
The UCOM program will provide a care manager/injury coordinator to follow the case of the injured worker through the continuum of care. The coordinator provides education to the worker regarding the extent of injury, follow-up referral appointments, communication with the client company about physical restrictions for temporary alternate work, and facilitates communication with the employer and the insurance company. Claims management is established, and meetings scheduled with the client company, insurance company, and injury coordinator to discuss the status of the injured worker who is out on lost-time injuries.
A referral network of specialists must be established for the follow-up care of the injured worker.
Central data management establishes a database for the practice, and access of information from the em- ployer to the practice via the Internet.
The provision of injury management services requires several crucial components for success:
- clinical staff able to provide fast, efficient treatment
- physicians familiar with local workplaces (including job functions, hazards, and relevant regulations)
- the ability to identify appropriate physical restric- tions for the injured worker
- case management of the injured worker from the time of injury through return to full duty
- efficient completion of forms and insurance re- ports to facilitate the claims process
- a mechanism to provide feedback to the employer after the injured worker has been treated
- a cost-efficient charge system for all care provided
- use of a billing system that designates the appropri- ate process for each of the employers contracting for occupational injury management
- a system for referring the injured worker to a rehabil- itation professional who is occupationally oriented
- a referral network of specialists who agree to facilitate appointments, provide feedback to the case management system, and complete required
Rehabilitation is another key aspect of a comprehensive UCOM product line. This service may be provided in- house, through referral arrangements, or via contractual relationships with outside vendors.
The optimal model is to have a rehabilitation profes- sional (physical therapist/occupational therapist) on staff to evaluate, treat, and manage injured workers based on established protocols.
The first step in the rehabilitation of an injured worker is the preparation of an evaluation and treatment plan, immediately followed by the application of specific treatment modalities. This approach places the injured worker on a fast track to return to work.
Collaboration between the primary treating provider and the rehabilitation professional has been shown to markedly decrease treatment times and cost for employers. Integrated with the health surveillance product line for pre-hire screenings, this service identifies the functional abilities required to perform the job. At minimum, components of the rehabilitation component for the UCOM practice should include:
- initial evaluation at the time of injury
- treatment modalities for injured workers, with the focus on immediate post-injury interventions and an “industrial athlete” mentality (i.e., an awareness that the worker must be sufficiently rehabilitated to carry out the tasks required by his or her specific job for as long as requires; this may be quite different from being deemed generally “ready to work”
- job analysis and functional screening
- identification of temporary work restrictions
- patient education for injury prevention
- outcomes developed, monitored, and reported to client
Combined with a health surveillance product line (JUCM April 2008), establishing a loss management/ injury management and rehabilitation initiative will help create a firm foundation for your occupational medicine practice.