The Truth on Medical Management and WC Claims
I was standing in line to pick up a prescription at my local pharmacy when I noticed a man at the consultation counter becoming agitated. As the man continued to raise his voice, I couldn’t help but overhear his conversation. Evidently, he was involved in a work-related auto accident which left him “in bad shape” – his words not mine. He was claiming to have run out of his narcotics (Norcor to be specific), and was trying to get his prescription filled prior to what was evidently allowed. The staff at the pharmacy offered to call his physician, and while this was not exactly the response he seemed to be looking for, it did seem to de-escalate the situation for the time. While I didn’t stick around to learn the outcome, I’ve seen this pain-seeking behavior too many times in the claims world (not to mention I’ve seen a few different TV episodes with similar incidents). When confronted with this situation, most of the adjusters I have dealt with chalk this up to either a patient problem or an appropriate course of treatment. However, I question if the physician did truly evaluate the best course of treatment for this employee’s recovery, or went this course of treatment at the patient’s request. Was a narcotic the best option for pain management? Did this physician provide the claimant with information regarding this medication and institute a narcotic management contract upfront? Did this narcotic management include a regular drug test to confirm that this narcotic wasn’t being abused?
While the scenario only represents one aspect of poor medical management, it’s the key element in reducing the overall workers’ compensation spend. Let’s take this same situation and look at a blended approach, where the physician agreed to a limited period of the recovery for the narcotic, had a contract upfront and was working through other pain management or healing options. Would it be that this individual may not have been in this situation? While there’s no guarantee, the possibility of a better outcome is much greater with an active management program.
Medical management begins at the first notice of injury and doesn’t end until the employee reached Maximum Medical Improvement (MMI). In some states you have the ability to direct medical treatment or at least direct the initial medical treatment, but in all states, you have the ability to provide your employees with a good network of physicians. This isn’t a responsibility of your workers’ compensation carrier. You, as the employer will be the front line, and have the responsibility to provide your employees with good medical care (regardless if they choose to take that opportunity).
What I’ve found consistently, is when a person is injured, the initial concern is getting good care. If those treatment options provide good customer service, good patient care and no hassle medical bill payment, employees often appreciate this assistance. For more information on how to get started, see my blog on outcomes-based networks.
Unfortunately, the failure to ensure good medical management has a direct impact on:
- Duration of treatment and disability
- Employee morale (both the injured employee and co-workers)
- Cost of the Medicare set aside
- Ability to resolve the claim
- Overall claim spend
Some key elements of an effective medical management program include:
- Intake and initial medical treatment
- Management of medical process through:
- Nurse case management involvement
- Prompt approval of prescribed treatment
- A narcotic management program
- Medical reviews
- Independent medical examinations
- Peer reviews
- Utilization reviews
If you have questions or concerns regarding your medical management, chat with us. We’re happy to help!
- Workers' Compensation E-Book
- The Best Claims Management Under the Sun Webinar Replay
- What's Up with Outcomes-Based Networks?
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