CMSA Today - Issue 8, 2014 - (Page 7)

President's Letter Workers' Compensation Case Management: Up Close & Personal BY KATHLEEN FRASER, MSN, MHA, RN-BC, CCM, CRRN I am always as passionate about every issue of CMSA Today, as I am about all things case management. However, I have worked in the workers' compensation arena for the past 20 years, so I am thrilled for this issue, which is dedicated to workers' compensation case management. If you are not working in that arena, please don't read this statement and discount this issue. As I write this, I have a huge smile on my face because I so love the challenges we as case managers face, yet the amazing difference we make in the lives of injured workers and their families - not to mention in the lives of our insured and claims professionals. Integrated case management meets its fullest potential where physical and behavioral health walk arm and arm. I have always been of the opinion that government advisors only need to look at how workers' compensation coordinates and manages health care, and all would be right with the world. The case management profession actually began with workers' compensation at Liberty Mutual Insurance. Workers' compensation case managers must consider all aspects of the patient's recovery such as family supporters, home life, and work life, and give a truly holistic method of care. Workers' compensation provides not only medical benefits, but also replacement of lost wages for persons injured while at their workplace. This opens up a world of psychosocial challenges not seen in most areas of case management, requiring workers' compensation case managers to utilize our talents as solution makers as well as problem solvers. It is a highly individualized, structured, goal-oriented practice that provides clients with a transition from the acute injury stage to a safe, productive return to work when possible. Treatment is designed to maximize each individual's ability to return to work safely with less likelihood of repeat injury. If they cannot return to work, then treatment should help them reach their maximum medical improvement and assist them with the next stage of their journey. CMSA's vision statement reads: "Case managers are recognized experts and vital participants in the care coordination team who empower people to understand and access quality, efficient health care." In addition to this, I envision the vision statement for workers' compensation case managers as: "To provide injured workers, who have temporary or permanent restrictions resulting from workrelated injuries or illnesses, the opportunity to return to work and perform value-added tasks consistent with medically documented capabilities, within a reasonable timeframe." We incorporate medical knowledge of both physical and psychological diagnosis with years of extensive clinical backgrounds. To this, we add knowledge of expected length of: disabilities; statistics; the Americans with Disabilities Act (ADA); current state and federal workers' compensation law; and the best physicians, clinics, hospitals, rehabilitation facilities, home health, transportation, and DME providers. Then, to round out our expertise, throw in experience meeting with these facilities and professionals to facilitate the most appropriate services. Lou Holtz stated, "Life is 10 percent what happens to you and 90 percent how you respond to it." Often in workers' compensation cases, employees and workers do not respond well. A disability may or may not be a handicap to an individual, depending on one's adjustment to it. It can be a physical or a neurological deviation in an individual makeup. It may refer to a physical, mental, or sensory condition. It may be Post-Traumatic Stress Disorder (PTSD) where the injured worker was not physically injured but was robbed while working in a convenience store. There are the dilemmas that the opioid epidemic brings to case management, which is referred to as the plague of workers' compensation. But the most frustrating challenge, in my opinion, is the fraudulent claims. We are trained in all things medical where the only agenda is to get well. We are not trained as special investigators to uncover fraud. These usually are accompanied by unwitnessed injuries while on their way to the front office to be terminated. When I was assigned my first fraudulent claim, I was indignant, thinking I did not become a nurse to take care of a patient that was not really ill or injured. "How can I advocate for that patient?" I asked myself. However, I realized being a patient advocate is advocating for what is best for that patient, and it is not best for anyone to attempt to make a living out of deception. So, now I have told you more than you probably ever wanted to know about continued on page 22 "When we see problems as opportunities for growth, we tap a source of knowledge within ourselves." - Marsha Sinetar Issue 8 * 2014 CMSA TODAY 7

Table of Contents for the Digital Edition of CMSA Today - Issue 8, 2014

Workers’ Compensation Case Management: Up Close & Personal
Association News
CMSA Corporate Partners
Improving Outcomes
The Impact of the Aging Workforce
Inside the Mind of a Traumatic Brain Injury Case Manager
Index of Advertisers

CMSA Today - Issue 8, 2014