CMSA Today - Issue 3, 2016 - (Page 12)

Return to Work Tracking Outcomes and Return to Work within the Hospitality Industry The Marriott International, Inc. Approach BY DONNA J. SCHROY, RN, CCM I n early 2015, Marriott International, Inc. sought to objectively measure how its Nurse CARE Management program was contributing to cost containment and return-to-work efforts. Cost containment is a responsibility for all case managers. Both the Case Management Society of America and the American Association of Occupational Health Nurses reference cost savings in their definition of case management. In summary, both definitions imply that the goals of case management are to provide quality health care along a continuous process, preventing fragmented care and delayed recovery, augment the client's quality of life, and assist in the process of an employee's return to work using resources efficiently to reflect cost containment.1 Knowing that cost containment is one objective in the overall function of case management, the question was posed, "How can we measure our efforts regarding cost?" The goal was to create a tool that objectively addressed injury recovery time frames and return-to-work efforts. Measuring the outcome of nursing interventions is challenging. Much of what we do as case managers is intangible. As Nurse CARE Managers, we serve as advocates for our associates, provide education, offer resources, and coordinate care. How can we tell if these interventions are effective? A review of several comprehensive cost savings programs helped identify two factors that were determined to be most important for us to track. First, how do our case management activities impact functional recovery? Second, how are we doing with regard to accommodating transitional work assignments? With regard to tracking case management activities, this required us to select an evidence-based data set. For our program, we chose ODG (Official Disability Guidelines). ODG is an all-encompassing resource for up-to-date medical treatments, return-to-work guidelines, and evidencebased decision support. This type of program could be adapted to other evidence-based databases, such as MDA (Medical Disability Advisor) and in some cases may be statespecific. After deciding what information we needed from our report, we appropriately named it "NCM TTD TRACKER and RTW REPORT." As mentioned above, the program measures the NCM efforts regarding return to work against what ODG has developed based on a composite of more than 10 million reviewed cases, years of research and medical evidence. After identifying the appropriate number of disability days by using the ODG Co-Morbidity calculator, we then compare that number of days to the actual number of days the associate was off work. Once this difference is calculated, the program then measures the potential ODG costs against the actual wages paid to the associate. This application allows us to assess how many days an injured associate varied from the ODG, plus what cost, negative or positive, was associated with it. It is important to note that the ODG number of days can vary greatly based on the state of injury, job class, comorbidities and other confounding factors. Below in Exhibit 1.0, you will find an example of our first tracking piece. In this scenario, an associate was placed off work for a medial meniscal tear and post meniscectomy. The NCM formulates, via the ODG Co-Morbidity calculator, that the number of days for an average of 95 percent of claims is 57. The NCM knows based on her knowledge of the case that the associate was off work by the authorized treating physician for seven days; therefore the difference between the ODG days and actual days is 50. The associate's TTD rate was calculated at $350.00; therefore 57 days transfers to a potential cost exposure of EXHIBIT 1.0 95% ODG DAYS 57 12 CMSA TODAY #OOW DAYS 7 DIFFERENCE ODG VS. OOW DAYS 50 Issue 3 * 2016 * DIGITAL WEEKLY TTD $ $350 $ ODG COST $2,850 $ WAGE REPLACEMENT $350 $ WAGE REDUCTION SAVINGS $2,500

Table of Contents for the Digital Edition of CMSA Today - Issue 3, 2016

Tracking Outcomes and Return to Work Within the Hospitality Industry: The Marriott International, Inc. Approach
Optimizing Workers’ Compensation Programs through Integrated Utilization Management and Case Management Interventions
A Challenge for Case Managers: Engaging with the Multigenerational Workforce

CMSA Today - Issue 3, 2016