CMSA Today - Issue 3, 2016 - (Page 6)

President's Letter Workers' Compensation BY KATHLEEN FRASER, RN-BC, MSN, MHA, CCM, CRRN T his issue of CMSA Today is my area of expertise: workers' compensation. Review of the history of workers' compensation programs leads to an understanding of today's health care delivery and workers' compensation systems. In fact, case management began in the workers' compensation arena. Skillful case management demands specialized knowledge, skills and understanding of pertinent terms, practices, and parameters not usually taught in health care settings. CMSA, in its Standards of Practice for Case Management, describes that case management practice extends across all health care settings and providers of various professional disciplines. This, without a doubt, applies to the practice of workers' compensation case management, whether in health insurance plans or employer settings. Workers' compensation case managers (as all case managers) should use the CMSA Standards as a guide for the implementation of their roles. All standards are relevant to workers' compensation, including and perhaps especially the legal and ethical expectations. Due to the large number of stakeholders, the role of case management is more challenging, yet also even more critical. Collaboration and communication with all parties must occur at every segment and level of care in workers' compensation case management. Case managers are key professionals in maintaining open lines of communication among the stakeholders in the workers' compensation arena. The breakdown of these lines of communication may adversely impact the claim; protract worker disability; delay injured worker access to timely medical care; or delay recovery along with the return to function, and, ultimately, maximal medical improvement and return to pre-injury status. Case managers in workers' compensation settings assess the needs of the worker who suffers a work-related injury or occupational illness through claim file and medical record review; direct contact with the worker and his 6 CMSA TODAY Issue 3 * 2016 * DIGITAL or her family, medical providers, employer, and others; and evaluation of current treatment plan and care setting for that treatment. Part of the assessment process in workers' compensation case management is to evaluate the extent of injuries or occupational illness, probable treatment plan, expectation of complete recovery, impact of the injury or illness on job requirements, and estimated time out of work. Case managers have the responsibility to adhere to established standards of practice and codes of ethics and professional conduct; promote the adherence of ethical standards in the workplace; and sometimes establish ethical standards in their profession. Ethical practice also extends to all members of the health care team involved in the care of an injured worker or the worker suffering from an occupational illness. General ethical principles as defined by a number of ethicists also apply to the practice of workers' compensation case management. This issue will go into the many aspects that influence the workers' compensation environment, from optimizing workers' compensation programs to our aging workforce. Tools are shown to assist in the role of the case manager and to assist the injured worker to safely return to work. Maya Angelou stated, "My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style." Please join us in Long Beach, Calif., the week of June 20th for our 2016 conference. We have listened to all of you on how to improve, what to keep and what to get rid of, in order to provide you with the best conference ever! Group (three or more) pricing, as well as the $150 member discount, are still available. I really do hope to see as many of you as possible at this year's event! Kathleen Fraser MSN, MHA, RN-BC, CCM, CRRN President, CMSA National Board of Directors Kathleen Fraser is the president of CMSA National, and a past president of Houston/Gulf Coast CMSA Chapter. She has more than 35 years of nursing experience, and more than 21 years of case management experience with 20 years in workers' compensation. Fraser has worked in acute hospital, long-term care, and insurance managed care. She can be reached at kathleen.

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