Having the wrong treatment protocol on day one can contribute significantly to bad outcomes with injured workers. The claims are referred to as outliers, many of these ’red flag’ cases never return to work. Best practice care begins with the use of evidence-based UR recommendations such as ODG. Using a proven pharmacological safety and monitoring opioid management program, evidence-based medical treatment and rehabilitative process-focused plan. That means coordinating every aspect of care, including programs such as quality network diagnostics, in-network physical therapy, appropriate durable medical equipment (DME) and in more severe cases Work Hardening, which uses work (real or simulated) as a treatment modality.
Case managers work closely with the primary treating physician, getting the doctor on board as soon as possible with plans for proven programs, evidence based PT facilities, patient progress monitoring and return-to-work or modified work duty recommendations. Sometimes I get a case that started wrong, we have to collaborate, pull the plug on a situation then try to fix it. It takes a firm yet gentle approach. You have shown all involved parties where the system failed and map out the road to a better outcome.
“It comes down to doing the right thing for the right reasons for the right injury at the right time. To manage chronic pain successfully – mitigating disability and maximizing return-to-work – you have to offer a comprehensive approach.” — Greg Todd, CEO and founder, Integrated Prescription Solutions Inc. (IPS)
References: Risk & Insurance, Dec 2014 – Prospective View: Fast, Early Action