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Making the Case for Nurse Case Management

Tuesday, March 5, 2019

In 2015, the U.S. Bureau of Labor Statistics reported 2.9 million nonfatal workplace injuries occurred that year with 50 percent of the injured workers experiencing time lost from work.[1] The findings approximate that 75 percent of employees return to work after 12 weeks of lost work time, but only 20 percent return after a year. Simply stated, the longer injured workers are sidelined, the less likely it becomes that they will return to work at all.  The failure to return to work is a poor outcome that affects an individual’s physical and mental health as well as their personal, family, social, and economic well-being. 

Helping injured workers avoid long delays in returning to work is essential. However,  about ten percent of U.S. workers’ compensation claims involve nurse case managers.[2] Although case management may not be necessary for all workers’ compensation claims, engaging a nurse case manager in the right instances can avert delays in returning to work.  The N Factor: How Nurses Add Value to Workers Compensation Claims includes an analysis of 42,000 workers’ compensation claims with reported findings that nurse involvement resulted in the injured worker returning to work faster, future medical costs were 16% lower, overall costs were 15% lower, and claims were resolved 12% faster. [3]

Early intervention is the key to success and the most critical point in time to affect the outcomes in medical care, claim costs, and return to optimum function and work is immediately after injury. Proactively assigning a nurse case manager to help guide the injured worker early in the claims process can accelerate a return-to-work plan, prevent delays in progress, and reduce costs. Delays in referring a claim to case management by just one week were found to increase claim costs 18 percent on cases reported at two weeks, as opposed to those reported at one week.[4] Additionally, the opportunity to realize cost efficiencies on medical spending is significant.  One study found that nurse case manager involvement resulted in an average cost savings on medical and indemnity of $6,100 for an 8:1 return on investment.[5]

Employees who are injured on the job tend to withdraw from their co-workers and supervisors when they are off work. Without support and guidance during the course of their rehabilitation, the injured worker may become confused or frustrated and seek the advice of legal counsel. Attorney involvement typically adds cost and delays to a case. Early nurse case management intervention promotes healthier relationships among all parties because the worker has an advocate. The nurse case manager will explain the treatment in layman’s terms, coordinate medical appointments, collaborate with the treating providers to expedite treatment plans, and work with all parties to facilitate return-to-work opportunities which typically results in shorter claims durations and more successful return-to-work outcomes.

When a nurse gets onboard at the beginning of the trip, a case is less likely to derail. If a nurse is assigned to a case months or years after the injury, the case may be so far off track that there is little to do but pick up the pieces, rebuild the track, and set a new course to move the case toward a resolution. To help maximize the realization of positive outcomes nurse case management should always commence at the beginning of the trip.

The nurse cases managers at ExamWorks Clinical Solutions are committed to keeping your cases on track.  For more information or to make a referral please contactcasemanagement@examworks.cs.com .

 


[1] UNITED STATES DEPARTMENT OF LABOR.” Occupational Safety and Health Administration. N.p., n.d. Web. 21 Mar. 2017
[2] Wojcik, Joanne. “Careful Use of Nurse Case Managers Can Improve Outcomes.” Business Insurance. N.p., 25 Mar. 2011.
[3] Helmsman Management Services. (2015). The N Factor: How Nurses Add Value to Workers Compensation Claims. Retrieved from: https://www.helmsmantpa.com/Documents/HMS_NFactor.pdf
[4] Wojcik, Joanne. “Careful Use of Nurse Case Managers Can Improve Outcomes.” Business Insurance. N.p., 25 Mar. 2011.
[5] Study Finds Nurse Case Managers Add Value to Workers’ Comp Claims.” Claims Journal. N.p., 31 July 2015.