Nurse Case Manager - A Workers' Comp Perspective

What exactly is the role of the nurse case manager in Workers' Compensation (WC) cases?  What criteria defines a nurse to function and practice as a nurse case manager?

Many nurses are employed by insurance carriers, employers and TPA's to "manage" the medical aspects of a WC claim in addition to using outside nurse consultants.

In this arena, the role of the nurse case manager is dependent on who you ask and you will get a myriad of answers ranging from utilization review,  to actual "case management" of an injured/ill party.

Let's review what the concept of 'case management' means.  The definition of case management was promulgated by the professional association of case management - CMSA (Case Management Society of America - cmsa.org).  That definition is as follows:

"Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

CMSA introduced the first "Standards of Practice for Case Management" in 1995, there have been two additional revisions, 2002 and 2010.  The most recent revision addressed fragmentation in the health care system, using evidenced-based guidelines, transitions of care, expansion of the interdisciplinary team in planning care for individuals, incorporating adherence guidelines and other standardized practice tools and improving patient safety [www.cmsa.org - Standards of Practice for Case Management].

The practice of 'case management' requires a multitude of skills and specific knowledge base to effectively manage a persons' health care needs in and out of the context of Workers' Compensation.  It is an advanced practice.

The Commission for Case Management Certification (CCMC - ccmcertification.org) is the certifying body for case managers. Not all case managers who are practicing case managers are "certified."   What does that mean, well, between CMSA and CCMC these organizations have provided a framework for ethical sound and safe practice.  CCMC issued the "Code of Professional Conduct for Case Managers" which delineates the Ethical conduct in which a case manager must practice.

These organizations were initially established from a grassroots process. Concerned, season Registered Nurses across the country came together; they recognized the importance of setting standards and criteria for practice to insure ethics and standards of practice be observed.  The role of case management was a relatively new role that would, as it has, evolve and spill over to group health, medicare, medicaid, private pay individuals, hospitals and primary care settings.

I encourage the reader to visit these websites to better understand what the role of nurse case managers include and the standards of excellence and ethics that ought to be in alignment with the value system of the purchaser of such services.

Workers Compensation is unique because of the medical-legal aspects of a claim.  The role of the nurse case manager is to take an aerial view of the case, identify the care needs and how those can be met qualitatively, efficaciously and timely.  Establish a relationship with the injured/ill person and educate and empower them to make sound decisions.  Quality medical care is not only cost effective in the long term, but a win-win for both the employee and the employer.

A healthy workforce is a happy and productive workforce.  Remember we will all have similar needs for quality medical care at some point in our lives.  Create a program that you yourself would submit to, that is the litmus test.

Maria Perez, RN, BSN, MPH, CCM

Mindfulness Training: Stress & Health Management

I was just sitting with a nurse case manager from a major insurance carrier discussing the benefits of Mindfulness Training. All employees, inclusive of claims adjusters, CEO's, union employees, non-union employees, lawyers, doctors, etc. are at risk of health decline due to stress. For many of us, where we spend the most time of the day is in our jobs/careers/professions. The nurse I was with was commenting how there is always a "free floating anxiety" due to the inevitable changes companies and our lives undergo. The one thing that is certain is change.

However, for many of us we expect certain things to go on the same and we lack the skills to handle these changes in an effective manner. We then operate from reactivity and trauma.

I will speak to the side of what an individual may do to empower themselves to be effective managers of stress. We all have different levels of resilience and capacities. However, we all have the capacity to learn Mindfulness Training that can strengthen our resilience and much more.

Through Mindfulness Training we are able effect brain changes as a result of 'neuroplasticity' which essentially is developing new neural circuits in areas of the brain that promote emotional modulation, attention, focus, concentration, learning, anxiety reduction, and self healing.

In order for learning to occur, one must be able to have attention, concentration and focus. No training program will be fully optimized without these factors present.

Both sides of the equation, management and employees are the same, we are human with the same life issues; we get old, we get sick, we die; we want happiness and peace.

I propose that Mindfulness Training be included as a tool in Safety Programs, in addition to post injury and illness for developing the necessary skills to empower one to turn adversity to advantage. It's a win-win.


Maria Perez, RN, BSN, MPH, CCM

Mindfulness Training

While at the VPPPA Conference I have listened to various talks on safety issues and solutions to increase Safety Awareness.

A key tool that is not talked about is Mindfulness Training that has been subject to extensive research. Research findings have demonstrated efficacy in developing increased attention, focus, concentration and learning to name only some of the known benefits.  

There are many ways to practice mindfulness, but the technique that has been studied over the last three decades is very specific.  This is the Mindfulness Training that we offer.  

To learn more contact Maria Perez - office 516 621-5500 / cell 516 852-0398 / or email Maria here.

Work Place Safety: Is Mind Training the Next Paradigm? by Maria Perez

What is the next evolutionary tool that every innovative company wants to have to reduce their Workers' Compensation costs related to human resources and productivity?

Meditation has been extensively researched for its health benefits for over thirty years. Case Management Network proposes that Mind Training using Deep Mindfulness Meditation techniques (Loizzo) may result in reducing accidents and injuries in the workplace. 
 
During the Q & A at one of the seminars I attended at the RIMS Conference, someone raised the issue of "what’s next" in further reducing accidents and injuries. My response led to a brief discussion of neuroscience and how a  Daily  Meditation Practice  may be used to impact workplace safety. This sparked an interest in some of the attendees that merits further investigation.

PART I: The Numbers

Let's first review the latest available data for workplace accidents and injuries.  "Every day in America, 12 people go to work and never come home. Every year in America, 3.3 million people suffer a workplace injury from which they may never recover. These are preventable tragedies that disable our workers, devastate our families, and damage our economy."
– Secretary of Labor Hilda Solis, April 28, 2011 blog post.

Top 10 most frequently cited OSHA standards violated in FY 2011 (Federal OSHA data)

1) Scaffolding, general requirements, construction (29 CFR 1926.451)
2) Fall protection, construction (29 CFR 1926.501)
3) Hazard communication standard, general industry (29 CFR 1910.1200)
4) Respiratory protection, general industry (29 CFR 1910.134)
5) Control of hazardous energy (lockout/tagout), general industry (29 CFR1910.147)
6) Electrical, wiring methods, components and equipment, general industry (29 CFR 1910.305)
7) Powered industrial trucks, general industry (29 CFR 1910.178)
8) Ladders, construction (29 CFR 1926.1053)
9) Electrical systems design, general requirements, general industry (29 CFR 1910.303)
10) Machine guarding (machines, general requirements, general industry) (29 CFR 1910.212)

Top Five Injury Causes - Liberty Mutual's Work Place Safety Index Report for 2011 (for the full report go to www.libertymutualgroup.com/researchinstitute)

All combined accounted for 71.7 % of the total 2009 cost burden. 

1) Overexertion (lifting, pushing, pulling, holding, carrying or throwing) -  $ 12.75 billion in direct costs
2) Fall from same level - $7.94 billion 

3) Fall to lower level -  $5.35 billion 

4) Bodily reaction (bending, climbing, reaching, standing, sitting and slipping or tripping without falling) -  $5.28 billion                            

5) Struck by an object - $4.64 billion

'Overexertion' maintained its first-place rank. This event category, cost businesses $12.75 billion in direct costs and accounted for more than a quarter of the overall national burden. 

'Fall on same level' ranked second as a leading cause of disabling injury. With direct costs of $7.94 billion, this category accounted for 15.8 percent of the total injury burden. 

'Fall to lower level' ranked third at $5.35 billion in costs. 

'Bodily reaction' which includes injuries resulting from free bodily motion such as bending, climbing, reaching, standing, sitting, and slipping or tripping without falling, ranked fourth at $5.28 billion. 

'Struck by object' took the fifth-place ranking at $4.64 billion. 

PART II: Meditation 

Injuries are the result of an interconnected set of events. Responsibility must be taken both individually, and as a company, in order to avert preventable injuries.  Much work has been done to address this, but more can be done. No injury or event is an island.  Follow the trail for causes.

Case Management Network, Inc. proposes that a Daily Meditation Practice may ultimately lead to a significant reduction of preventable accidents.  How many times in accident investigations was the cause human error? We assert the mind was not fully present, because if it had been, the accident would not have occurred.    

Meditation is a tool for mind training: "Brain research has demonstrated that the contemplative practices enhance attention, problem solving and learning." (Lozzio) (Joseph Loizzo, MD, PhD is a Harvard trained psychiatrist and Columbia University trained scholar with over 30 years of studying the beneficial effects of meditation in healing and learning.) 

However, we don’t generally think of mental and social skills, such as being communicative,  empathic and emotionally intelligent as a measure of functioning well both as individuals and groups. Understanding this makes learning how to work collaboratively essential.

The most important faculty we all have in common is our mind.  Think about this; it is quite profound. Our mind is like the engine of a car. So our 'engine' is what drives not just our body's internal systems and organs, but our entire being which includes our thoughts, perceptions, feelings, cognition, and consciousness.  

A mind that is distracted, dull or upset can wreak havoc in productivity, teamwork and safety. Meditation creates the mental space for learning, attention, focus and concentration. 

The physiological changes occurring in the brain with a consistent meditation practice are the development of new neural networks which create the permanent connections for transformation to occur.  This is called neuroplasticity: “The brain’s ability to modify its structures during the course of an individual’s life.” (Siegel). Daniel J. Siegel, MD has written extensively on mindfulness and problem solving.

We know that through mind training we can develop increased awareness, focus and concentration.  We believe these to be key mental factors for creating a more expansive, conscientious person working collaboratively in a safe and healthy manner.  

Where do most of us spend most of our waking hours?  The workplace, hence we need our minds to be clear, sharp and socially engaged so that clear thinking and collaboration with others evolves as a natural progression. This is how we will strengthen our lives, our companies and our economy.  

For mind training to succeed in improving workplace safety Case Management Network, Inc.  recommends that corporations take part in this endeavor. Employers have the same mind stressors and concerns as everyone else.  Let's dare to change the existing paradigm from an adversarial, or dissociated model, to a collaborative one. One in which everyone will win, have happier healthier people, optimal productivity, reduced accidents/injuries and related costs.  

Copyright 2012 Maria Perez

WORKSHOPS: Case Management Network, Inc offers meditation training that can be tailored to meet individual organization needs. For example: One-day workshops/Half-day workshops/Weekly workshops.  

STUDIES: We are also seeking to work with an organization(s) that would be interested in participating in a study where we can measure outcomes in utility and efficacy, in order to build an evidenced based program which can be rolled out with your company leading the way to the next paradigm in how to reduce workplace injury.   

Please contact - Maria Perez: maria@casemanagementnetwork.net - office 516 621-5500 – Cell 516 852-0398

RIMS 2012 Annual Conference & Exhibition

Rim's 2012: Pennsylvania Convention Center on 1101 Arch Street, Philadelphia, PA 19107

As everyone in the industry knows, RIMS 2012 Conference and Exhibit begins tomorrow, April 15, 2012. I'll be there! We, at Case Management Network, Inc, eagerly anticipate the opportunity of connecting with colleagues, building new relationships, and returning with the newest risk management solutions for our clients. 

Welcome to Case Management Network, Inc ONLINE!

Case Management Network, Inc.® is here to assist you to navigate the medical care community for best solutions in clinical outcomes and cost effectiveness.

Quality care is a standard that must be pursued for the well being of all. It is the logical and most cost effective choice. It is not cost effective to have incorrect diagnoses, unnecessary treatment/surgery, poor follow-up care, ill prepared and uneducated consumers; to name but a few. These results are expensive, not just in dollars, but in physical and psychological trauma.

While we are in the process of creating this blog you may visit our CEO and Founder, Maria Perez at LinkedIn to get better acquainted with our services.

We look forward to having a vibrant conversation and welcome your comments.

Warmly,
Maria Perez