Tendon Transfers and Decreasing Caregiver Costs

Posted by on Aug 24, 2012 in Blog, Case Management, WC, Workers Compensation

PRICELESS Hand function is, by most, considered the most important ability leading to independence with activities of daily living.  Attendant care is by far considered a medical necessity because of the lack of hand function needed by a person to groom, dress, eat, toilet, drive, use a phone, use a computer, manage money, and the list does go on.  Tendon transfers have been an elective surgical intervention for dozens of years but are for some reason, a well kept secret for populations such as spinal cord injuries.  No one would hesitate to offer Chipper Jones of the Atlanta Braves a tendon transfer if he had an injury that would warrant it.  But take a 23 year old C5-6 tetraplegic, and you will find recommendations such as a power wheelchair, hoyer lift, attendant care, occupational therapy, orthotics, assistive devices and assistive technology that are all costly, and require maintenance and replacement.  You will rarely, if ever find a recommendation for tendon transfers. Three primary tendon transfers, which are deemed very useful to the C5-6 SCI population, have the potential to strengthen pinch, grip, and elbow extension. A “key” pinch procedure might offer the ability turn pages, hold a book, take money out of your wallet, use and ATM, catherize yourself, write with a pen or pencil, brush your teeth, feed yourself with utensil WITHOUT a u-cuff or other device. Improved grip strength might allow you to grasp a water bottle, a doorknob, hold a medicine bottle and even take the cap off! Elbow Extension gives you triceps strength and increases your “work space”.  A person could then prop sit, help themselves scoot and sit, propel a manual wheelchair, and reach outward and upward. A young lady’s story at the Shepherd Center caught my ear.  She had been injured at the C5 level for almost 15 years.  She had attendant care, family and friends, and a husband and 2 small children.  She went through all three procedures on both arms.  The procedures themselves are outpatient.  She returned to therapy 3 weeks later for 3 times per week for 8 weeks.  Now she has a lifetime of independence she did not have for 15 years that does not require maintenance or replacement.  She was able to discard all assistive device and adaptive equipment.  She was able to put on her make-up,  catheterize herself and shave her legs. The best part of all this… she made her kids a homemade macaroni and cheese for the first time!  She was able to grip the egg, crack it, stir it up, get a GALLON of milk out of the fridge, open the top, pour, put a pot of water on the stove, grate cheese and...

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Why We LOVE Case Managers!

Posted by on Aug 8, 2012 in Blog, Case Management

The Main Objective is… The main objective of case management is ‘continuity of care’. Without proper management, recovery can be prolonged and more costly than necessary.  These patient advocates and front-line professionals serve at the epicenter of the health care system for the insurance company or health care organization. They are engaged with the patient’s progression of care from admission to the hospital through discharge, up to and including facilitating post-hospital care. As a result, they have first-hand experience dealing with patient flow disconnects and bottlenecks. Case managers experience up close these hand-off challenges when attempting to manage the progression of the patient’s care from admission to discharge, and into the post-hospital care environment. There are five (5) essential functions of a case manager. Assessment: Establishes the needs of the individual Planning: Ensures service provision is coordinated and comprehensive Linking: Coordinates services to ensure needs are met Monitoring: Stays on top of any changes Review: Review on a regular basis ensures services remain responsive to changing needs The practices of case management are constantly evolving. Changes in health care laws, regulations, reimbursement methods, accreditation standards, and innovations in care delivery systems are some of the factors that affect such evolution. Remaining current about the most recent practices of case management is important for ensuring that their clients receive best care...

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ER Documentation Review Tips

Posted by on Aug 2, 2012 in Blog, Claims Tools, ER Documentation, Litigation Tools, Medical Records

Review ER Records from Multiple Angles Reviewing emergency room documentation can be challenging.  Gathering and assimilating the appropriate information from ER reports represents a crucial step in evaluating a case, relatedness and specific injury issues. Learn your basic ER documentation and how it all fits together! Follow these tips. loans for bad credit instant decisiononline cash loan lenders A patient’s medical history can disclose pertinent details regarding his current/prior condition. Review medical authorization forms personally signed by the patient.  These can offer critical insight into the case and provide access to the patient’s past medical records without violating HIPAA regulations. Review ER records against other physician’s notes, prior surgeries/tests and EMS records, to determine whether the complaint relates to past symptoms or issues. You can learn a great deal about a patient’s medical state based on the physician’s notes.   Also be aware that new findings/complaints can develop after ER discharge and all the more reason why a close review of the initial ER record is important and follow up on the records is important. Do ordered tests match completed tests?What was specifically ordered?  Was the physician trying to rule something out or confirm a clinical finding or suspicion?  Did the physician NOT order testing, despite the injured party’s request for it? Did the injured party complete the ordered diagnostic tests? Sometimes confirmatory testing will have to be done with in a specific time parameter, so follow the order trail and request test/lab results. Review discharge instructions and note how/if/when the injured party complied. Compliance issue can greatly impact the file/case. Also remember that patient does need to take responsibility when following doctor orders....

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