Six ways to help aging workers stay on the job

Posted by on Jan 31, 2017 in Blog

The workforce is getting older. The U.S. Bureau of Labor Statistics reports that the rate of workers age 55 and up in the labor pool has gone up in recent decades – and will continue to climb. The changing faces at the conference table mean employers must take a hard look at their policies and procedures – especially those that relate to workers’ compensation and other claims. Thanks to normal aging, older workers are at higher risk for chronic diseases, take more time to recover and face other age-related setbacks. How can employers help? Through innovative programs. Here are six options. Read more in our recent article at Property Casualty 360. Launch wellness programs and encourage participation. Make sure they address the needs of your older workers and encourage healthy lifestyles. Offer ongoing workplace physicals. If health issues crop up, an employer may be able to make changes to job duties. Project costs based on an older worker’s ability to recover. Keep in mind that older workers may take more time to heal from a surgery or setback and could need extra therapy. Create a committee to discuss all older workers’ claims early on. Quick referrals to the right medical doctor, along with more regular follow ups, may be in order. Evaluate potentially protracted losses. This depends on the job, but they need to be done early by nurses at a local clinic or through case management. Let them mentor: If older workers can’t physically get back to work, consider letting them take a leadership or mentoring role, which could reduce loss time and worker’s compensation payments. After all, older workers bring much more than achy backs to the job. They offer a wealth of experience and knowledge and are playing big roles in today’s offices and job...

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Pros and Cons: Electronic Health Records

Posted by on Jan 24, 2017 in Blog

Four things to watch for when reviewing electronic medical records In the past decade, health providers have made big changes in the way they document patient visits, monitor lab results and track their patients’ health. Gone are the paper forms. Here to stay are the tablets and software programs where nurses and doctors record their patients’ health information. Adoption of these Electronic Health Records was among the key pieces of the Health Information Technology for Economic and Clinical Health Act of 2009 and the Federal Health IT Strategic Plan. So far, the federal government’s efforts to encourage the move to these electronic records has paid off. According to a May 2016 report, by 2015, more than 4 in 5 of all non-federal acute care hospitals had adopted a Basic EHR with clinician notes. About 80 percent of small hospitals with less than 100 beds, rural hospitals and critical access hospitals had done the same. When used correctly, Electronic Health Records can come with plenty of benefits, including better follow-up of test results; improved care coordination; cost savings and efficiencies; and increased patient participation. But, just because health care facilities have implemented this electronic recordkeeping, it doesn’t mean every doctor fully uses them. According to a data analysis published in the June issue of Applied Clinical Informatics, researchers found that 43 percent of primary care physicians used workarounds – typically pen and paper. Doctors preferred alternative methods for three reasons: as a memory aid, for improved efficiency and for easier internal and external care coordination. Researchers concluded that future EHRs and work systems need to evolve to meet providers’ needs. If you’re reviewing Electronic Health Records for a case or a claim, here are four things to know: Not necessarily easier: It might seem counterintuitive, but electronic records often are much more difficult to cross reference than a traditional record. If the software for a hospital and a clinic, for instance, can’t communicate with each other and access the other’s electronic records, it makes it more difficult to track every record and result. Not necessarily better: Each hospital has its own Electronic Health Record system and none of them necessarily improve patient care or documentation. Some are pieced together. Some components, even within a single health system, can’t communicate with each other. So always determine if there still might be a paper trail. Audit trail opportunities: Electronic Health Records do give us important access into the history of a case. The date and time stamps are vital pieces of information for determining whether records were tampered with. Always complete a chronology of any record – written or electronic – so that inconsistencies, gaps and possible tampering are clearly identified. Shortcuts...

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Tips, Trends & Findings

Posted by on Jan 17, 2017 in Blog

Here’s a collection of studies, reports and stories that caught our eye in the last month. Health technology to watch in 2017: From security and compliance to informatics and mobile health, Physicians Practice covers the eight health technology challenges and opportunities in 2017. On informatics, the publication writes that the use of electronic health records leads to “dramatic reductions in malpractice claims,” “faster lab results, “ and the “potential for significant cost savings and improved quality of care.” Are ICUs overused? More than 50 percent of patients admitted to the intensive care unit at Harbor-UCLA Medical Center in Los Angeles may have been too well or too sick to be helped from ICU care, according to an article on MedPage Today. The article says researchers concluded that health care providers must more closely follow ICU priority ranking guidelines set by the Society of Critical Care Medicine to boost patient care and save money. Innovation needed for senior care: A survey by CareMore found that seniors need more help navigating the healthcare system. According to the report, nearly 65 percent of seniors polled had been to three or more health care providers in the last year, but few have expert help to coordinate their care. Nearly 70 percent relied on themselves or a family member. For those hospitalized, 63 percent said nobody coordinated their care within the critical months after discharge. “Coordinating care across multiple providers who treat a single patient is a key strategy for ensuring positive clinical outcomes, while also reducing costs,” the report says. OSHA expands reach: WC Magazine writes about the Occupational Safety and Health Administration’s new regulations for reporting workplace injuries, which went into effect in December 2016. According to the article, OSHA has “expanded its reach to encompass almost any employment practice, policy or procedure, whether active or passive, that can be construed as deterring employees from reporting injuries and illnesses. Claims and comorbidities: Research presented at the National Workers’ Compensation & Disability Conference shows that workers’ compensation claims from employees with pre-existing conditions such as diabetes, obesity, hypertension and addiction come with higher price tags, longer durations and more litigation. “The workers’ compensation industry needs to do a better job of managing underlying chronic conditions along with an employee’s injury in order to better manage claims costs,” an article in Property Casualty 360. Medical marijuana licensing: Nearly 30 states have medical marijuana programs, but states are struggling with licensing issues for new medical marijuana businesses, according to an article on Some states award just a few licenses. A few have no limit. And others are still developing their program or have combined licensing of medical marijuana and recreational marijuana businesses. For more...

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Time for an LNC?

Posted by on Jan 10, 2017 in Blog

7 reasons why claims adjusters should work with Legal Nurse Consultants As an insurance adjuster, the cases you’re reviewing might not be much different from those examined by the generation of adjusters before you. There are injuries caused by car crashes and slips and falls, along with cases involving faulty products or workplace accidents. The claims may be, for the most part, the same. But the treatments – and even the records themselves – may be entirely different from what your counterparts were scanning a couple of decades ago. Electronic health records, for instance, have nearly made paper ones obsolete. Concerns over the country’s opioid addiction epidemic are forcing entirely new ways to handle chronic pain. Telehealth allows patients to consult with doctors in far-flung regions. But these new health care advances aren’t the only changes. Escalating medical costs and provider fees; more litigated cases; and higher litigation fees make it vital that adjusters review cases with not just a careful eye, but a critical one. Legal Nurse Consultants, who often bring years of work experience as a registered nurse, are trained to review complex medical records and uncover the facts and tidbits that can make or break a case. They provide adjusters with full medical reviews and analyses for complicated claims of all kinds and sizes. Are you wondering if you should hire an LNC? Here are seven things you’ll get if you do: Improved medical understanding: An LNC can translate complicated medical information, records, charges and codes so adjusters understand all aspects of a case. Accurate record: The more you understand about a claim, the better you can navigate the claim and understand which treatments were related to the case and which were related to pre-existing conditions. Leg up on the opposition: Without the expertise of a medical professional, claimants and opposing counsel likely will have very little understanding of what’s actually in the record. Early assessment: An early grasp of a claim’s medical details can improve claim resolution and decrease litigation costs. Better picture: When adjusters understand the related diagnoses, conditions, treatments and charges, the claim payout is a more accurate reflection of the actual medical costs. Economic reasons: Nurses are less expensive than a reviewing physician. Because of reduced costs, they are able to review the entire case and build a road map.  Physicians are often very expensive and usually hyper-focused on one specific question. Smaller cases get attention:  Historically, medical and nurse reviews have been reserved for big cases. But overutilization, overtreatment and unrelated care can happen at all claim levels. An LNC can help review records and provide a better understanding of smaller cases. Need help? Find out more about MKC Medical Management’s...

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Whiplash and Back Pain

Posted by on Jan 3, 2017 in Blog

10 red flags when reviewing records for minor motor vehicle accidents For motorists, the National Highway Traffic Safety Administration has good news and bad news. According to a March 2016 report, there were 219 fewer fatalities from motor vehicle crashes in 2014 than in 2013 – part of an ongoing decline in the number of motor vehicle-related deaths across the country since 2006. But the number of people injured during a car crash is on a slight uptick. In 2014, 2.34 million people sustained injuries in a motor vehicle accident. In 2013, the number totaled 2.31 million. While the increase in injuries is considered “statistically insignificant,” the boost represents thousands of patients, countless insurance claims and a bevy of complaints about sore necks and bad backs. Of course, many injuries from automobile collisions are severe. But, when the accident is a “minor impact collision,” studies have shown that occupants are unlikely to suffer longstanding injuries. The treatment and length of the open or unresolved claim, however, can be protracted and may involve plaintiff counsel. Bruises, after all, heal quickly. Psychologic factors, in fact, might be the reason behind most complaints of chronic pain after a minor collision, according to a report about the biomechanics of minor automobile accidents. In fact, researchers have found that claimants complaining of whiplash get better more quickly if they don’t have access to compensation for their pain and suffering. As you review records from a minor crash, there are plenty of red flags that could signal big problems. Here are 10 red flags to look out for: No damage, significant injuries: The vehicle suffered very little damage, but the patient complains of significant injuries – or offers multiple variations of physical complaints. Extended care without assessment: The patient seeks extended periods of chiropractic care, physical therapy, acupuncture and pain center treatments before seeking help from an orthopedist, an evaluation from a neurologist or an assessment from another medical specialist. Lack of improvement is a big RED Flag. Ongoing treatment, no specialist: The patient undergoes ongoing treatment from a family practitioner or primary care physician, but does not seek treatment from a specialist. MRIs, CT scans: The patient undergoes high-level diagnostics immediately. Remember: An MRI, a CT scan and similar tests should be done to confirm or rule out a condition – not as part of a fishing expedition. Prior problems: If a patient undergoes surgery or is hospitalized after a minor collision, it may be an indicator of prior health issues or problems or conditions that pre-date the accident. Compare, contrast: Compare the billing statements against the narrative records. Missing records are a red flag. Examination required: Review carefully the mechanism of injury throughout...

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