Is a nurse case manager the plaintiff’s friend?

Posted by on Jun 27, 2017 in Blog

Why the answer may surprise you   Your client recently suffered greatly from an injury and is seeking what he feels represents adequate compensation so he can recover and return to the workplace – if returning to work is possible. Then you learn that the insurance company has engaged the services of a field nurse case manager to actively work the case. Immediately, you assume that they plan to severely limit your client’s compensation – the compensation they are owed – or, even, may begin to push for a return to work. In your mind, the list of drawbacks can go on and on. Bottom line, you may think that the hiring of a nurse case manager by an employer or payor is not a good sign and poses a direct threat to your case. Right? Well, not exactly. Don’t fall prey to flawed assumption Yes, plaintiff attorneys commonly assume that the influence of an authoritative nurse case manager can only spell trouble for the plaintiff’s case. But don’t fall prey to this flawed assumption. An experienced nurse case manager with high integrity can be just as much of an asset, if not more, for the plaintiff as she is for the defendant. Examine this assumption by considering the true objective of the nurse case manager: They are tasked with guiding 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, according to the Case Management Society of America. The professional nurse case manager should focus on the best treatments available, helping to move and navigate the injured worker through various diagnostics; physicians and providers; treatments; rehab; and, eventually, a return to work, if and when appropriate. Insisting on best practices In addition, she uses her knowledge, experience and observation to ensure that the physician and other providers follow these best practices through the entire case. She can do this for the plaintiff’s case just as well as she can for the defendant’s. Those findings may favor the injured worker. They can enlarge the plaintiff’s case, provide for a stronger case and support the award of more substantial proceeds. Those findings also can backfire on the insurance company or employer – more quickly than a clogged blunderbuss if they have not focused on best medical practices, attempted to do damage control or are trying to cut corners just for expediency. The professional nurse case manager can provide supportive and verifiable information and numbers that may indicate that your client might never be able to return to work or a normalized lifestyle. They may even find that your client also needs...

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The Forever Battle

Posted by on Jun 20, 2017 in Blog

Reducing and preventing physician medication order entry errors Physician medication orders entered for the wrong patient is a constant battle for hospitals. At MKC Medical Management, as we investigate our client’s claims and cases, we see it all of the time. Many factors can lead to medication errors. In fact, the Institute for Safe Medication Practices has identified 10 key elements with the greatest influence on medication use and notes that weaknesses in these areas can lead to medication errors. They are: patient information drug information adequate communication drug packaging, labeling and nomenclature medication storage, stock, standardization and distribution drug device acquisition, use and monitoring environmental factors staff education and competency patient education quality processes and risk management Medication administration is a complex and multistep process that involves prescribing, transcribing, dispensing and administering drugs, as well as, monitoring patient response.  An error can happen at any step, but we see many errors happening in the beginning – at the prescribing stage.   Researchers tackle issue With the introduction of electronic medical records, there have been numerous studies focused on ways to reduce and prevent order entry errors. Researchers at Montefiore Hospital in New York, for instance, wanted to find a way to detect wrong-patient orders in their electronic medical records system. They devised a tool to track errors, such as prescribing medications for the wrong patient, and to suggest ways to reduce potentially life-threatening mistakes. The study lasted from December 2010 to June 2011. It found that two different interventions could decrease the number of wrong-patient orders that were later retracted. Phase 1 of Montefiore’s research: Physician Interviews Interviews with 233 physicians over a four-month period showed that 76 percent of the original orders had been for the wrong patients. They were near misses that could have turned into actual medical errors involving orders for imaging or lab tests or medications. Their findings of the study translated to wrong-patient electronic orders being entered by one in six clinicians for one in every 37 patients admitted to the hospital, an average of 14 such orders per day. This did not include or reveal how many orders for the wrong patients went through and were carried out. Phase 2 of Montefiore’s research: Verify Patient Identifiers In the randomized controlled trial, 4,000 providers were assigned to groups, which were prompted to verify patient identifiers before entering orders, re-entering patient identifiers – or neither. The results were encouraging compared to the control group. ID verification reduced the odds of retract-and-reorder events by 16 percent; ID reentry decreased them by 41 percent. It took clinicians only half a second on average to verify a patient’s ID, versus 6.6 seconds for reentering identifiers. The latter...

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Tips, Trends and Findings

Posted by on Jun 13, 2017 in Blog

Here are studies, reports and stories that caught our eye in the last month. No “standard” claim: Isn’t one rear-end crash like every other rear-end crash? No, says an article in Property Casualty 360 that’s part of a six-part series about adjuster ethics. “Each claim is unique, the people involved are individuals, and each claim needs to be adjusted on its merits,” the article says. “When we try to do away with individualism in each loss, we either over-pay or under-pay, hence the claim is no longer ‘fair and equitable.’” Bodily injury claims: Claimants must prove both liability and damages to be entitled for compensation in bodily injury claims. But, says an article in Claims magazine, liability is often overlooked. “A good rule of thumb for all adjusters is to never underestimate the importance of liability as a critical element of the claims investigation,” the article says. “Beyond the potential accuracy improvement in indemnity payments, there is a dramatic rise in subrogation potential.” Cars could someday alert drivers to their own medical emergencies: Sudden cardiac events for drivers behind the wheel can turn into tragedies for not only the driver, but his passengers and others on the road. Toyota, along with a team of researchers at the University of Michigan, are exploring technology that could monitor a driver and predict if they are going to have a heart attack or other adverse cardiac event while driving, according to an article in Insurance Journal. The role of social media in personal injury claims: Defense attorneys are adding a new weapon in their arsenal as they fight personal injury claims: A plantiff’s social media accounts. “Many plaintiffs make things very easy for the defense, simply by posting things on social media that undermine their claims,” says an article in Forbes. “For example, a simple post about mowing the lawn could be used as evidence to refute a personal injury claim about a back injury.” Can robots review personal injury claims? The answer, at Zurich Insurance, is yes. The company is using artificial intelligence to decide personal injury claims. “We recently introduced AI claims handling … and saved 40,000 work hours, while speeding up the claim processing time to five seconds,” chairman Tom de Swaan told Reuters as reported in Claims Journal. The robots began doing the work in March to review paperwork, including medical...

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Physician Peer Review or LNC Report?

Posted by on Jun 6, 2017 in Blog

What’s the best practice? Both When reviewing medical records, it may seem redundant and not at all cost effective to pay for both a physician’s peer review and a legal nurse consultant’s examination of the same claim or case. They both, however, offer unique perspectives. And, when you combine the two, the result affords you a more complete timeline of both the events that have happened and the medical future for the patient. The Physician Peer Review A physician peer review or medical review of a case can give you a pinpointed, detailed reporting of what has happened to date. It provides intricate details about specific pieces associated with the medical event and how those pieces fit directly together. More myopic in construction than an LNC report, the medical review yields very precise answers and insight into a medical event and the subsequent treatment strategies. Simply put, it’s a very accurate snapshot in time of the patient and the event. The LNC Report Also a major standard in the industry, an LNC takes the medical review and expands it. MKC nurses create a detailed medical record summary with ongoing embedded commentary, helping the reader understand both the material and its impact on the case. Contact us if you would like to see a sample report. An LNC report provides information about peripheral factors relevant to the case as well. It also considers long-term patient care and interaction, pre-accident medical information, specific information about the mechanism of injury and ongoing details pertinent to the injury and case. This broader approach often uncovers inconsistencies that may otherwise go undetected. An LNC’s granular level of review is equally important to the case as the focused review of the physician.  As one claims examiner once explained, “We know we will never have a silver bullet on these cases, but what is more valuable is that with the nurse review the details of the record evolves into a shotgun effect, thus exposing equally important details that are often missed.” Using a Whole Person Approach The patient involved may have a single event or episode, but the effects and ramifications of that single event can weigh heavily on the future treatment of that injured party. By using both reports, you gain a more complete picture of the claim, the specific injuries and the prognosis. Without using both reports, you could very well end up making future patient decisions with one eye...

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