photo credit: Josh Liba

The most important role of the case manager is to advocate while educating. Case managers must advocate on the client’s behalf to get each client the right resources and the right care at the right time and by the right provider–all while considering the patient’s own resources and abilities. Clients need to understand the information they have been given and the implications for their future, while learning how to manage and navigate the landscape on their own. The workers compensation patient has an additional learning curve as they navigate the legal system and employment issues all while recovering from an injury.

Jo Carter, a Commissioner with CCMC explains, “The workers’ compensation setting is a highly regulated area of practice, with both health care regulations to follow and state-by-state reimbursement systems and laws. When you’re providing case management services, you have to be aware of how those regulations affect the process. There is also the interdependence of many other stakeholders, including attorneys–an attorney who may be giving the worker specific advice based not necessarily on returning them back to health and the highest level of independent function, but on the legal and financial aspects of the claim. That can create conflicting goals and dynamics. There can be additional pull for case managers who are employees of the insurance company in workers’ compensation cases. Their struggle is to advocate for the client while evaluating for fraud and abuse. With all these factors in play, it’s not surprising that the workers’ compensation industry has much more experience using case management and has led the way in identification of ethical dilemmas and state regulations that require case manager certification to manage these complex cases.”

In order to be a successful case manager working within the confines of the workers compensation arena, one must possess a distinct knowledge and skill set.  The nurse case manager should be a master communicator, negotiator and facilitator, as well as technologically savvy enough to maximize time; working smarter within the confines of the clock.  Here at VP Medical Consulting, we do not want nurses who can simply attend an appointment and report back the findings.  We want nurses who are engaged, critical thinkers, and able to think outside the box.  Our nurses must be willing to stand on their principles and rally for what the patient needs while functioning within the confines of the payor source.  Our nurses are either certified by CCMC or are working toward certification.

If you need an experienced workers compensation case manager, consider VP Medical Consulting.

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Going to see your doctor these days can be like sitting an exam. You have to get all your information ready beforehand, and then when you are in the examination you have to try and remember everything that might be important. Effective communication is the key to getting the most out of your doctor – so how do you do that? Here are 5 top tips on how:

1)      Prepare. Before you even leave your home, list all the symptoms you can, whether or not you think they are relevant. If this is a routine check-up, note any changes since last time. List any and all medications being taken and how often, to help the doctor understand your current medication regimen.

2)      Honesty. Be up front about lifestyle choices. If alcohol, tobacco and other drugs feature then be clear about this to help the doctor to see the big picture. Do not avoid raising a subject just because you think it is sensitive or embarrassing. If you hide something from the doctor they may not be able to make the best decision for you.

3)      Pertinence.  If you do not ask questions then the doctor might assume that you understand and nothing else needs explaining. So you should pipe up with any Who / What / When / Why / How questions that you might have. Query any medical terms used that you don’t understand. Ask about treatments and procedures as well as the doctor’s general diagnosis.

4)      Persistence. If you feel that you haven’t understood what the doctor has told you, ask for clarification. Do not be rushed or made to feel stupid or awkward – it is their job to explain it to you. If necessary, schedule another visit or phone call to clarify things. And of course, you are always within your rights to seek a second opinion.

5)      Particulars. Write down everything that you’ll want to remember. Ask for literature (not just books and pamphlets, but also audio and video) that is relevant, and trusted online sources of information.

Above all, remember that for communication to be effective, both sides have to be understood. Your questions need to be heard and answered, and the doctor’s information needs to be clear and understandable.

Taking proper care of a sick person, whether it is yourself or a loved one, needs an understanding of the condition and treatment – so don’t go home without both.

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I attend physician appointments with my patients every day.  I am always surprised at the lack of questions posed from the patient and/or family members.  When did we decide that the doctor knows best and we should simply take his or her advice without questioning the why, how come, and what is my alternative?  A story in Better Health suggested that there are typically five reasons patients fail to ask questions.

1.  Fear-In my practice I do feel that there is a fear of many of my patients that they will look or sound stupid.  I think it is much more stupid to fail to ask!

2.  Doctor Knows Best-Someone had to graduate at the bottom of their class.  Is it your doctor?

3.  Not wanting to interrupt-These days the visits are shorter and shorter and our physicians are rushed to get to the next room, but you are the one paying for this visit.  Be prepared with questions in hand and take the time you need.

4. Not being asked by the doctor if they have questions-Fifty percent of the time or less, physicians fail to ask their patients if they have any questions.  In my experience, very few visits end with a physician requesting questions.  Good thing I am there to help.

5.  Feeling rushed-This goes back to number 3.  It’s your time.  Ask questions now because it is much easier to get an answer when you are face-to-face with the doctor than trying to get an answer from him or the staff at a later date.

As a case manager, I work as an advocate for the patient.  I help them remember what they planned to ask and even ask questions on their behalf.  I educate my patients on the terminology used by the physician and provide alternative treatment options to consider.  Unfortunately, not everyone has a case manager to attend their appointment with them, but there are things you can do to make the most of the time you have with your physician.

• Be prepared-do your homework, research your condition, have your medication bottles with you, complete your health history
• Write down your questions-this way you won’t forget to discuss each item and if you are too fearful to ask, you can always hand the questions to your physician or the staff
• Remember you are a consumer-it is your right to not only ask questions, but to be an active participant in your own health care

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Have you ever had the difficult task of convincing your senior person they need assistance with their daily life.  Typically these conversations don’t go over very well.  It is a difficult decision to make when a family member is no longer able to live alone without assistance in order to ensure safety and maintain quality of life.  In my family full of stubborn folks, (see, I get it honestly) I have seen first hand the resistance in bringing in a home health aide. When my grandmother finally agreed, several persons were brought in, but she disliked each one.  She found fault in what was done, and even accused one aide of stealing things she herself misplaced. Worrying about a senior loved one can take a toll on everyone. 

Take responsibility by looking out for the signs that can help indicate it is time to bring in a trained certified home health aide either part time or for more severe cases full time.   For example, does your family member:

1. Gets lost while driving their car in their community
2. Misplace or continue to lose things
3. Require frequent hospitalizations
4. Mix up medications
5. Battle with depression
6. Isolate themselves from friends and family
7. Fall and hurt themselves
8. Have a fear of being robbed when they are not
9. Have difficulty with travel
10. Have trouble preparing their own food
11. Becoming confined to a wheelchair or walker
12. Failure to properly care for their own personal/ hygiene needs
13. Wander

A certified home health aide can provide companionship for your senior loved one, assist in daily activities such as cooking, dressing, bathing, cleaning, bathroom, administering the proper medication, as well as accompanying or driving a senior person to a doctor, and laundry.   The ideal way to attain a home health care aide is to contact an accredited and insured agency.  Do your research and make sure the agency is accredited and insured.  Check to see what training the employees providing care for your loved ones have had as well as what type of background checks were completed. 

There is no easy way to tell your senior loved one that they require a home health aide, though you can make it as painless as possible by working with a patient advocate.  Case Managers can act as a third party and mediator to  determine when they might require some extra help.  Losing your independence is difficult.  With a caring family and a well trained and insured aide the transition can help prolong a senior person’s quality of life.

*adapted from American Care Manager

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These folks were apparently using the government contracts to provide reporting on these monitoring devices as a means to practically print money.  They had a number of tricks up their respective sleeves, including unbundling items so that certain parts of a device could be double billed, providing false information from the results, and repeatedly billing for services for the same patient.  This went on for several years before they got the whistle blown on them.

An interesting point is that this seems to be quite the family affair.  In addition to the husband and wife team mentioned in the article, their grown sons served time in a related criminal case. Robert Parsons and Matthew Parsons both pleaded guilty in 2006 to federal health care fraud charges for using their respective cardiac laboratories, and the Holter monitoring technology developed by their grandfather, Bruce Del Mar, to defraud federal insurance programs. Both were sentenced to one year in prison.

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Nurses Week is celebrated each year from May 6^th til May 12^th, which is the birthday date of Florence Nightingale.

We all know that nursing today is nothing like it was 100 years ago, right?  Just for fun, there is a link to a graduating class from 1910 .  The truth is, I did start this post thinking about how incredibly different the profession is compared to 100 years ago.  Of course, it has been a little while since I took “History of Nursing 101”.  Plus, I had a bit different perspective back then.

When I was doing a little research to write this, it struck me as an older, wiser head now, that while things indeed have changed radically, with technology, education, new opportunities in the field and more, there are many aspects to nursing that really haven’t changed much at all.

If you go to the link http://www.nurseweek.com/features/99-12/workhist.html and read the article, there is a certain sense of how things never change so much as they stay the same.

Here are some items I thought bear reflection:

• No antibiotics, so nurses were in near constant danger of contracting a serious infection from their patients and environment.

• Long hours, tough jobs

• What we call home health care today was huge “back in the day” and called private duty nursing

• You had to love hard work to enjoy being a nurse

• Attention to detail and follow up was a big part of the nurses’ role

• Scientific knowledge (as far as it went) was a requirement

• Knowledge and practice of good hygiene was paramount

• Compassion, empathy and a commitment to service was part of the nurse’s stock in trade

When you look at today’s environment:

• Home health care is back on the rise due to “new” models in medicine

• We do have treatments for the infectious diseases that our foremothers (and fathers) didn’t have, but today we face other, difficult to treat infections, such as MRSA and C-Diff

• You still gotta love the job, at the end of the day!

• Scientific training and education is still the backbone of nursing education

• Hygiene, infection control are still vital

• Long hours, tough jobs

• Compassion, empathy and a commitment to service remain some of the primary characteristics of today’s nurse

So, while we have “come a long way, baby”, our core values as nursing professionals remain the same.  And that’s a good thing!  Here’s to you…Happy Nurse’s Week!

How Nursing was in the 1900′s

Basic information about Nurse’s Week for 2010

Nursing World Organization

Sen. Pat Roberts (R.-Kan.) sponsored an amendment to the health-care reconciliation bill that would have repealed the new tax on medical devices included in the health care law signed by President Obama.

(CNSNews.com) - The Senate defeated three separate amendments offered to the health-care reconciliation bill on Wednesday night that would have abolished or limited the impact of a new tax on medical devices—including prosthetics, such as artificial limbs—that was enacted in the new health-care law President Barack Obama signed.
Sen. Pat Roberts (R.-Kan.),“People with disabilities, diabetics, amputees, people with cancer, just to name some of the people—and more—who will see their costs go up because of this tax. We do not want to do this. Why would we want to do this on those who are most vulnerable?”

As a case manager I see major problems with the new healthcare plan.  I personally think we would have done better with a plan which would have put the healthcare dollars in the hands of the patients in the form of Health Savings Accounts coupled with nurse case managers or primary care physicians as the educators to provide assistance in the decision making process.  This tax on health care devices, including prosthetics, limits innovation.

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Accredited hospitals in America have steadily improved the quality of patient care over a seven-year period, saving lives and improving the health of thousands of patients, according to The Joint Commission’s latest annual report. The report, Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2009, provides scientific evidence of improvements in the care of patients with heart attacks, heart failure, pneumonia, and surgical conditions.

The data shows:

• Hospital performance on two individual measures of quality relating to  inpatient care for childhood asthma is excellent after only one year of  measurement. Specifically, there was 99.8 percent performance on providing  “relievers” to childhood asthma inpatients and 99.1 percent performance on  providing systematic corticosteroids to childhood asthma inpatients.
• The overall heart attack care result improved to 96.7 percent in 2008 from  86.9 percent in 2002. (A 96.7 percent score means that hospitals provided an  evidence-based treatment 967 times for every 1,000 opportunities to do so.)
• The overall heart failure care result improved to 91.6 percent, up from  59.7 percent in 2002, an improvement of 31.9 percentage points.
• The overall 2008 pneumonia care result is 92.9 percent, up from 72.3  percent in 2002 – an improvement of 20.6 percentage points.

Quality, safety and patient satisfaction results for specific hospitals can be found at www.qualitycheck.org. For a complete copy of Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2009, please visit www.jointcommission.org.

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This year marks the centennial year of Florence Nightingale‘s death.  Florence Nightingale (1820-1910) is the founder of modern nursing.  Her contributions to nursing theory, education, practice, research, statistics, public health, and healthcare reform are foundational and inspirational and allow me to do what I do today.  She was a health care advocate to influenced leaders of her time.  She impacted public awareness and changed how people understood and valued health.

Not only was Florence Nightingale a patient advocate, she was also an advocate for nurses and nursing.  She asked that we continually be renewed to sustain our effective, compassionate, and caring practices (something I need to do more of).

This year a grassroots organization has come to honor nurses, our values and wisdom, and to act as catalysts for achieving a healthy world.  There are estimated to be more than 15 million of us.

International Year of the Nurse, has set out 8 goals.

1.  Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality

5. Improve maternal health

6. Combat HIV, AIDS, malaria, and all communicable/noncommunicable diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

To learn more go to 2010iynurse.net