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The consequences of initial care direction

bulls-eye-1044725_1920-pbAccurate initial care direction can make all the difference in the outcome of a workers’ compensation claim. When experienced clinicians are engaged and referencing proven triage guidelines, their guidance bolsters treatment safety, accurate diagnosis, and documentation of items that may delay recovery, such as comorbidities, and fosters lasting return to work. The primary purpose of any triage service should be to recommend the correct level of care, and proven triage guidelines are critically important in providing direction. Some triage providers may claim high rates of sending injured employees to self-care; however, if what an employee really needed was to see a healthcare provider, inflated self-care is not a benefit for the employee or the employer. Transparency is key when taking a look at self-care conversion rates, as it gives the employer insight into the validity of triage recommendations.

Protection from long-term cost

The best way to evaluate the accuracy of initial treatment direction is to measure claim development 15-30 days later to ensure effective recovery and continual productivity. Third party administrators have the long view of cases and can see incorrect self-care recommendations causing long-term cost and absence from work. For example, Sedgwick reviewed client programs that moved from a triage company using home-grown guidelines to triage services using proven Schmitt-Thompson guidelines for self-care or treatment recommendations. Our analysis showed that 10-15% of the cases receiving self-care recommendations had 20-50% higher average temporary total disability days. Inaccurate front-end self-care recommendations cost the employee and the employer down the road.

The introduction of telemedicine: Delivering accuracy and saving time

Telemedicine is a quickly expanding service that will continue to grow for occupational injury care. As another tool in the clinical consultation process, telemedicine referral protocols and best practices should also be based on Schmitt-Thompson guidelines. Injured employees may be directed to one of the following treatment options: self-care, telemedicine or in-person care.

Important information about the employee gathered during triage can be passed along to the telemedicine provider to make the online experience faster and more efficient. Potential technology delays can also be mitigated through the clinical consultation triage process, keeping the treatment experience seamless and eliminating pathways that may otherwise cause the injured worker confusion or disengagement.

Injured employee satisfaction

In our own experience launching telemedicine for Sedgwick customers using clinical consultation services, we’ve received positive feedback. Since telemedicine was added as a treatment option, more than 60% of injured employees using the service have responded to post-visit surveys and they have all scored the experience with four or five stars, on a scale of one to five. Consistent and proven triage protocols can make all the difference, and consistent clinician guidance and qualification of the injured worker for telemedicine is a critical first step for a successful experience. The overall process is simple.

graphic for accuracy is a commodity

Provider benchmarking

In-person care referrals should be qualified via proven protocols, but provider choice is also critical. To take one step further in delivering accurate care, clinical consultation nurses  should use benchmarking information whenever possible to match an injured employee with a local provider proven to get the best outcomes in occupational injury care and return to work facilitation. At Sedgwick, we see 73% earlier return to work and 40% faster claims closure when an injured worker is matched with a 4- or 5-star medical provider.

Remember, consistently pairing an injured employee with the correct initial care following an injury is a critical foundation for a safe, effective recovery. It is important to follow stringent and proven guidelines to make sure accuracy prevails. Is your own program evolving to include the latest protocols and care options to best support your employees? Share your experience in the comments and let us know if you have questions

Andrea Buhl, MSN, RN, FNP-BC
SVP, Clinically Integrated Medical Program

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One Response to Accuracy is a commodity

  1. Dave Trotter says:

    Nicely said. It all can begin with Interoperable Pre-Auth Determination Filtering.

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