On company I met at RIMS in Orlando, was very interesting. They had a doctor in Antartica!
I spent some time talking to Brian Cullen, Executive Director at Medcor, and found it was the same approach I’ve been recommending for 20 years.
Telephonic triage for workplace injuries seems like the current trend. Workplace injury triage is currently performed mostly by supervisors, sometimes with consultation from a human resource professional. What are their qualifications and core competencies to do this effectively?
Triage Problems Facing Businesses
Claims are generally not being promptly reported to the insurer or TPA. Lag time adds unnecessary cost. Many industry studies indicate the ultimate cost of a workers’ compensation claim escalates quickly if claims are not reported in a timely manner. Most indicate the cost of a workers’ compensation claim increases 40% if not reported within 3 days of the workplace injury.
Injured workers are usually directed by supervisors to seek medical treatment from the nearest treating facility. Too often the only way to know if you need to see a doctor, is to go to the clinic. Overtreatment is a typical outcome. Emergency visits are substantially more (workersxzcompxzkit) expensive than other potential medical providers such as Occupational Health Clinics. The cost of Occupational Health Clinics are much more expensive than the nurse telephonic triage approach. Once in the medical system, a claim begins its own life cycle.
How Can A Nurse Triage Program Assist?
A telephonic nurse triage system takes the decision making process about medical treatment out of the supervisor’s hands alone and adds to it the advice of a medical professional. Immediately after an injury occurs, the injured employee and the supervisor call a toll free number and are connected to an occupational health nurse. The nurse is trained to ask questions using a systematic approach to the questioning developed by emercency room and occupational health doctors and supported by great technology.
The nurse assists in the determination if the employee:
1. needs immediate 911 medical transportation to an emergency room
2. can wait and go to a more appropriate facility on a non-emergency basis
3. is ok to self-treat the injury without visiting a health facility
4. agrees with the medical assessment and recommendation of the nurse.
Benefits of the Nurse Triage Approach to Workplace Injuries
Employees obtain immediate medical attention from a trained occupational health professional. They love the new benefit that helps them deal with their pain. Extensive data shows that costs are much less than a visit to a hospital or clinic. Supervisors no longer need to be solely responsible for making the medical assessments of injured employees with all the awkwardness of the work relationship. Employees are soft-channeled to a designated medical facility, usually an occupation health clinic, identified in advance by the employer location.
The initial triage report from the nurse is faxed to the designated medical facility before the employee arrives – reducing the time an employee waits to be treated while shortening the time away from work. The paperwork is begun and emailed at the conclusion of the call.
All calls are recorded and the nurse is well-trained and personable when asking a series of questions to get at the cause of the injury. This locks an employee to a story at the time of the workplace injury. It may make all the difference in avoiding a runaway case. Employers can identify specific loss control oriented questions for certain types of injuries, use of personal protective equipment for example.
The results of the triage process can be measured and the ROI is compelling. It reduces the actual number of claims handled because as many as 50% of the calls result in a non-referral to an outside metical provider. Good triage has been shown to lower the ultimate cost of a claim by driving more accountability. It cuts the number of instances where the ‘story’ or nature of the injury or body part changes. Soft-channeling by the nurse increases utilization of discounted network providers typically saving 25% per bill. The return on investment is often $3 – $5 for every dollar invested.
For more information contact Brian Cullen at Medcor 630-240-6741 www.Medcor.com.
Author: Brian Cullen, ARM, CLIC, Executive Director with Medcor has joined our list of guest bloggers. Thank you Brian. He can be contacted at 630-240-6741 or bcullen@medcor.com
Click on these links to try it for yourself.
WC Calculator www.ReduceYourWorkersComp.com/calculator.php
TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php
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