How to Use Nurse Case Management to Lower Federal (FECA) Workers Compensation Costs

Taming Federal Workers Compensation (FECA) with Medical Expertise

I had an interest in learning more about how Federal workers compensation cost controls operate, so I asked Lisa Firestone, owner of Medical Care Advisors (MCA), what type of cost containment can be done on the federal side of workers compensation. Here’s what she told me.

After spending years in the alphabet soup of federal contracting, Managed Care Advisors (MCA) has thrown its hat in the ring of acronyms-as-words with CARE: Concentrated Action for Recovery and Employment. They take a special approach to nurse case management.

One of the tools utilizing the skills of the multi-team approach in the federal sector includes the CARE team meeting face-to-face with the relevant representatives of the Department of Labor’s Office of Workers’ Compensation Programs (OWCP). In the federal sector, the OWCP is responsible for the official adjudication of claims. This contact drives case progression in three deliberate phases:

1. Before – Case summaries are submitted to the assigned OWCP Claims Examiners prior to a meeting. While offered as a form of preparation, this step sometimes prompts action and resolution for cases even before the CARE team arrives.
2. During – The meeting itself provides a platform for clear communication, and brainstorming for case resolution. Simply put – no one has to play phone tag. What might have taken months to happen before can now be decided in minutes.
3. After – Most importantly, these meetings help establish rapport between a Federal Agency client and an OWCP Claims Examiner and other members of the claims staff up to the level of the District Director. When a Claims Examiner has a to-do list a mile long, being able to put a face with a name can be the difference between getting squeezed in today and waiting three weeks for a reply.

“The CARE unit of nurse case managers focuses on resolving our clients’ long term cases,” says Firestone, including those on the federal workers’ compensation periodic roll. While management of older cases has always been an integral aspect of MCA’s approach to case management, CARE is another step along the evolution of that commitment, she explains. The CARE team brings industry best practices to bear on these challenging cases.

I asked her “What do you do with a case of 1-30 years?” and she explained that while every case is different, a CARE nurse often begins with a methodical review of case records ranging from one to 30 years of treatment and administration, with emphasis on identification of obstacles to resolution. This information is often distilled into a one-page summary, which can immediately bring any stakeholder in the case up to speed. The CARE team then works with the client to formulate a resolution strategy. While plans are a good starting point, the CARE unit’s real strength is finding creative ways to jump-start these stalled cases, and following through on identified plans and actions.

Since many of these cases involve ongoing lost time days, MCA’s approach to case management stresses objective verification of total disability, analysis of medical care utilization, empowerment of the injured worker, and clarification with employer and claims team that appropriate benefits are being provided and administered. The result of this team approach is reliable cost control. CARE nurses maintain the integrity of the injured worker and treating provider’s roles while analyzing objective data.

CARE nurses are able to progress these cases by using a variety of techniques. Telephonic contact with the injured worker ensures commitment to the healing process, and fosters a positive mindset for increased activity, including returning to work. Case reviews by the MCA Medical Director, an MD, identify gaps in medical reasoning, and avenues for case progression. Written contact with the treating provider opens communication and can lead to appropriate reductions of restrictions.

Lisa Firestone is an owner of Managed Care Advisors, Inc. (MCA) is an innovative, woman-owned small business enterprise specializing in managed care, employee health benefits and workers compensation consulting and case management services. Contact http://www.managedcareadvisors.com/

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:[email protected]

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