CLM 300 - The Doctor Is In -- How to Maximize Medical Outcomes for Injured Workers

By Scott Clark posted 04-01-2009 10:06 AM

On Wednesday April 22, 2009 from 2:30 -- 4:00Pm the above-referenced session will be discussing workers' compensation outcomes.  This session is designed to highlight some different techniques being used to manage the medical portion of the worker's compensation file.

For too many years, workers' compensation managed care has been relegated to a discounted program with nurses handling the medical aspects of a claims file with little or no involvement with the adjusters who are provided the responsibility of the management of the indemnity side of the file.  For years I have believed that this is a flawed platform and one which was abandonded by the group health providers as not cost effective and with no ability to measure medical outcomes.

This session will provide an insight as to how the medical management of a workers' compensation claim can be integrated back with the adjuster and involve the treating physician as a partner, as opposed to a villain.  The medical community is now used to outcome measurement and the ability to adequately treat an injured worker with a competent physician providing aggressive therapies and measuring the outcomes will be the wave of the future.  I hope you will joint us at RIMS!

1 comment



04-16-2009 04:17 PM

We have been working with our clients on this type of program for several years now. Included in our protocol is a face-to-face meeting with the dedicated adjuster, the client and one or more of the primary care providers (most of which are practices staffed and driven by ER Physicians) thereby giving direct rapport/access to the adjuster and the employer. This has also been carried over to some of the more popular specialty practices such as Ortho, Neuro, and physical therapy providers. We have had employers actually documenting practice parameter deviations such as less positive triage or referral that was traced to the clinic's utilization of Physician Assistants in these cases and immediately involved the practice manager’s direct intervention. One study revealed the difference in average cost per medical claim with a so called "employer friendly / preferred provider"; over time a cost reduction from $1,500 per claim to less than $500.
Dennis Slabaugh, ARM, CRIS