White Paper: Nurse Triage for Workers’ Compensation
Employers-looking for new and innovative solutions to traditional workers’ compensation challenges-have begun to leverage nurse triage hotlines, which essentially enable a more proactive and compassionate response to employee worksite injuries.
These nurse hotlines provide valuable injury management services, which include timely reporting of injuries; a nurse’s medical expertise to assess injuries and triage them to the best, most appropriate level of care; and coordination of a safe and prompt return-to-work (RTW) result.
When properly coordinated with other managed care strategies, nurse call centers dramatically improve workers’ compensation costs and outcomes for employers, and enhance medical care and satisfaction for employees. In this white paper, we outline the key benefits, savings, and considerations in implementing these programs.
Timely, Accurate Reporting of Injuries
Although it’s well understood that prompt reporting of injuries leads to improved claims outcomes, there are still many barriers to achieving this best practice. The first obstacle is simple compliance. Many employees may not report injuries until they become worse or require serious medical attention. In some cases, supervisors who have a full plate of responsibilities may be delayed in submitting required paperwork.
With a nurse triage hotline, an injured worker or supervisor simply calls a toll-free number immediately following the incident. With this hassle-free procedure, the lag time in reporting injuries is significantly reduced. The call center gathers all the necessary injury and claims information and fills out required forms. It then sends the first report of injury via email or fax to all the appropriate stakeholders, including the employer, physician, claims adjuster, and RTW coordinator. Immediate dissemination of injury information allows each stakeholder to initiate their respective roles in the workers’ compensation process, supporting optimal outcomes.
Nurse Triage Ensures Appropriate Care
Beyond timely reporting, another key challenge in workers’ compensation is ensuring that every injury receives the care and treatment appropriate to its level of medical severity. Although employers may train supervisors on how to respond to worksite injuries, these managers are not medical professionals and should not be expected to make treatment decisions. Many err on the side of caution, sending employees with even minor injuries to the emergency room.
To address these challenges, a nurse at the call center provides an objective medical assessment of the injury and channels the employee to the most appropriate, cost-effective level of care. In severe cases, a nurse will advise emergency care. With minor injuries, however, the nurse may provide simple first aid or self-care guidelines, or send the patient to an occupational clinic in the employer’s preferred provider network.
After speaking with a nurse, many injured employees do not require or request additional medical services. As a result, 20 to 40 percent of all calls become “report only” or “first aid” injuries and do not result in compensable claims. For many employers, this has led to a 20 to 30 percent reduction in claims costs.
Optimal RTW Results
Nurse hotlines should also offer an online database, in which employers can house detailed job descriptions and transitional work assignments for all essential positions in various departments. With this information, employers stand ready to respond on the day of injury and are able to match modified duty assignments to employee work restrictions. As a result, many employees are able to return to work immediately, reducing lost time by as much as 50 percent.
Employee Care and Satisfaction
In the end, nurse hotlines benefit employees most of all. Triage nurses are highly compassionate medical professionals, who listen closely to the details of each injury and provide personalized attention to each employee, focusing on unique medical needs. As a result, employees have an overwhelming positive experience. Employers that provide this type of service send a clear message to their staff-that they care about employee health, safety, and recovery. /span>
Key Hotline Considerations
Employers may hesitate to utilize a nurse hotline, believing a call center may not be able to accommodate unique policies or procedures. However, sophisticated hotlines allow for a high level of flexibility. The injury reporting and triage process can be customized to support employer-specific requirements, whether it’s including certain providers into the referral process or customizing the injury information that is collected.
Another perceived issue is being forced to manually re-input injury information into claims systems. Hotlines have addressed this issue as well, designing real-time interfaces that electronically transmit data into popular software.
At first, supervisors may view call centers as an additional step in process and initially resist adoption of an injury hotline program. Once employers enroll, however, a program representative will train staff on how to fully leverage the program, and provide promotional material, such as posters and wallet cards, to remind staff to utilize the toll-free hotline to report injuries. Supervisors quickly realize the program actually relieves them of the burden of having to make medical decisions on where to send an employee for care, as well as decreases their workload by reducing paperwork and forms.
Paul Binsfeld is the CEO of Company Nurse, a firm specializing in medical triage and injury management for workers’ compensation. Binsfeld has over 20 years of experience in the workers’ compensation industry. By working with many different types of employers, he identified a common need for early intervention in the workers’ compensation claims and injury management process. As a result, Binsfeld developed a nurse injury hotline to address many of today’s workers’ compensation challenges.
For more information, email email@example.com or go to www.companynurse.com.