Complex cases in workers' compensation are a major contributing factor to rising workers' compensation costs. Complex cases do not necessarily start off as catastrophic, but expenses can get out of hand very quickly, and these cases can become catastrophic if they are not managed appropriately.
In order to keep an eye on workers' comp costs, Kevin Glennon, RN, BSN, CDMS, QRP and Vice President of Clinical Services for Total Medical Solutions, recommends the first step is to take an inventory of how many complex cases you are currently handling. Ask yourself these questions about each case:
- Is more than one body system affected?
- Does the case involve more than one physician?
- Are there more than three prescription medications involved?
- Does the claimant require durable medical equipment?
- Does the claimant require home health care?
- Are home modifications required to accommodate the claimant?
- Does the claimant have an infection?
If you answered yes to one or more of the questions above, chances are the case is complex. Complex cases should be given extra care and attention to help the patient recover as quickly as possible, and manage costs before the spiral out of control.
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