COP NURSE INTERVENTION

1
COP NURSE INTERVENTION

• Improving Early Disability Management

2
Basic Project Objectives

• To improve nurse intervention services to injured
  workers and to better coordinate interaction with
  Federal agencies to reduce
  
• Lost Production Days
• Service Provision Costs
• Maintain/improve customer satisfaction

3
SRA Findings

• COP/RN Interviews
• Like the program
• Able to identify cases that need early
  intervention by a field nurse
  
• Able to answer questions regarding billing and
  authorizations, etc.
  
• Able to overcome medical barriers such as
  understanding when an authorization is required,
  enrollment of provider, etc

4
SRA Findings

• Employing Agency Interviews
• Do not understand the COP RN process or results
• Frustrated by lack of information such as when
  they are assigned, the results of the assignment,
  etc.
  
• If reports provided them with valuable
  information they would like the intervention to
  be even earlier
  
• Very positive about FN intervention
• Frustrated about paying 100 when the EA is well
  aware that the injured worker has returned to
  work prior to the end of COP

5
SRA Findings

• District Office Interviews
• Lack of clarity about the program and its
  purpose
  
• Lack of understanding about what the COP nurse is
  permitted to do
  
• Need for some cases to be adjudicated more
  quickly or a FN assigned more quickly than
  current procedures permit
  
• Reduction in number of cases falling into COP
  case referral universe
  

6
SRA Recommendations

• Revise the name
• Reduce the number of false positives by creating
  a process to speed RTW reporting
  
• Revise the COP/RN report
• Share info regarding early nurse management
  referrals with the EAs
  
• Streamline the COP RN referral process

7
Recommendations (cont.)

• Create process by which Adj. unit and SN obtain
  COP/RN reports immediately when necessary
  
• Create written procedures that include roles
  responsibilities for all parties
  
• Revise responsibilities of COP RN
• Clarify the policies of who can talk to whom
  about what
  
• Allow COP/RN to authorize some non-invasive
  treatment
  
• Reduce the number of lost work days for initial
  referral

8
Assessment of Recommendations - First priorities

• Establish an electronic method for the COP FN to
  see case data and update iFECS
  
• Revise the COP FN closure report and require
  consistency in its usage
  
• Retool the triage levels and establish procedures
  for COP FN, SN and CE responsibilities with each
  level
  
• Change initial referral to early nurse case
  manager from 15 days of lost time to 10 days

9
Current Triage Codes

• Triage Code 1 Is not working due to surgery,
  diagnostic testing or PT
  
• Triage Code 2 Is not working for other reasons
• Triage Code 3 Has returned to work part-time
• Triage Code 4 Is not cooperating with nurse
  intervention

10
Proposed COP RTW Case Worksheet

• Triage Code 1 Catastrophic Obtain info,
  notify SN immediately, close case
  
• Triage Code 2 Emergency Hospitalization
  Obtain info, notify SN immediately, close case
  
• Triage Code 3 Surgery Imminent Obtain info,
  close case
  
• Triage Code 4 Claimant Not Cooperative
  Document non-cooperation, close case
  
• Triage Code 5 No Return to Work Obtain info,
  close case after 30 day intervention
  
• Triage Code 6 Return to Work Part-Time Obtain
  info, close case after 30 day intervention
  
• Triage Code 7 Return to Work Full-Time LD
  Obtain info, close case after 30 day
  intervention
  

11
First priorities (continued)

• Return of the new and improved CA-3
• Explain the COP FN program to the EAs through
  inter-agency meeting presentation
  
• Share information about the nurse referral as
  well as the case management report with EAs
  
• Target workers compensation training at the DO
  level to explain the process and benefits of the
  program
  

12
CA-3 Report of Work Status

• Multi-purpose form
• Capture claims where injured employee stopped
  work after CA-1 was filed but still during COP
  
• Capture post-COP changes in work status
• Electronic submission through AQS