Homecare
Four - six weeks is the average time this home care service is prescribed to improve IE's functional improvement and become independent in ADLs.
What is occupational or physical therapy.
Home therapy should be short term and should see most often to ensure safety in home and to assist with simple exercises. IE should transfer to outpatient therapy to maximize improvement in functional abilities as soon as possible.
Important to look at functional gains and wean to home exercises with formal therapy.
Contact with therapist is very important in case management- to provide job description, review for functional improvement, and if no improvement what are next steps. Should see functional exercises program and not just ultra sound, heat and massage.
At Amtrust we have many resources to assist us with claims handling. This resource manages our preferred vendors, assisting with any questions or concerns with a specific product/vendor.
Who is the Clinical Product Managers?
Bill Review- Angela Rogers
Case Management/ Vocational Rehab/ Field MDM and Nurse Triage - Maggie Fallon
Diagnostic Testing/ IME/ Home Health Care/Impairment Ratings/ Peer Reviews- John Insco
Dental- John Insco
Drug Testing/Pharmacy/Durable Medical Equipment- Mina Nakhla
This can be located under Claims SharePoint Site under Managed Care Resources
This is the oldest National Park in the US, established March 1, 1872.
What is Yellowstone National Park?
On March 1, 1872, President Ulysses S. Grant designated Yellowstone as the first national park in the United States and the world. Today, the park is home to the world's largest collection of geysers, including the iconic Old Faithful.
Others in the tops 5:
Sequoia National Park - 1890
Yosemite National Park - 1890
Mount Rainier National Park - 1899
Crater Lake National Park - 1902
During a hospitalization, name an individual that can assist you with obtain update of IE's level of care and anticipated plan for recovery.
What is
Case Manager/Discharge Planner
Family Member/ IE
Provider/Therapist
First degree burns effect the outer layer of skin name another type of burn you might see in complex claims.
What is
First Degree- Superficial Burns- only affect the outer layer of skin, epidermis. The burn site is red, painful, dry, and has no blisters. Mild sunburn is an example.
Prognosis: Long-term tissue damage is rare and often consists of an increase or decrease in the skin color. usually heal within 7-10 days without scarring.
Second Degree-Partial Thickness Burns
Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful.
Prognosis- Some take longer than 3 weeks to heal, but most heal within 1-3 weeks without scarring but often with pigment changes to the skin
Third Degree-Full Thickness Burns-
Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.
Prognosis: Without surgery, these wounds heal with severe scarring and contracture. There is no set timeline for complete spontaneous healing for third-degree burns.
Fourth Degree Burns
Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.
Name of homecare aid service that focuses on the health and safety of the IE, such as bathing, grooming and exercises.
What is a Home Health Aide- Home health aides generally focus more on the health and safety of their patients and their daily tasks include bathing and grooming and home exercises. May not include housekeeping and cooking.
Personal Care Aide- often assist patients with errands, cooking and housekeeping.
Personal Care Aide is less expensive.
One of the resources besides a Complex MCM that is available to target RTW dates, and anticipated treatment.
ODG assist with disability durations and treatment recommendations. This can be used to assist with outlining targeted RTW dates with the understanding to change dates in following procedures and diagnostics. When looking at treatment- look at duration and if IE exceeds- need to ask yourself why? What are next steps? Complex MCM, Field MCM, letter to MD?
According to a study or retailers this food is the most stolen food in grocery stores. In fact 4 percent of this from stores shelves ends up stolen.
What is cheese?
Cheese is the most stolen food in grocery stores, trumping other high-theft items like meat, chocolate, alcohol, seafood and baby formula.
This facility provides skilled nursing services or skilled rehabilitation services for the short term on a daily basis in an inpatient setting after an inpatient stay of 3 or more days.
What is a subacute Care?
Typical Medical Conditions Treated: Heart Failure, Hip and femur procedures, joint replacements, Septicemia
Daily Therapy Requirements: 1- 1.5 hours a day
Average Length of Stay- 27 Days
Average Cost of Care per Patient- $10,800
Name 1 types of burn we might see in the complex claims.
What is?
Radiation burns. Burns caused by prolonged exposure to ultraviolet rays of the sun. Also caused by exposure to other sources of radiation such as therapeutic cancer treatments or nuclear power plant leaks.
Chemical burns. Burns caused by strong acids, alkalis, detergents, or solvents coming into contact with the skin or eyes.
This is how frequently you should address homecare needs of the IE.
You should continuously address the home care needs of IE.
Does IE have the correct level of care? RN vs LPN, Aide vs LPN
What is aide doing for IE- housekeeping, cleaning, bathing, exercises,
Home Care Needs- if long term should assess yearly- consider Field MCM for home visit, if not long term, should see a decrease in services- if not what does this mean to file?
As IE ages or care taker ages may see a need for increase in services or long-term care placement.
Consider Respite Care
This resource is used to visit therapy, home and/or provider to obtain requested information on medical and/or disability concerns.
What is a Field MCM?
With the addition of telephonic MCMs, this resource most often should be used for tasking. Missed opportunities to use for a home visit and/or therapy.
He was the 1996 U.S. Republican Vice Presidential nominee that was also the quarterback for the 1964 and 1965 AFL Champions Buffalo Bills?
Who is Jack Kemp?
This facility is hospital-based care, and, as such, admission requires documentation that patients have a complicated course of recovery that requires prolonged hospitalization.
What is LTACH- long-term acute care hospital?
Type of Medical Conditions: Complex Medical Conditions, Complex wound and burns, Mechanical Vent Weaning
Daily Therapy Requirements- None
Average Length of Stay- 27 Days
Average Cost: $38,500
A method doctors and emergency medical providers use to easily calculate the treatment needs for a person who’s been burned.
What is the rule of nines?
The rule of nines is meant to be used for:
The rule of nines assigns a percentage that’s either nine or a multiple of nine to determine how much body surface area is damaged. If over 10% will most likely see an IE in burn unit.
For adults, the rule of nines is:
Arm ( including hand) 9 percent each
Anterior Trunk( front of body) 18 percent
Genitalia- 1 percent
Head and Neck- 9 percent
Legs ( including Feet) 18 percent each
Posterior Trunk ( back of body) 18 percent
This is important as it will assist MDs in addressing IE's needs in regards to treatment- IV, Skin Grafting, sweat glands, risk for complications
Other things to consider when assessing severity of burns
location of burn on the body
This is how frequently you should address DME supplies needed by the IE.
What is continuously?
DME supplies- is IE using, how often, what do they have in home.
Rental vs Purchase
Is home visit needed to assess what IE needs?
This medical resource is to assist in developing strategic actions to assist with medical and/or disability management, in a collaborative manner with Claims and Managed Care
What is a Medical Round Table?
Claims and/or medical case manager should be prepared to discuss what has been attempted on claim to address barriers/issues, following the session, documentation of outcome and strategy are placed in ANA to take action.
This state is home to no documented poisonous snakes.
What is Alaska?
California has the most snake species however Arizona has the largest amount of venomous snakes.
This facility has intensive rehabilitation therapy in an inpatient facility with IE expected to benefit from 3 hours or more of therapy at least 5 days a week.
What is a Inpatient Rehab Facility? Both hospital and community based.
Typical Medical Conditions; Brain Injury, Multiple fractures, neurological disorders, Strokes, Major joint replacements
Daily Therapy requirements: greater than 3 hours
Average Length of Stay: 13 days
Average Cost per Patient: $17,000
Infection/Sepsis is a complication of severe 2nd and 3rd degree burns, name another complication.
What is shock, blood loss ( hypovolemia) , muscle contractures, hypothermia and death?
It’s important to gain adequate physical treatment for burns, but don’t forget to find help with emotional needs.
Treatment includes- surgery ( skin grafting, contractures), )therapy OT, PT, Counseling), rehabilitation and could include life long assisted care.
Name one thing to consider when deciding if IE is safe to return to home with home care services vs placement in rehab facility and/or skilled nursing facility.
What is?
1) Functional Abilities
2) Support at home - children, wife
3) Housing- assess physical living arrangements
4) Possible DME needed
Remember discharge planning begins the day or admission.
This resource is used to collaborate/partner with you to resolve the medical and disability aspects of the claims.
What is Complex MCM?
This resource should be used to partner with you to bring the medical and disability aspect of the resolution.
Complex MCM should be on cases where need for medical and/or disability management and where they can add value to file.
The simple farmer who was recruited by Don Quixote to be his squire in the novel by Cervantes.
Who is Sancho Panza?
Readers can easily understand that the two characters stand for different things. While Don Quixote represents illusion, Sancho Panza represents reality. They complement each other in a dualistic way.
Facility within a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds.
What is a Trauma Unit/ Trauma ICU?
Typical Medical Conditions: Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability. These might include serious head, chest, abdominal and skeletal injuries sustained as a result of accidents, sport or violence. The patient has in the same body area a combination of trauma and burns (partial and full thickness) of 15% or greater. The patient has an amputation proximal to the wrist or ankle. The patient has one or more limbs which are paralyzed. The patient has a pelvic fracture demonstrated by x-ray or other imaging technique.
Upon discharge from Burn Unit the IE name a discharge need you may anticipate.
What is?
Nutritional Counseling
Psychological Counseling
Compression Burn Garment- control scar maturation (should be worn 20-23 hours a day for at least 6 months and perhaps as long as 2-3 years)
Typically 3 sets of garments last 3 months
Physical Therapy/Occupational Therapy
RTW Concerns- if IE works around heat or change in tempratures- this may extend disability
Opportunity to address with employer other alternatives- limited work hours