Approaches to Care for Catastrophic Cases

• Publication year: 2019
• Author: Betty Ottman, RN, CCM

Approaches to Care for Catastrophic Cases

Betty Ottman, RN, CCM

San Francisco, California

Historically, the management of catastrophic cases has followed the same trajectory as non-catastrophic industrial cases. However, this model does not promote a predictable optimal outcome. A 2014 study examined a different model for managing catastrophic injuries that shows better results.

What constitutes a catastrophic injury? This category includes traumatic brain injury, complex multiple trauma, spinal cord injury, severe burns, and amputations of an extremity. Moreover, a catastrophic case will often include a combination of these diagnoses. Fortunately, only 1 percent of all industrial injury cases are catastrophic, but they make up at least 20 percent of the costs of all cases (Miller, "The Impact of Catastrophic Cases on Workers Compensation Medical Loss Reserves"). The catastrophically injured face significant lifelong medical and custodial expenses. These costs are higher now than ever before due to newer lifesaving techniques and medical innovations.

Currently, the industry standard for a catastrophic case is for the carrier to have a traditional case management company and nurse case manager (NCM) handle the case. The NCM may not have critical care experience or even general knowledge of appropriate catastrophic care. In some cases the NCM will meet with a hospital representative and family; in others it is done telephonically. The NCM plays no active role in deciding the hospital course or facilitating for the most appropriate acute rehabilitation facility. Once the patient is discharged to home, delays and limits in obtaining medical care and supplies occur due to ineffectual utilization review processes. These delays can cause significant complications for the patient. Also, the primary treating physician chosen to handle the case may not have clear a understanding of the management of catastrophic injuries. This leaves an individual with numerous life-changing injuries at risk of being in the hands of medical personnel who lack the experience, knowledge, and understanding required for a successful recovery.

The current industry standard method fringes on poor medical care. However, there is another model that may greatly improve the outcome of the catastrophically injured, thereby reducing the financial burden while significantly increasing the likelihood of a meaningful recovery. A study by Millican, Inc. (an independent actuarial and consulting firm) of...