Originally published in CLM

By Mike Fordyce

Getting injured on the job is a traumatic experience for all involved. Maybe the worker fell off a roof while on the jobsite. Maybe some building materials fell on them from above. Or maybe they got into an automobile accident during the course of their normal workday.

Whatever the case, for those workers facing severe brain and spinal cord injuries, the road to recovery can be long and complex.

It’s often a difficult time for their families as well, and the last thing they are thinking about is researching where to get the most effective treatment for their loved ones. In the beginning, they are focused on life and death and the day-to-day, not the long-term, and are often inexperienced with the health care system in general.

Fortunately, within the workers compensation system, injured workers have experienced case managers and claims professionals who can help them navigate the acute care, rehabilitation, and long-term care system. While local hospitals and rehab clinics have their place in the general rehabilitation of knees, hips, backs, and geriatric care, there are important reasons why young trauma patients require what are referred to as specialty centers of excellence—facilities that specialize in catastrophic injuries.

Here is what workers compensation claims and case managers should keep in mind and talk about with their injured workers.

Expertise

Many rehabilitation centers advertise that they can deal with brain and spinal cord injuries, but they may not have the expertise, experience, and programs to address the full scope of care that is needed. Specialty centers generally focus exclusively on one-two diagnoses, and have dedicated and expert doctors, staff, physical facilities, equipment, and treatment programs for those specialized conditions.

Specialty centers generally have long histories of programmatic excellence, experienced physicians, and staff not found in general rehabilitation units. Specialty centers understand the psychosocial factors account for 40 percent or more of outcomes, and have strong staff-patient ratios and numerous psychosocial programs with decades of expertise. Centers that treat more than 200 patients with spinal cord injuries and 200 patients with traumatic brain injuries per year should be strongly considered.

Outcomes

As much as outcomes matter to patients, they are equally important to insurers. That is because there are real, long-term economic benefits in quality outcomes, such as levels of independence and return to employment. Specialty centers of excellence have proven track records of helping injured workers and their families achieve better outcomes. Injured workers with greater levels of independence are likely to use less home health care and other added services, which can result in significant cost savings over the life of a claim. For example, the national average for post-treatment attendant care for persons with C6-C7 tetraplegia is approximately 17 hours per day. For specialty centers, that figure is significantly less, which, over a lifetime, can result in several millions of dollars of savings.

Specialization

As opposed to general rehabilitation centers that treat a broad range of injuries, model programs specialize in just a few specific types of injuries and younger patients. Not only does that lend itself to greater staff expertise, but also it creates a critical mass of similar patients.

Large numbers of like-patients create a very powerful peer culture that can make a big difference to both patients and their families. It’s comforting to be with others who are going through the same thing that you are. Rehabilitation programs that focus on patients with catastrophic injuries generally have two-to-three dozen subspecialty programs and clinics, such as community reintegration, airline travel training, sexuality, fertility, adaptive technology, and driving.

Communication with Carriers

At specialty centers of excellence, workers compensation carriers, claims professionals, and case managers work closely with the clinical team, helping patients and families navigate the rehabilitation journey. This is different from some other facilities, where carriers may be excluded or not made to feel welcomed as a part of the team. Specialty centers of excellence have treated thousands of workers compensation cases nationwide over the years, and their doctors and staff understand the needs of workers compensation and the difference from commercial payers or Medicare and Medicaid. Specialty centers value this collaboration and partnership, viewing it as everyone being on the same team for the benefit of the injured workers and their families.

Facilities and Equipment

Medical science is changing constantly, and for rehabilitation it is critical to have access to the latest treatment technologies. The facilities and equipment at specialty centers offer the very latest in everything from robotic locomotion, adaptive communication devices, aqua therapy, functional electrical stimulation, as well as other new treatments and equipment. Local hospitals and rehabilitation facilities typically don’t have the same range of equipment and technology.

Family Support

It’s always important to understand that when an individual gets hurt, their whole family gets hurt. Specialty centers welcome family inclusion at all levels and understand that family support and training are significant determinants of long-term outcomes and costs. Specialty centers typically offer on-site family housing and numerous family support, educational, and training services to help family members adapt and prepare for life at home.

Patient Education

Rehabilitation after a traumatic catastrophic injury takes time. It’s a process. At the best specialty centers of excellence, education is synonymous with rehabilitation—the goal is to educate and empower patients to be able to take care of themselves after they go home, or instruct others in their care. Specialty centers have designated education centers, books, videos, and other mandatory classes.

Long-Term and Lifetime Support

When a patient goes home, after rehabilitation, what services might they need? Unlike general rehabilitation facilities, specialty centers are especially skilled in helping patients reintegrate back into their daily lives and manage their safety, home health, transportation, pharmacy, supply, and social reintegration needs. Some specialty centers offer long-term follow-up care and interdisciplinary reevaluations. Some centers also offer nurse advice lines, where rehabilitation graduates and case managers can call for clinical assistance and evidence-based recommendations.

Research

Specialty centers of excellence are also typically designated by the federal government as model systems centers for research. Research is a core mission for specialty centers; they aim to move the field forward for the benefit of patients and their families.

In today’s fast-paced, acute-care world, patients with catastrophic injuries are being transferred to rehabilitation hospitals in the first two-to-three weeks after injury. Families are having to make a huge decision in a short amount of time while under significant stress. Workers compensation case managers, claims professionals, and executives are encouraged to quickly help injured workers and their families do their research about options, understand the lifetime implications of their rehabilitation decision, and facilitate acute-care referrals.

Mike Fordyce is the president and chief executive officer of Craig Hospital in Englewood, Colorado.