Meet Donna Leischner, APN, MS, CCM, COHN-S, she is a workers’ compensation medical case manager for CompAlliance, based out of the Springfield, IL area.
Donna received a file for a 52 y/o employee admitted on 5/11/2020 to the hospital into the ICU.
The adjuster had been unable to obtain any information on this case and decided to refer the file for case management.
Donna was unable to perform the customary in-person assessment, as at this time, no visitors were allowed into the hospital. However, as Donna had a long-standing excellent working relationship with the in-house case manager, she was able to obtain a timely comprehensive update.
This recovering worker was diagnosed with COVID-19, on a ventilator and initially was deteriorating rapidly. The case manager was able to obtain the treatment plan and then communicated the appropriateness of the plan to the referral source.
This recovering worker had significant comorbidities including morbid obesity, hypertension, diabetes, and heart disease. He remained in the ICU for a week. This worker was employed at a fast food restaurant, and it was assumed he was infected at his place of employment.
Against all odds, this worker was able to be weaned off the ventilator and began to recover. Due to the remaining weakness post-infection, the employee began to receive physical therapy in the hospital, but it was clear he would not be able to be discharged to his home setting, as he lived alone.
The case manager communicated daily at the least with all parties, sometimes even more frequently. She made herself available for whatever was needed. The main impact the case manager could make at this point was to facilitate communication between all stakeholders. This provided the family in Arizona who could not travel due to travel restrictions to have confidence in the care being provided for their son and brother.
Discharge Planning to Rehabilitation Facility Coordinated
As the case manager began the discharge planning process, she maintained close contact with the worker’s brother (who lives in Arizona). The employee’s brother noted the home environment would need modifications (comprehensive cleaning, a new bed, air conditioning, etc.) prior to him transitioning back home to the apartment (his family pays for). The brother was also concerned this recovering worker would require a power of attorney designation as it was unclear as to his current mental status and ability to fully care for himself.
By discharge, it remained evident this worker would need to transition to a rehabilitation facility. The case manager determined many facilities in the area were unable to accept him due to his diagnosis. She was able to locate a facility with a COVID unit. This recovering worker stayed in rehab for a couple weeks and was successfully rehabilitated to the point of being able to self-care, though he remained weaker than his pre-COVID diagnosis.
Home Discharge Facilitated
The case manager then facilitated discharge and coordinated an OT/PT evaluation upon discharge to ensure safety and to identify any needs within the home. As this employee did not have a primary care physician, the case manager also assisted in locating this resource for his follow-up care. The brother arranged for food, cleaning, A/C and a new bed within the home prior to discharge.
As his last two COVID tests were negative, the case manager has arranged to meet him for the first face to face meeting at his upcoming appointment.
She states her goals for this upcoming visit will be to
- Assess functional capabilities
- Assess ADLs
- Arrange transport to the appointments as he does not drive
- Assess the recovering worker’s opinion of his own condition
- Assess his adherence capabilities with medications, therapy, and physician recommendations
- Assess his current mental status and document any areas of concern
- She will also attempt to determine his pre-COVID mental capabilities if at all possible
In summary
Case management success on this case was due in part to quickly obtaining and assessing hospital records for the adjuster, providing almost daily communication with adjuster and the brother, These updates resulted in assuring the brother’s confidence that the adjuster and case manager were on top of this case and were here to help his brother. As a result, the brother’s anxiety/stress decreased.
The case manager was instrumental in facilitating and coordinating a timely and appropriate transfer to a rehabilitation facility post hospital discharge, and then to the home after rehabilitation. The case manager facilitated communication with the rehabilitation facility (by speaking with the administrator, director of nursing, unit nurses, and medical records department) for updates which were relayed again to the adjuster and the brother.
The case manager was able to convey a sense of empathy and advocacy to all stakeholders.
Following are some brief comments the case manager received from both the referral source and the brother
“You have been amazing in this whole process. It’s almost impossible to get responses as an insurance analyst normally, but especially now. The rate at which you’ve been able to get these records and analyze them has been much appreciated. This is the start to a timeline, this at least lets us know he won’t be released in the next couple of weeks. Thank you so much Donna! JF”
“This is exactly the kind of thorough information I need. Thank you very much. Please continue to be “wordy”. The more the better. Please let me know what you need from me. Thank you, Jxx”
“That’s awesome, Donna. You all are amazing. You are welcome to relay this information to my brother, but I will need to be kept on this email thread and I will need to have all of the relevant information so I can reiterate the importance of his adherence, etc. … Thank you for your continued world class care for my brother. You truly are impressive. Thank you, Jxx”
“I’m so glad. I did not want you to have to go there last minute. You are awesome Donna. I will tell you, I spoke with our CEO about your service. He saw the notes throughout the file and agreed you have handled everything above and beyond. Do something for yourself this weekend😊 Thank you!! JF”
