Utilization Review

The Freedom Nurse

The workers’ compensation industry is filled with extraordinary individuals whose journeys are as fantastic as they are. This blog entry introduces Captain Cynthia Ortiz, U.S. Army Reserves & Workers’ Compensation Utilization Review Nurse. Captain Ortiz has dedicated a large portion of her life to serving the country that she passionately loves while advocating for injured workers on their way to recovery. This Fourth of July, let’s celebrate Captain Cynthia Ortiz and the countless other workers’ compensation professionals who serve, or have served, in the U.S. Armed Forces. Let’s remember to say thank you for their service, sacrifice, and for inspiring us all.

ACOEM Publishes COVID-19 EBM Practice Guideline

A leading evidence-based medicine (EBM) guidelines publisher announces the publication of the very first EBM Coronavirus (COVID-19) Guideline for occupational health. The announcement comes at a critical time as state jurisdictions fight to mitigate the pandemic’s effects on their respective economies and workforces. This is an important publication as it establishes an objective starting point for occupational health providers to consider.

California Employers & Work Comp Stakeholders Sound Off

The nation’s largest workers’ compensation community came together recently in Dana Point, California to attend one of the country’s more prominent trade conferences. To kick off the event, a panel of work comp subject matter experts, representing system stakeholders and employers, was assembled to address issues ranging from California’s chief public official’s appetite to tamper with seemingly sound system reforms to automation and technology’s role in workers’ compensation.

The California King Case: Imperceptible Implications for UROs

Irrespective of overwhelmingly positive data published on appropriate UR decisions, the UR process becomes a target of criticism. Largely driven by a lack of understanding, a push to unravel this layer of protection for injured workers persists. The overutilization of unnecessary medical care is not a benefit, it is a risk. Here are my thoughts on how the King case may motivate this movement come next year’s legislative session.

Complacency or Complexity: California UROs Crawl to Accreditation

Another important July 1st deadline has come and gone for the California workers’ compensation community. As of mid-June, nearly half of California’s Utilization Review Organizations had yet to complete the accreditation process required by newly modified Labor Code section 4610(g)(4). Is the crawl to compliance due to a complacent system culture or a costly and complex accreditation process?

Collaboration Drives Improved Health Outcomes

Health care information technology may be making the world smaller in many ways, but wide divides remain in the care and claims continuum. Bridging the gaps in the workers’ compensation space requires a conscientious focus on collaboration, human to human. Collaboration effectively creates an interactive and adaptable system capable of delivering improved patient health outcomes.