Professional Profiles, News & Events


Change in Florida Law Impacts Vocational Rehab Pros

By Gil Spruance – Special to the Voice News

The recent Florida legislative session made significant changes to the workers compensation law and the rehabilitation/reemployment of injured workers. Many QRPs are asking how these changes will affect them in the near future, and what the long term implications will be.

As a rehabilitation counselor for 30 years, working within the workers compensation environment, I follow legislative changes to evaluate how I will do business in the future.  Each and every legislative change over the past 30 years has affected my business one way or another.

The new law can be found at:

SB 2150 http://www.flsenate.gov/Session/Bill/2011/2150/BillText/er/PDF The entire document is 71 pages, but the workers compensation section (440.491) is only pages 11-20. If approved by the Governor, these provisions take effect July 1, 2011.

Vote:  Senate 35-3; House 89-29

The Senate summarizes the changes (to the workers compensation law) as follows:

Repeals certain responsibilities of the Department of Education for monitoring rehabilitation providers and services; repeals rehabilitation provider qualifications. These changes, overall, will not significantly affect my business, but will make doing business in the workers compensation environment a little easier.

The first significant change is the fact that BRRS will no longer regulate carriers or rehabilitation counselors (formerly known as QRPs).  The QRP Directory will no longer exist, and the bi-annual QRP renewal process will no longer be required. However, the essence of the credential remains intact. To work as a Rehabilitation  Provider (RP – new term) requires one of the following:  CRRN, CRC, CCM, CDMS, CVE or COHN. It is still a law that all Reemployment Assessments and Reemployment Services be provided by RPs only. And it is still a law that the same RP cannot do both, unless an RP had been involved in the case within the first 60 days of injury. Also, the recent rule requiring electronic submission of the DWC-21 through the BRRS web portal will no longer be in effect.

In fact, the DWC-21 and all other DWC forms used by the rehabilitation community will no longer be required. (The DWC-21 has long been used by BRRS as a data gathering mechanism.  BRRS will no longer be collecting this data). The carrier no longer has to report its voluntary service activity to BRRS, which they had been doing via the DWC-21.

When a RP completes a Reemployment Assessment (REA), there is no longer a requirement to send a copy to BRRS. However, if a carrier refers an injured worker to BRRS for training or education and has obtained a REA on their own, the carrier must submit the REA to BRRS at the time of referral.

There have been many changes made to BRRS which will now be under the Department of Financial Services, rather than the Department of Education. BRRS no longer writes rules governing professional practices and standards, with regard to reemployment services voluntarily provided by the carrier through the private sector. BRRS will continue to provide training and education to the injured workers in the state, as they have been doing for many years.

Ed. Note: Gil Spruance, MS, CRC, CCM, CVE, CLCP, MSCC is President, Spruance & Associates, Inc., a privately held disability management firm. He has been a rehab counselor in Florida since 1979 and is a member of the National Association of Rehabilitation Professional (IARP).

To comment on this or other articles please email voicehab@gate.net.


PMSI Home Health Management Program

Mary Scrank reviews a care report with Technical Lead, Jennifer Jenny.

 

Holistic Approach to Home Health Management

Clinically-Based Program’s Results “Dramatic”

PMSI, a leader in workers’ compensation specialty care services, has applied its extensive clinical and cost containment expertise to Home Health Care with dramatic results.

“Recognizing that most claims requiring in-home nursing will require additional medical services and equipment, we realigned our program resources late last year to provide a more holistic approach to care,” explained Brian Bell, Vice President of PMSI Business Development. “Operationally, we looked to simplify the process for adjusters and case managers by provisioning all the service and equipment needs through a single point of contact. Through this approach, we identified a commonality in the diagnoses requiring home health in workers’ compensation.”

At a time when cost control is a hot topic across the industry, this holistic approach provided an additional layer of visibility into the clinical utilization and associated outcome across the life cycle of a claim.

“With a cross functional approach to operations and clinical monitoring, we examine how each case is triaged through the claims process,” Bell told the Voice. “When it comes to Home Health Care, historically no one has looked closely at utilization,” Bell added. He indicated utilization monitoring is particularly necessary in catastrophic cases, but applies to all care in the home.

 

The company maintains that by assuring quality

care and service there is a 99.5% injured worker

satisfaction rate with care providers.


“One of PMSI’s core competencies is our clinical expertise and we applied that to home health services to develop a program that is clinically based. Our program involves the application of evidence-based guidelines, eliminating the guesswork from the care management process,” continued Bell. The company reports that the program, launched in November 2010, has realized additional savings of 12%-18% for clients.

PMSI reports that the company seeks to mitigate risk of unnecessary costs with a nationwide network of care providers providing 24-hour service placement assurance coordinated through a single point of contact. The company maintains that by assuring quality care and service there is a 99.5% injured worker satisfaction rate with care providers.

Mary Schrank, Home Health Care Operations Manager for PMSI, explains the organization’s approach to partnering with adjusters and case managers. “We understand the workload that adjusters and case managers face today and the complexity that cases requiring Home Health Care add to that workflow. Our program simplifies the process for them through a streamlined order process and timely reports that include evidence-based clinical recommendations. As a result, adjusters and case managers can focus on the critical details that require their expertise.”

The company is consistently monitoring outcomes and pointed to a recent case that involved an injured worker requiring a total hip replacement. A comprehensive review of the treatment the worker was receiving found there were services being provided that were not directly related to the compensable injury.

PMSI reported that through collaborative and objective clinical management there was an immediate $1,200 savings to the client and an injured worker who was able to return to work faster.

Debra Borger-Cerrato, RN, CRRN, CCM, Senior Manager of Home Health Product Development added that advanced technology has helped to provide clinical management in real time. “Available technology in the hands of our medical professionals provides information about the medical necessity and appropriateness of care in support of evidence-based outcomes,” she said. “A high percentage of cases we manage involve non-skilled home health aides—accounting for over 43% of spend in the most frequently referred injury types—for which the utilization component is often left unmanaged.”

 

If the appropriate equipment or devices are not being

provided, agreed the managers, money is wasted and

the injured worker is not being served.


Bell added that other cost drivers associated with Home Health Care include durable medical equipment, orthotic and prosthetic devices and transportation. If the appropriate equipment or devices are not being provided, agreed the managers, money is wasted and the injured worker is not being served.

And how is the program working out? “We have received tremendous feedback from our customers and agency partners.” said Mary Schrank, Home Health Operations Manager. “Our unique combination of clinical oversight and operational excellence delivers measurable value to our customers, and a positive outcome to the injured worker. We are enthusiastic about continuing to enhance our customer and patient partnerships,” she concluded.

 

Ed. Note: To read more about the home health care program provided by PMSI, visit www.pmsionline.com. You can also call 877-275-7674 (ASK. PMSI).

 

 


Compounding the Effort to Simplify

Grass roots effort to meet the needs of physicians treating patients taking multiple medications has grown and in use by other companies.

Keeping Customer First Puts Company on Fast Growth Track; Drug Compounding the Latest Innovation

By Ray Brasted

A Florida full service pharmacy and ancillary medical benefits management company, myMatrixx, continues to make news as one of the fastest growing private companies in the U.S., as reported by Inc. Magazine.

Under the direction of founder and CEO, Steven MacDonald, myMatrixx has focused on technical innovation “to keep the customer first.” As he put it after learning of the magazine report, “We are a customer-centric company.”

This focus has guided myMatrixx in its mission to simplify the solutions it seeks to bring to the workers’ compensation arena, bridging the gap between the injured patient, physician, dispensing pharmacy and the insurance professional.

For example, to meet the needs of certain patients who have been suffering pain over an extended period of time, the pharmaceutical technique of compounding drugs has been developed at myMatrixx under the direction of Phil Walls, RPh, Senior Vice President of Pharmacy Operations.

“There was a growing need for compounding services,” Walls told the Voice. He gave as an example the company’s ability to provide a topical compound containing the specific medications, in the right amount of dosage, required by a patient. By using just one topical compounded medication rather than taking multiple pills each day, the patient’s risk of over-medication declined and cost was lowered while compliance increased.

“An interesting thing began to happen as we developed our services,” Walls pointed out. “The topical use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ketoprofen has long been available only from a compounding pharmacy. Now we are seeing the marketing of topical products such as Voltaren® Gel and Flector® patches from pharmaceutical manufacturers. However, the advantage of compounding – the addition of multiple ingredients in a single product – is lost when commercial products are used, as well as the accompanying cost savings.”

Because of myMatrixx’s dedication to simplifying what can sometimes be otherwise complicated, there is an ongoing program to work closely with physicians to develop the right dosage of medication for their patients.
“This began as a grass roots effort and the feeling among physicians, adjusters and patients was ‘let’s give compounding a try’,” Walls said.

Patients who had suffered pain for an extended period of time and were not getting any better were the first to have their medications compounded. “It was a case among the various parties of saying we have tried everything else,” Walls pointed out.

He said the company is at the point where it can show positive outcomes in a number of cases, with long term savings and better outcomes for patients.
The pharmacists at myMatrixx work closely with doctors to provide them with information on the most effective extensions and alternatives to commercially available products.

Writing on the company’s website, Walls and myMatrixx colleague Michael Nguyen, PharmD wrote: “The major focus of pharmaceutical compounding is to empower doctors to venture beyond the borders of commercial products and treat patients on the basis of fundamental medical principles.”
Walls credits the positive atmosphere and the leadership of company founder MacDonald for the growth of the company and the willingness to develop programs like compounding services. “It is exciting work and you can see the passion that permeates all of myMatrixx. Employees enjoy the work they are doing.”

In keeping with the efforts to make their system easier and more efficient to use, the company established 1Click Ancillary, a system which allows professionals to access information that instantly delivers a complete list and quote for all of the supplies and services they need in a single view.
You might say the approach to making life simpler for professionals in the industry is also compounding the growth of myMatrixx.

Ed. Note: myMatrixx provides pharmacy services, mail order, compounding, clinical pharmacy consulting, ancillary supplies, durable medical equipment and customized reporting. Visit www.myMatrixx.com for details.


NeuroInternational TBI Programs

Creating a niche for managing complex neurobehavioral and post-acute neuromedical cases.

NeuroInternational TBI Program in Florida

Company Specializes in Workers’
Compensation & Michigan No-Fault

Nestled in a serene upscale community setting, NeuroInternational – Sarasota has to be one of the neurorehab industry’s best kept secrets. The post-acute brain injury program is in close proximity to some of the world’s most beautiful beaches and at the heart of Florida’s arts and cultural epicenter.

From this setting serious work is being done. “The NeuroInternational team has a niche for managing the most complex neurobehavioral and post-acute neuromedical cases,” said Neal Flannery, Senior Vice President.

“The experienced team of brain injury specialists at NeuroInternational have quite a following in the worker’s comp industry, and we are earning the reputation of being Florida’s premiere post-acute brain injury program,” Flannery added.
“Our Sarasota-based neurobehavioral, neurorehab, and supported living programs have grown by over 300% this past year alone, mostly due to repeat business within the Florida Work Comp and Michigan No-Fault industry. Adjusters and case managers have learned to turn to us when they have a complex case that others can’t manage,” Flannery emphasized.

When asked about working with people with severe auto and work injuries, Flannery replied “our team members have decades of knowledge and experience in navigating and managing the multifaceted issues associated with challenging TBI cases.

“When these catastrophic injury cases come to us they often have pending litigation, financial dilemmas, complex emotional and behavioral issues, medical management needs and family/survivor relationship strains. Case managers, attorneys, families and survivors can trust we have the experience to provide necessary treatment and appropriate supporting documentation…team members and I have literally worked with hundreds of these cases,” he added.

“Our exclusive partnership with Comprehensive Medpsych Systems, Fl’s largest behavioral medicine group, and our contracted behavioral hospital program enables us to offer the industry’s most diverse TBI services.

“We have 22 behavioral doctors and clinicians who function as part of our team. In addition to post-acute neurobehavioral care, we focus on inpatient detox, substance abuse, PTSD, pain management, and other specialty services. We can even facilitate Baker Act admissions to our locked hospital program.

“When we get a referral we provide the adjuster or case manager with a phone list so they can speak to our satisfied customers; workers’ compensation adjusters, case managers, guardians, families, and clients who have benefited from our specialty services. When they tour our Sarasota programs and meet our staff professionals they see first hand the investment that has been directed toward client care,” Flannery concluded.

He pointed out that the management team, lead clinicians, and referral evaluators are accessible to stake-holders 24-hours-a-day, including weekends and holidays. “We pay attention to detail and work hard to ensure our clients are receiving the research-informed clinical care. We are very responsive to requests made by our payers and other customers, strive to ensure our clients are healthy, happy and safe. Managing that goal for some of our more difficult cases is a big task and it takes tremendous dedication ”

Flannery said that survivors and their families are on an emotional roller coaster following a traumatic brain injury. “It is easy to understand how they get beat down and lose trust in the recovery process, especially considering the financial, relational and emotional strain that is put on survivors and families.

“By standing true to our word and fulfilling all commitments, we have been tremendously successful in helping survivors and families learn to trust again. We have also helped adjusters and case managers make their client dissatisfaction issues disappear. Simply put, clients, families and other stake-holders have come to expect more from us,” Flannery said.

The key to the company’s success?: “We offer boutique-level services and deliver exceptional outcomes on a consistent basis. We work hard every day to make a difference and we stay optimistic that we can help change peoples’ lives for the better.”

Ed. Note: If you would like more information about NeuroInternational visit their website at www.neurointernational.com, or call Neal Flannery at 813-451-9539.

Personal Testimony
Provides Insight

One of NeuroInternational’s current clients personally attests to the quality of care provided. Jeffrey Besemann, a current client at NeuroInternational stated “I have a TBI due to a train hitting my car while delivering pizzas in my late teens. My life changed for the worse and I found myself in need of a residential brain injury program.

“I have been in other programs here in Florida over the past five years. I was very unhappy and felt like my life was going nowhere – it was in constant turmoil.

A few months ago I came to NeuroInternational and my life has completely changed ever since. I worked my way into an apartment offered by NeuroInternational and I have regained my independence. I feel cared for by the people here – they are like family to me – and I am making progress towards my work and educational goals. They focus on the positive stuff I do … the other places were not that way at all. I finally feel like my life has meaning and value again. I have seen many other clients come to NeuroInternational since I have been here and they have had the same positive experience as me.”


myMatrixx Continues to Innovate

Company has averaged around a 40% growth rate for the past several years.

Practical Technology Focuses on Customer

myMatrixx Launches
1Click Ancillary Program

Early in his professional career Steven MacDonald saw the future and in that future was the internet. The founder and CEO of myMatrixx, the Tampa-based pharmacy services company that has experienced tremendous growth in just nine years, continues to develop new strategies to meet the needs of customers.

“We have averaged around a 40% growth rate for the past several years,” MacDonald told business and technology reporter Mario Medina in a recent Inside Healthcare magazine article. He added, “we put the customer at the top, not the individual, because we’re not a business-centric company, we’re a customer-centric company.”

The company grew through the development of a real-time web portal that connects with 62,000 pharmacies and myMatrixx’s mail-order pharmacy and state-of-the-art compounding facility. Clients are provided with real-time reporting about paper bills and third-party claims as the company moves toward a goal of being totally paperless.

1Click Ancillary

The latest development was the launch in April of “1Click Ancillary”, described by the company as the industry’s first end-to-end web-based solution connecting claims professionals and clinicians to providers.

“1Click Ancillary is a powerful portal that links a claims professional with the actual supplier of products and services required to meet the injured workers’ needs,” according to a company statement. “On one end of the portal is an on-line marketplace that brings transparency to the market, and the other end of the portal is the connection points to those providers that eventually will service the injured worker.” MacDonald added that the user-friendly system will take away the often time consuming, inefficient and frustrating challenges of the past.

“1Click has been a long time coming,” said Chuck Sweat, myMatrixx’s Vice President of Ancillary Services, because it took several years of hard work to coordinate the vendor/provider data that makes the system effective.

How it works: 1Click Ancillary allows the customer to type in the product/service name and zip code and instantly receive a price list along with the vendors/providers who can provide the service or DME request in the geographical area.

“We believe 1Click Ancillary delivers a greatly improved customer experience,” said MacDonald. “Even if our clients want to talk to a human being, the technology allows our associates to provide more timely and useful information.”

With all of the development at his company, MacDonald believes there is still tremendous opportunity, as he explained to a reporter. “There’s going to be an electronic highway for these services, and we have the opportunity to build the roads.”

Ed. Note: myMatrixx is headquartered in Tampa, FL. For more information visit www.mymatrixx.com or call 813-247-2341. To arrange for a demonstration of 1Click Ancillary or for more information call 800-785-0884.


Traumatic Brain Injury Drug Program Promotes Training and Education

The team at Communicare, Inc. in Clearwater, FL, is working together to help individuals overcome drug addictions and misuse.

TBI Drug Program

Promotes an Emphasis On Training & Education

Communicare, a program which provides for persons with acquired brain injury and other neurologic impairments, began an innovative teaching program at its Clearwater campus.

Under the direction of Gordon J. Horn, Ph.D., Director of Programs and Clinical Services, the program will provide ongoing training and education for all staff members to make them aware of signs of substance abuse. “We will be educating everyone from the management level down through the line staff,” Dr. Horn told the Voice.

Traumatic brain injury and the potential for substance abuse are tied closely together. Studies have shown that as much as 80% of accidents leading to TBI involved drug and/or alcohol abuse. Dr. Horn said that it has also been demonstrated that individuals who used drugs and other substances prior to their injury, were likely to return to their baseline use within two years after their TBI.

Dr. Horn has been working closely with Communicare’s in-house Licensed Mental Health Counselor, John Gallagher, M.Ed., LMHC. Dr. Horn stated that Gallagher provides an integrated approach of counseling, substance abuse relapse prevention, and cognitive-behavioral techniques to treat the whole person and the complex problems following TBI and substance abuse.

Gallagher added that he and Dr. Horn work well together and “there is great communication.” His approach is also closely linked with the cognitive specialists and behavior services within Communicare.

Gallagher said that problems associated with substance abuse in TBI patients are similar to those found in the general population, but for TBI patients the problems are often more entrenched and specific. “When we have a new patient, we do a complete bio-psycho-social history and then we tailor a treatment plan for each individual,” Gallagher said.

The training program for Communicare staff is designed to provide the tools to identify potential “trigger points” and to notice changes in behavior patterns that might lead to substance abuse relapse. The program ties in with the Communicare philosophy which integrates every employee into the social fabric of the facility; helping residents adapt to their surroundings and in their transitions back into the community.

“It is very hard to find mental health counselors who understand and work with the traumatic brain injury population,” Dr. Horn pointed out. “John is unique in his drug and alcohol abuse program in that he has modified it to meet the special needs of traumatic brain injury patients with cognitive impairments.”

For his part, Gallagher was drawn into his chosen profession for a very clear and simple reason. “We are helping to improve people’s lives and while it can be often challenging there is a great personal payoff when we can make a difference.”

Ed. Note: More information about Communicare is available by calling 866-802-9191 or visiting www.communicareabi.com. The company has residential, community based and outpatient services, and has opened a home and community-based and outpatient program in Royal Oaks, MI. John Gallagher, M.Ed., LMHC also has an office in Orlando where he sees patients on a full range of mental health topics. He can be reached at 407-579-2070.



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