Heal My Bone (HMB):
Case management isn’t something many people have heard about. Is it a new idea?
Liz Haunch (LH):
“Case management first evolved after the Second World War to help soldiers who were suffering from complex injuries that required different types of hospital and outpatient care. Today their role is to make a significant impact on the speed and success of a patients’ rehabilitation.” HMB:
So why is it needed in today’s modern NHS?
“Looking at the treatment side of things, in a perfect world we wouldn’t exist. There would be complete co-ordination by the NHS of the all the care that a patient needs. “
“For a patient with a non-union fracture, there will certainly be orthopaedic care but also possibly plastic surgery, as well as the post-operative areas of fracture clinics, physiotherapy or occupational therapy. It’s not always easy to keep it all on track when appointments can be months apart and on different sites.” HMB:
Who approaches you to get involved, the patient? LH:
“Case managers are brought in by legal firms and insurance companies after an accident has taken place and another party is considered liable for causing it.
“Our job is to assist the patient by looking in detail at their individual needs and help them to avoid feeling pushed around, or lost, in what can be a bewildering set of circumstances.”
The majority of case management is dealing with the medical needs of the patient and case managers doing this sort of work should have a health care qualification or relevant professional background.
This experience enables us to see things from the patient’s point of view. You might say that we are the bridge between the patient’s complex and unique set of needs and a third party company who sees things in terms of a process to be followed.” HMB:
OK, so you’ve been asked to get involved, what happens next? LH
: “We begin by visiting the patient in their homes to understand what kind of problems they face each day. A tricky set of stairs to climb or a steep driveway is something that can only really be appreciated with your own eyes but might be the single biggest hurdle to a patient being able to live normally in their own home.”
“We then prepare a detailed report that is sent simultaneously to the patient, their legal representatives and the insurance company that has employed us. With everyone getting the report at the same time, it’s a fair place to start to discuss and agree a way forward. The ultimate goal for everyone concerned is to achieve a successful treatment outcome for the patient and to get them living a normal life and ideally back to work.”
“The question of whether a patient is really able to return to work properly is a fine judgment to make. Many patients are either keen to get back to a normal routine or in fear of losing their job that there is a great deal of pressure, both real and imaginary, to return to work when it might be too soon.”
So you are you are representing the patient but are paid by the insurance company; that must be delicate sometimes.
: “In addition to managing interactions with legal and insurance companies, at the centre of a case manager’s duties is the patient with an injury, and from our personal point of view, the patient should always be seen as the most important party.
“We aim to get the right balance for each individual patient; between helping them become self-reliant in their own home and ensuring that any entitlements to help them do that are delivered properly.” HMB:
You must have seen more than your fair share of fractures LH
: “It’s rare for our patients not to have fractures as part of their catalogue of injuries, but it’s certainly true that a lot of patients need case manager support because despite the best treatment, their bones have failed to heal and the impact on their life of a non-union fracture can be considerable and long lasting.
Non-unions are incredibly frustrating for patients and, in many cases, lead to months of waiting and anguish about the lack of treatment options, not to mention the prospect of additional surgery. Reducing that waiting time is an incredibly important job.
How did you hear about the EXOGENUltrasound Bone Healing System? LH:
“An orthopaedic surgeon had recommended it for a patient I was working with. It sounded interesting so I set about finding out more. HMB:
Since then you’ve encouraged the use of EXOGEN for a number of patients as part of their treatment. What’s the appeal? LH:
Nobody involved in the kind of cases we deal with wants healing to take any longer than it possibly needs to.We looked carefully at the clinical research which examined whether fractures heal sooner using EXOGEN, without the need for further surgery3
. The data says 86% of non-unions treated with EXOGEN healed, and this has matched our experience so far, as our patients with non-unions have had good results and made progress to full healing.” HMB:
When you suggest an EXOGEN to the insurance company, how do they react? LH:
“Insurers see that there is a strong body of evidence to show that healing takes place in a very high proportion of cases, the 86% I mentioned before and the cost of the EXOGEN device compared to months, or even years, stretching ahead where the patient has not healed and needs care and financial support is a straightforward decision.” HMB:
How do patients feel about using EXOGEN? LH
: “We get tremendous satisfaction from working with patients as they turn a corner in their recovery and the fact that
EXOGEN enables patients to have an active role in their treatment. --A lot of patients tell us the daily use of the device for 20 minutes helps them feel that they are contributing to their treatment..
“EXOGEN has quickly become one of our first considerationswhen we meet a patient with a non-union fracture and in our experience insurers are generally very happy to approve it.” HMB:
Tell us a little bit about the Case Management Society UK
“I am a director of the Case Management Society UK. CMSUK supports professional practice in this growing sector and provides development services to its 430 members across the UK. Further information on the work of case managers is available from the Society’s website www.cmsuk.org
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