Consulting A Recuperating Employee (for/from) Surgery (C.A.R.E.S.) is a pilot program that began on October 1, 2014. Through collaboration with two of our members and York Risk Services Group, we were able to get this program up and running, with a few minor tweaks in the process.

The goal of this pilot program is to assess the employee’s needs both prior to surgery and post-operatively. We had a dedicated Telephonic Nurse Case Manager (TCM) assigned (for consistency purposes during the pilot program) to perform a triage call with the injured worker upon authorization of a surgical procedure. See the checklist of questions the TCM will ask.

The TCM will act as an extension of the employer and the claims examiner with the focus being the employee’s well-being and recovery. The TCM will not be an advocate for making recommendations for home modifications, but rather will help to educate the injured worker about the post-operative limitations (an extension of what the doctor should have already explained), and what adjustments the injured worker will have to make temporarily to their daily living activities. For those with more extensive surgery (total knee replacement, back fusion, etc.), there may be some additional home items needed (raised toilet seat) that are not needed for most arthroscopic procedures, and further follow up may be warranted at the examiner’s and member’s discretion.

The average cost per claim to the employer should be around $1,000 or less, or 10 hours or less.

While we can measure the overall cost of this Program, we found it was difficult to measure the overall quality, effects and impact on the claim. The feedback we received from the members and injured workers was that this specific involvement by the Telephonic Case Manager has been helpful and a positive experience.

At the PWC Committee meeting on August 26th, the Committee members approved extending the C.A.R.E.S. Program to all PWC members for use with each of their contracted TPAs. Please note this is optional participation and not a mandatory requirement. You may choose to utilize these services either on an as needed individual claim basis, or to have all surgical procedures utilize these services, or not at all.

If you have any questions, please contact Jen Hamelin or Kathy McLean.