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Somerset Medical Center, located in Somerville, N.J., roughly 30 miles
outside of Trenton, is a nationally accredited, 355-bed regional medical
center. It provides a variety of comprehensive emergency,
medical/surgical and rehabilitative services to area residents as well
as a broad range of community programs, including health fairs,
screenings, seminars and support groups.
As its mission, Somerset Medical Center
provides high quality, comprehensive health care services by putting
their patients' needs first. With one of the highest percentages of
board-certified doctors in New Jersey, the medical center prides itself
on providing patients with superior services and results-and that's no
different when it comes to taking care of its own.
In fact, in terms of workers' compensation
insurance program results, there's no better health care service
provider in New Jersey. Among the 234 employers in New Jersey with
hospital payrolls, Somerset Medical Center has the lowest workers'
compensation experience modification rating and lowest workers'
compensation losses.
Since 2002, PMA and Commerce Bank Insurance
Services, Somerset Medical Center's broker, have partnered with the
medical center to routinely make its workers' compensation program the
#1 program in the state's health care industry. So what's the secret
formula? Teamwork, partnership and an ironclad commitment to setting
goals and achieving results.
Claims Reporting and Handling
One of the most effective means for reducing
the cost of workers' compensation claims is reporting them right away.
In a study of workers' compensation claims handled by The PMA Insurance
Group, the average cost was $7,494 for those claims reported within
three days and nearly triple that for claims reported in greater than 20
days.
"A lot of the reason claims cost more when
they are not reported timely is because a legitimately injured person is
sitting home, not knowing when and if they are going to be able to pay
their bills," says Caroline Burhenne, PMA Claims Service Manager. "Part
of the contact by our adjuster involves an explanation of the benefits
that will be forthcoming, which helps to ease the worker's worries."
As such, PMA and Somerset Medical Center
have worked together to educate managers and supervisors on the
importance of timely claims reporting and to institute a centralized
reporting process. Since 2003, those measures have helped to reduce the
medical center's claim reporting time and last year reduced its
average-days-to-report by nearly nine days to a record-low of 4.7 days.
"The availability and easy access to PMA
CINCHr [PMA's online risk management information system] for submitting
the First Report of Injury and reviewing claim status enables one-step
efficient and timely reporting," says Doris DiCristina, Director of
Employee Health Services, Somerset Medical Center. "In today's
fast-paced work flow, the utilization of technology to facilitate
processes supports our need to meet the ever-growing demands on our
time."
Additionally, PMA holds quarterly claims
meetings with the medical center during which all open, pending and
sometimes recently closed claims are reviewed and discussed to maximize
outcomes. These meetings are necessary to make sure PMA and Somerset
Medical Center remain focused on the action plan for each claim and
comprise a multi-disciplinary team that takes the time to discuss
multiple issues to ensure the best possible approach.
Proactive Risk Control Measures
"Somerset Medical Center has a unique
approach of looking at and examining all departments, all shifts and all
locations to determine accident trending and to develop a program to
address potential losses before they occur," says Christine Zichello,
PMA Risk Control Specialist.
Over the past four years, PMA has helped the
medical center to implement several risk control measures that help
prevent and reduce accidents, and control claims costs. Such measures
include forms and flow charts to help employees follow the claim
process, and identify and track the root causes of claims so they can
initiate preventative steps.
All efforts are ongoing. A recent risk
control assessment of Somerset Medical Center's operations showed that
claim frequency slightly increased for its housekeeping and dietary
functions. PMA immediately worked with the medical center to develop and
implement a workplace safety program that was presented to all members
of these departments.
Formal Return-to-Work Program
PMA worked closely with Somerset Medical
Center to develop a formal return-to-work program, which DiCristina
coordinates, to ease injured employees back to work as soon as it's
medically safe. When an employee is injured, she works with her PMA
adjuster to determine the injured employee's abilities. When a doctor
advises that returning to work would be safe, whether at reduced hours
and/or in a light-duty role, she works with the medical center's
departments to find work for the returning employee. "Departments can
usually use a free set of hands," adds DiCristina. "This program is
designed to help injured workers recover more quickly and to maintain
the hospital's production levels - and that's exactly what it's doing
for us."
Ultimately, methods such as proactive risk
control measures and a formalized return-to-work program have steadily
improved Somerset Medical Center's workers' compensation program. Last
year, the medical center experienced some of its greatest improvements
yet, with claim expenses, claim report time and lost work days reduced
despite the addition of 137 employees.
"In today's fast-paced work flow, the
utilization of technology to facilitate processes supports our need to
meet the ever-growing demands on our time."
Doris DiCristina: Director of Employee Health Services, Somerset Medical
Center
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