Success Story 1

Next Step Medical Advisory Program

Success Story #1

Story #1: Three year old case with no documentation of increased function

  • 52 year old female
  • Date Referred to Next Step: August 10, 2010
  • Date of injury: August 14, 2007
  • Diagnosis: Left wrist internal derangement, CRPS of left upper extremity, reactionary depression/anxiety, medication-induced gastritis, spinal cord stimulator implant (July 17, 2008), left shoulder impingement, carpal tunnel syndrome – right wrist
  • Medications: Anaprox BID, Ativan 1mg BID PRN, Dendracin Topical Analgesic cream, Duragesic Patch 50mcg Q 72 hours, Norco 10/325mg 8-10 tablets per day, OxyContin 40mg TID PRN, Prilosec 20mg 1 tab PO BID, Remeron 15mg 1-2 Q HS, Seroquel 25mg 1-2 Q HS, Sonata 10mg 1 Q day
  • Non-Industrial Medications: Aciphex, Dexilant, Levothyroxine, Lisinopril, Trilopex, Zantac
  • Obstacles: Escalation of medications, spinal cord stimulator, GI complications due to side effects of medications, case litigation
  • Treatments: Activity restrictions, bracing, physiotherapy (PT, OT, Hand Tx), sympathetic blocks, trigger point injections, spinal cord stimulator permanent placement, spinal cord stimulator reprogramming, home exercise program
  • Interventions: Comprehensive global chronological review done by Next Step team and specialty reviewers, round table discussion with all applicable parties for findings of file review recommendations and plan of action, multiple peer-to-peer conversations with PTP, urine drug screens, pain contract, CURES report obtained from physician by EK case manager
  • Outcomes: Urine drug screens inconsistent with prescribed medications, violation of pain contract agreement, CURES report showed multiple prescribers and medications above recommended amounts and dosages (according to evidence-based medicine), advise to carrier from Next Step Medical team about case progress for legal impact of case
  • Cost Savings due to Next Step Intervention:
    • Compromise and Release settlement for $80,000 on all issues
    • Carrier notes savings of $220,000 due to reserve of $300,000
  • Projected Cost Savings:
    • PD for one (1) year: $11,960
    • Medication costs for one (1) year, per California DWC pharmacy fee schedule: $21,178.14
  • Final Cost Savings:
    • $249,133.14 (minus Next Step program and Case Management expenses)