Archive for the ‘Best Practices’ Category

Medical Care Experts: Where Would We Be Without Them?

Monday, August 7th, 2017

If you’ve been following the blog-o-sphere and the LinkedIn-o-sphere, you know that the space is crowded. Lots of workers’ comp practitioners have glommed on to the idea that the way to get ahead is to write and post frequently. Connect with more than 500 others in the profession. Write something, anything, put your name on it and throw it up against the wall to see if anything sticks. Kind of the way Garrison Keillor used to say he changed socks on a book tour.

Every once in a while, something helpful and interesting appears and gains a bit of temporary caché for itself and for its author. Mostly, the topics center on the persistent rise in medical costs and, even more often, on the insidious and often criminal use of opioids, which a regrettable number of alleged doctors, having checked their Hippocratic Oath at the door, are prescribing at a hell-bent-for-leather rate at a hell-bent-for-leather profit. The poor, unfortunate souls for whom these scripts are written are nothing more than high-cost collateral damage.

Consequently, efforts to control workers’ compensation costs are now almost entirely dedicated to reining in costs associated with medical care with a huge emphasis on prescription drugs.

And why not? Injury frequency continues its 13 year, asymptotic approach to zero. While the same can’t be said for injury severity, these are, nonetheless, heady times for insurers. Kind of hard not to make money when the combined ratio is in the 90s.

Regardless of how good things are getting in workers’ comp world, the workplace is still the best place to control and manage the work injuries and costs that are bound to occur despite frequency’s decline and the rise of the robots. But that requires educated employers who understand that they, not the vendors to whom they outsource payment responsibilities, are the hub of the workers’ comp wheel.  Who approach workers’ compensation in a Management 101 kind of way understanding that a systemic, accountable process will reduce costs to a minimum and bolster profits as well as employee morale and productivity.

This means training supervisors in the proper response to work injuries, keeping close communication with injured workers, creating good relationships with treating physicians, bringing injured workers back to work as soon as possible under medical supervision, seeing that injured workers receive full pay while on modified duty, and measuring success every month just as one measures success in every other business enterprise.

These, and other program components, give enlightened employers a distinctive competitive advantage, and the results will speak for themselves.

But not all employers are enlightened; many have lost their way. Why?

Well, could it be we took a system we had made relatively simple for employers to manage (and let’s not forget that it is employers who ultimately pay the bills) and made it progressively more complicated with progressively more vested interests?

Many middle market employers, realizing they have no hope of navigating the haunted house maze medical care has become, have relinquished control to a myriad of vendors, the “experts.” Climbing this Tower of Babel is beyond them.

The question is: Can we do anything about this? Should we? Or, has this ship long ago sailed?

Eight Steps To Controlling Workers’ Compensation Costs: Conclusion

Friday, June 2nd, 2017

This is part 3 in a 3-part series. Here are parts 1 and 2.

Step 6 – Establish a partnership with your claim service provider

It is not the job of the insurer or third party administrator (TPA) to solve your workers’ compensation problems. That is something you do together. The insurer or TPA administers and manages your company’s claims according to relevant law and brings a diverse array of claims-related services to the table, including utilization reviews, intensive case management for catastrophic injuries and investigation of dubious claims. Your goal should be to develop a close working partnership. On your side, you need to report claims immediately, establish good documentation to serve as the basis for the insurer’s work and work with your adjusters and medical providers to bring injured workers back to work in any medically appropriate capacity as soon as possible.

Together, you and your insurer or TPA should maintain a steady and consistent focus on every open claim. Use all the tools and resources available to return your injured workers to the job; where this is not possible, work diligently to reach agreement on the appropriate way to achieve closure on the case.

Step 7 – Measure and track results

You know the drill – what you measure becomes important.

Be sure to establish clear objectives for what you want to accomplish and communicate them in concrete terms.

Here are three simple, but effective, ways to measure performance. These are measurements that senior management can readily understand and track on a monthly basis (we wrote about the need for simplicity in performance measurement recently here).

First, measure the total costs of losses per full-time-equivalent (FTE) employee (divide the total number of hours worked by 2,000 to get the number of FTEs). Doing so factors out both overtime and part time employment.

Second, measure the cost of losses per hundred dollars of payroll. Compare this to the premium classification rate at the time of the injury to find out if your loss costs are excessive.

Third, measure days lost due to injury per every 200,000 hours worked (equivalent to one hundred employees working 2,000 hours per year). This is the OSHA Severity Rate and is an excellent way to measure lost time.

With this data in hand, ask your insurance broker or carrier what the averages are for these metrics in your industry. They should be able to tell you. Then, benchmark yourself against your industry and yourself.

Track results and report them just as you would track and report production or quality objectives. Moreover, discuss the results with employees. If senior management pays consistent attention to the organization’s loss reduction performance, everyone else will, too.

Another measurement factor focuses on accountability: make support of and participation in your injury management system an ongoing part of performance reviews for management and supervisory staff. Not doing this sends a subtle message – safety and injury management are really not that important at your company.

Step 8 – Define and communicate responsibilities

In a well-coordinated injury management system, everyone knows his or her proper role and responsibilities. Each person must understand how to respond. Injured workers must immediately notify supervisors of any injury. Supervisors must respond in a caring manner and make sure that workers who sustain injuries are escorted quickly from the work site to the right medical provider. Supervisors also are charged with analyzing accidents and taking steps to ensure they don’t happen again. Supervisors should thoroughly document accidents and injuries with the assistance of injured workers. And senior management should follow through by making sure that corrective action identified actually does occur.
It is a truism of business that well-defined responsibilities go a long way toward assuring that objectives are met or exceeded. Workers’ compensation cost control is no different.

We recommend that, among other program documentation, you create a simple brochure that might be called, “What to do when you’re injured on the job.” The brochure should say what employees should do and what management will do. It should describe your Modified Duty Program and accident investigation protocols. It should hammer home the need for every injury to be reported during the shift on which it occurs.

Conclusion

Workers’ compensation is not an insurance problem. It is a management problem. Employers committed to taking control can reduce costs significantly. At the same time, their companies will benefit from improved morale and productivity. Like so many of life’s thorny issues, workers’ compensation can be managed if you only have the will to do it.

Eight Essential Steps To Controlling Workers’ Compensation Costs: Steps Three Through Five

Wednesday, May 31st, 2017

Yesterday, we began our Eight Essential Steps series with Steps One and Two, making a commitment and focusing on lost time. Today, we’ll tackle Steps Three through Five.

Step 3 – Develop an injury action plan

Many employers think that when an injury occurs responsibility for getting the injured worker back to work shifts to the claims adjuster. Nothing could be further from the truth, and it is this basic misunderstanding that causes many claims to deteriorate with oftentimes negative consequences for both worker and employer.

The claims adjuster’s job is to determine compensability, coordinate benefits, follow the law and work within it and the workers’ compensation insurance contract to resolve the claim satisfactorily. And while adjusters play a vital role in the process, they can never be your human resource director.

Misunderstanding the role of the adjuster creates an atmosphere in which injured employees are left to drift, groping their way through a quagmire of medical services, uncertain benefits and a cloudy future. In fact, a truism in workers’ compensation is, “When a claim goes south, costs go north.” As the employer, you need to structure a clearly defined path from the moment of injury through early return to work and back to full employment. What you do or don’t do in the first few hours after an injury has a significant impact on your ultimate costs.

Employers need to create a turnkey action plan – a clear set of policies, procedures and expectations with supporting tools and documentation. The plan must include a way to stay in continuous contact with injured workers throughout the recovery process, keeping employees connected to the organization and motivated to return to work.

Step 4 – Establish relationships with high-quality medical providers

A close relationship with medical providers of exceptional quality who understand work-related injuries is essential to managing costs. The pivotal emphasis should be on quality, not price. This sounds paradoxical in these times of higher and higher medical costs, where medical treatment now accounts for nearly 60% of workers’ compensation loss costs and where a bazillion companies unleash an army of people to reign in those costs in so many different ways (NCCI reports 13% of medical costs are devoted to lowering medical costs – go figure). However, ample research shows that doctors who specialize in occupational medicine with a sports medicine approach and who follow ACOEM (American College of Occupational and Environmental Medicine) guidelines, consistently provide injured workers with high-quality treatment while shepherding them back to the workplace in a compassionate and caring manner. Board-certified occupational medicine physicians know a worker should remain out of work no longer than is medically necessary. This leads to an active recovery and lower costs.

Take the time to shop for providers who offer the highest-quality care with an active sports medicine philosophy. Look for physicians who will take the time to understand your needs, perhaps through actual work site visits. Once you have identified potential providers, develop a written agreement that sets explicit procedures for handling workplace injuries. Be sure that each provider is willing to identify specific restrictions resulting from injuries and work with you to accommodate appropriate modified duty placements.

Now, admittedly, this approach can be difficult in the 21st century workers’ compensation medical environment. Large medical networks have enrolled more physicians than there are entries in the New York City telephone directory and have wrung out of each a discounted rate for service. This arrangement might be good for the networks, but not necessarily for you. In workers’ compensation, like in most everything else, you get what you pay for. So, our suggestion is that you should be prepared to negotiate higher payment for the good service you expect. We’ve found it worth it in the long run.

As with any valued vendor, you should provide positive feedback to physicians who take the time to care well for your injured workers. However, while everyone appreciates praise for a job well done, you should always remember a physician’s first responsibility is to the patient. The more the physician understands you have the same outlook, the more the physician will trust you and work with you to accommodate the injured worker’s needs appropriately.

Step 5 – Stress early return to work

Time away from work can be frightening and debilitating for injured workers. Their physical, emotional, and financial well-being are often in turmoil. They are worried about their job and how they will pay their bills, particularly so in today’s economic climate. They often begin to think of themselves as “disabled.” The longer they are out of work, the harder it becomes to get them back into the work routine. Consequently, it is crucial to speed recovery through the use of modified duty, one of the most important tools an employer has to reduce lost time and costs.

Modified duty is a bridge back to full duty, keeping workers active and part of the team. Instruct your medical providers to focus on what employees cannot do while injured, clearly delineating work restrictions.

For a moment, put yourself in the skin of the injured worker and imagine you are talking with your doctor about your injury. Would you want the doctor to list for you the potentially countless physical tasks you could actually still do while injured? Or, would you want the doctor to tell you the realistically few things you should not do? The latter approach is the one doctors prefer, too.

Once you have the medical restrictions, work with your supervisors to develop progressive, short-term transitional jobs and tasks. You don’t want the injured worker to sink roots into what should be a short-term job. Most important, make sure employees and supervisors carefully follow the physician’s restrictions. The goal is to speed recovery, not aggravate the condition and make things worse. As medical treatment continues and your medical provider gradually lifts restrictions, increase job demands to ease the employee back to his or her original job.

 

That’s it for now. We’ll be back with the last three steps Friday morning.

Eight Essential Steps To Controlling Workers’ Compensation Costs

Tuesday, May 30th, 2017

Many US companies have recognized two basic truths about workers’ compensation:

  • The workplace is the best place to control loss costs; and,
  • They, as employers, more than any other group, are best positioned to reduce and control loss costs.

These employers do not hand the problem off to their legislators, their insurers, their TPAs or their attorneys; instead, they manage workers’ compensation as a controllable expense, an accountable business program providing a competitive advantage. They partner with their insurers and TPAs to get the most out of everyone.

You would think 17 years into the 21st century this kind of business intelligence, really nothing more than Management 101, would be so widespread we’d never need to talk about it. But such is not the case. Many employers of all sizes and shapes continue to find themselves paying more than their industry peers, and we still have myriad conferences every year where anyone and everyone pays good money to hear “experts” impart the secrets to safe workplaces and low workers’ compensation costs.

But there really are no secrets. It’s pretty much common sense and sound management. I should know. For more than 30 years, our company, Lynch Ryan, has been privileged to assist many of America’s leading corporations as they attacked this issue. Here’s what we’ve learned after all that time: There are eight essential strategies that help progressive employers turn workers’ compensation liabilities into assets. The principles are simple, founded on basic human values. They involve a concrete action plan and sound management. More important, they work.

Today, we’ll focus on the first two steps. Tomorrow, we’ll post three through five, and Friday finish up with the last three.

Step 1 – Make a commitment

Harder to do than you’d think. C-Suite leaders are busier than the Ed Sullivan Plate Spinner. However, as with any major corporate endeavor, commitment starts at the top. You’ll need a pithy and cogent argument to convince your leadership team that workers’ compensation should be afforded priority status throughout the organization. You’ll also need to educate the team that realistic and attainable goals should be set and communicated to the organization from the top down and then measured religiously.

If you approach injury management simply as the “idea of the month,” you will certainly fail. Commitment involves building safety and injury management into the very fabric of your organization. You should never lose sight of your goals. And you should never compromise your commitment to safety by drifting toward expedient, short-term objectives that place production quotas above the safety of your people.

Corporate commitment should be in writing, signed by the CEO and communicated to the entire organization.

Step 2 – Focus on reducing lost time

Chances are, your company has been working to create a safe working environment. That’s good. Safety is essential in controlling workers’ compensation, but it’s only half the equation. Good safety programs have a positive effect on the frequency of injuries, but the best safety program in the world will not eliminate all accidents. People being human, injuries will happen. Try as we all do, work conditions change and we make mistakes.

To really attack workers’ compensation costs, you need to focus on reducing severity: the length of time injured employees stay out of work. Severity is the real cost driver in workers’ compensation. Every day that an employee is off the job costs you money.

When your machines break, you fix them immediately. Think of something as simple and common as the department copier. An out of commission copier slows everything down. When you purchased or leased that machine, you insisted that prompt maintenance or even replacement was part of the deal. You need to treat your most important resource, your employees, the same way. The goal must be to keep days away from work to an absolute minimum. You need to focus, laser-like, on the goal of returning every injured employee to work, through modified or transitional duty, and thereafter to the original job as quickly as possible. That’s good for you and it’s also good for the injured worker.

Many will argue severity is no longer the prime mover, medical expense is. While it is true that we spend a lot more on medical expense than on indemnity, consider this: The longer someone stays out of work, the more medical costs they incur. And often, this medical expense is nothing more than justification to extend absence beyond what is medically necessary. Focusing on severity reduction significantly reduces the growth of medical expense.

 

That’s it for today. If you’re interested in the other six strategies, numbers three through five will be right here tomorrow morning. Come back Friday for six through eight.

Hope you have a good day.

Workers’ Compensation Performance Measurement: Keep The Bull’s Eye Simple

Wednesday, May 17th, 2017

For the last decade, injury frequency has been trending steadily lower. There are a number of reasons for this: automation, loss of manufacturing jobs, better safety engineering, etc. Injury severity, however, has not followed suit despite technological gains in claim administration and medical management and an ever so slow move to the use of predictive analytics.

This creates challenges for employers, especially of the small and middle market variety, and, to a certain degree, even for a few national, enterprise accounts who find themselves pretty much where they were ten years ago in terms of style and policy with respect to workers’ compensation. One reason for this is the deep rooted legacy mentality and resistance to change of many insurers and Third Party Administrators. In many ways, these organizations remind me of flies circling around a light in a lampshade, mistaking movement for progress.

However, employers still foot the bill and are still in command. Keeping in mind that the workplace is the best place to control workers’ compensation costs, employers still need to build and maintain solid programs to prevent and contain loss. Case in point is Bob Oberosler, Vice President of Loss Prevention for Rite Aid, a national pharmacy chain. At the New Jersey Self Insurers Association’s Annual Meeting a couple of weeks ago, he described his company’s work to craft a forward thinking loss prevention and workers’ compensation management program and communicate it to employees who are far and wide, indeed. But before that could happen, Mr. Oberosler said, he faced an even more daunting task – getting management’s commitment and buy-in to the effort. The good news is this happened and Rite Aid has been enjoying some spectacular results because of it.

This got me thinking. In order to sustain C-Suite commitment, a risk manager, or Loss Prevention VP, such as Bob Oberosler, needs to provide the Leadership team a steady, easily understandable Performance Measurement Results Dashboard. So, what should be the characteristics of such a Dashboard?

Performance measurement should have four characteristics: It should be simple, it should be meaningful, it should be consistent and it should be continuous.

By simple, I mean easily and quickly understood by senior management. Meaningful means that it should sit in senior management’s sweet spot; it should be something that is anticipated and valued by leaders. It should be consistent, because those leaders, once trained to view performance in one way, do not appreciate abrupt course changes. And to be effective over the long term, it has to be a continuous and routine process. The mantra should be: What is consistently well-measured is highly valued.

With this framework in mind, I usually recommend that monthly or quarterly reports to senior management measure two things religiously: Incurred losses per full time equivalent employee (and this should be done by department, division and company) and incurred losses per every hundred dollars of payroll (again, split out by department, division and company). Before any measurement occurs, however, management should settle on targets, which should be a bit of a stretch, but attainable. And target selections should be set against actual performance in the prior three or four years. For instance, if costs per FTE have been in the $200 to $300 range in the last few years, a good target would be a reduction of 30% to 40% in the current year.

Senior managers have finite attention spans. Therefore, workers’ compensation performance measurement should fit on one page, a Scorecard that senior management can assimilate in no more than a few minutes. If the information is pithy enough, that’s as long as it should take, but it should also lead to fruitful discussion about management actions to enhance performance, discussion that comes out of knowledge.

There are many other solid and valuable workers’ compensation metrics, but, in Lynch Ryan’s experience, these two are the ones that senior managers appreciate the most.

All of this assumes, of course, that, as at Rite Aid,  a serious and ongoing safety, workers’ compensation and injury management program is humming along and that all parts of the organization have been trained in how to keep it that way.

The Psychosocial Buzz Is Getting Louder

Friday, March 24th, 2017

“We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality, or even litigation. It is the negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury.

This suite of roadblocks is classified as “psychosocial” issues – issues which claims leaders now rank as the number one barrier to successful claim outcomes according to the Workers’ Compensation Benchmarking Study’s 2016 survey – and they drive up claim costs far more than catastrophic injuries, mostly due to delayed recovery.”

That’s the beginning of a new White Paper authored by friend and colleague Peter Rousmaniere and Rising Medical Solution’s Rachel Fikes. The Paper, How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity, reports on Rising’s 2016 Benchmarking Survey and describes how the workers’ compensation claims management community is ever so slowly coming to realize the leading cause of delayed recovery for America’s injured workers is psychosocial in nature and that efforts to deal with this have, up to now, been woefully inadequate.

Rousmaniere and Fikes point to enlightened employers and insurers who are leading their companies to a greater acceptance of the need for competent, professional intervention to help injured workers overcome mental and emotional barriers delaying their return to employment.

They cite the work of Denise Algire, Director of Risk Initiatives and National Medical Director for Albertson Companies, a grocery chain with more than 285,000 employees. They also report on efforts by The Hartford, Nationwide Insurance and CNA.

All of the progressive actions undertaken by these organizations have one thing in common: the development of an empathic interview methodology devoted to understanding the “whole person” to discover which claims will need more intensive and specialized intervention.

At the Albertson Companies, Ms. Algire espouses the Advocacy-based model of claim management. This model emphasizes building a conversational and trust-based relationship with an injured worker through organic dialogue. She has introduced a modified Linton tool for screening injured workers for psychosocial comorbidities and has contracted with an external telephonic triage firm to conduct initial screenings.

At The Hartford, Medical Director Marco Iglesias reports 10% of claims fall into the psychosocial bucket with at least one psychosocial comorbidity, but they consume 60% of total incurred costs. He says adjusters now ask each injured worker an important question: “When do you expect to return to work?” The Hartford’s analytics indicate any answer longer than ten days is a red flag for the future.

Nationwide Insurance, under the direction of Trecia Sigle, VP of Workers’ Compensation Claims, is building a specialized team to address psychosocial roadblocks. Nationwide’s intake process will consist of a combination of manual scoring and predictive modeling, and then adjusters will refer red-flagged workers to specialists with the “right skill set.”

Pamela Highsmith-Johnson, national director of case management at CNA, says the insurer introduced a “Trusted Advisor” training program for all employees who come into contact with injured workers. CNA’s Knowledge and Learning Group helped develop the training with internal claims and nursing staff.

This White Paper adds to the now undeniable research indicating the psychosocial problem is the biggest one facing the workers’ compensation claims community today. The leading experts agree that empathy, soft talk and the advocacy-based claims model is the method of choice for helping injured workers whose claims carry a psychosocial dimension. The experts cited in the White Paper all agree that adjusters will require extensive and repetitive training to learn the new techniques.

However, all of this is a heavy lift for an adjuster community overburdened and overwhelmed with work, a group for which the average lost time claim load is often north of 150. Even with better training, they can’t do it alone. To really turn the psychosocial tide will require a well-rounded team of claims adjusters, nurses, case managers and external, well-trained clinicians working together with transparent, technologically advanced communication.

The missing links thus far are those well-trained clinicians and the advanced communication. Without these two components, the adjuster community will be sore-pressed to achieve meaningful results.

Workers’ Compensation’s Costly Psychosocial Issues (2)

Wednesday, February 1st, 2017

First, a review.

Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. We confidently picked up our saw and walked out on the proverbial limb to suggest this thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

Finally, we listed the serious factors that make finding a solution to this looming crisis tremendously difficult.

But early in 2015 in New Jersey two Neuropsychologists, Mary Ann Kezmarsky and Richard Filippone, had an idea. Over a couple of decades, they’d treated a number of workers’ compensation claimants and had been appalled by what appeared to be the lack of a coherent system to deal with the issues they saw in their patients. They weren’t exactly sure what to do about it – they didn’t know much about workers’ compensation – but they saw it as a business opportunity.

They contacted me, and over the next year we created a company, Work Comp Psych Net (WCPN), and built a systemically organized and integrated specialty network of workers’ compensation clinicians and therapists to treat injured workers in New Jersey who might have behavioral health issues delaying recovery. Here’s how we did it:

  1. Over the last half of 2015, we recruited, credentialled and vetted 44 mental health professionals covering 55 offices throughout New Jersey’s 21 counties. Providers within WCPN’s network include psychologists and neuropsychologists, as well as cognitive rehabilitation and biofeedback specialists. All of the clinicians and therapists gave up a weekend to attend Lynch Ryan training in workers’ compensation. They learned about the New Jersey law, as well as the way workers’ compensation works – how a premium is constructed and  what indemnity and medical benefits are. They now understand experience modification, maximum medical improvement and the law regarding injuries “arising out of and in the course of employment.” Further, they have been educated regarding early return to work and have agreed to work with employers, adjusters and nurses to effectuate modified duty wherever possible.
  2. We built (with difficulty, because it wasn’t easy) the nation’s first electronic Claimant Intake & Referral Portal that allows claims adjusters, nurse case managers and attorneys to refer a claimant instantly. The paperless portal’s referral system is geographically and specialty based, meaning that referrers are assured that claimants will not have to travel far to reach their assigned clinician. In the past, referrals and appointments took weeks, even months, to arrange, but they can now be finalized within minutes. In Beta Testing from May through October, 2016, the longest time from referral to Provider scheduled appointment was 27 minutes.
  3. We built (with even more difficulty) the nation’s first mental health Electronic Health Record system for workers’ compensation. The EHR is set up as a roadmap for all WCPN clinicians to follow, meaning reports have a consistently structured form. The EHR is paperless, HIPPA-compliant and cloud-based. Initial Psychological Evaluations and subsequent treatment reports reach claims adjusters in pdf form within five business days.
  4. Our clinicians are all highly qualified and experienced; they know how to treat workers with mental health issues delaying recovery. But to make the system work we needed to understand the needs of adjusters and defense attorneys who would be referring the injured workers the clinicians would treat. Consequently, we conferred with experienced adjusters and defense attorneys. After doing so we decided that every referral would begin with a thorough Initial Psychological Evaluation (IPE), which, although not technically an IME, would be done at the IME level (we priced the IPE at $450, and, since nobody’s complained, we now think that’s too low, but we’re sticking with it). If the Initial Psychological Evaluation determines the presence of one or more mental health issues which are deemed to be work-related and requiring treatment, the treatment prescribed is initially authorized for up to 12 sessions unless medically justified, extraordinary circumstances are present. Additional treatment requires the approval of the referring party.

We officially launched in November, 2016. Over the intervening three months  we’ve learned two things (among a lot of others): First, our solution works extremely well; referrers have been highly receptive and pleased. They appreciate the ease of referral and the EHR reports.  They appreciate even more the fact that our clinicians and therapists have been trained in workers’ compensation. We’ve signed contracts with insurers and TPAs. Second, this could be a national solution.

So, our solution is working in New Jersey, but every state workers’ compensation system is grappling with how to deal with psychosocial issues that frequently hobble recovery. This may be work comp’s final frontier. Time will tell whether our template and software could help others. Regardless, we will continue to improve our solution at Work Comp Psych Net, as well as report on our outcomes.

It’s taken us nearly two years to get to this point, so if any reader wants to take this issue on in another state, we’d be happy to offer the wisdom (and sometimes folly) of our experience.

 

 

Are We Only Paying Lip Service To Psychosocial Issues In Workers’ Compensation?

Wednesday, November 4th, 2015

It is a cliché in the workers’ comp industry that claims adjusters never want “to buy a psych claim.” Perhaps that’s why they rarely resort to psychologists until the horse is out of the barn and grazing four pastures over. By then it’s a last resort kind of thing.

I was reminded of this last week in Idaho at the Industrial Commission’s annual conference when Bob Wilson opined during his presentation that he considers the “psychosocial” issue one of the most difficult facing the workers’ comp industry today, one that will become even more problematic tomorrow, a veritable iceberg dead ahead.

I could not agree more.

So, why is it adjusters don’t want to “buy a psych claim?” Pretty simple, really. Most claims adjusters have had the unfortunate experience of referring an injured worker to a psychologist after all else has failed only to discover that the injured worker turns into the psychologist’s lifetime annuity and the adjuster’s worst nightmare. Treatment goes on forever. Also, it often turns into an attitude thing. Claims adjusters consider “going on forever” claims their “problem children.”

That’s a logical inference. The steady march of time is a formidable opponent as one tries to assist an injured person to return to the bosom of the workplace. The longer a worker stays out of work, the more difficult the problem becomes. Comorbidities begin to sprout like the weeds in my woebegone garden. In many cases, staying out of work becomes the new full-time job. What’s an over-burdened adjuster to do?

Perhaps on Day 1 of the claim giving strong consideration to the psychosocial would help. Unfortunately, as adjuster pros know, the First Report of Injury won’t give many clues here. Deep digging is required. If available, predictive analytics can be the adjuster’s best friend. Still, an even better bosom buddy is experience. Over thousands of conversations with injured workers, an experienced claims adjuster will acquire a profound recognition of nuance. Not settling for the basic questions, but rather peeling the injured person’s personality onion to discover what really matters will allow for early detection of those relatively rare cases where speedy referral to a qualified psychologist might make all the difference.

And psychologists need to shoulder some responsibility here. Most know not even the first thing about workers’ compensation and give every indication of being proud of it. The only insurance premium that matters is the one labeled “Malpractice.” Experience Modification is nothing more than an oxymoron. Many do not understand, and do not want to understand, that helping someone become as mentally healthy as the day of exiting the womb is not the same thing as maximum medical improvement.

And what if payers and psychologists could agree to the rules of the road right up front. For instance, coming to an understanding about qualitative and quantitative goals, about the need for a finite number of sessions, about agreeing that there are certain signs which, if manifested at the beginning of a claim, suggest that the claim would benefit from early psychological intervention? And what about the idea that entrance into a payer network should not be determined solely by a License to practice and the forced acceptance of a ridiculously low fee? Quality and results matter.

There’s a fair amount of education that ought to go on here. Payers would be wise to begin that education today. Why? Because identifying early and resolving quickly the factors that have the potential to turn physical injuries into mental health problems will save employers, the folks who pay the bills, a significant amount of money and adjusters, whose goal it is to put the toothpaste back in the tube, considerable otherwise wasted time.

Peter Rousmaniere’s Seismic Shifts in Workers’ Comp: A Thought-Provoking Call To Arms

Monday, February 23rd, 2015

In the mid-1980s, workers’ compensation underwent a management revolution. Until then, employers bought insurance policies, and when injuries occurred passed the baton to their carriers. Then they went back to making widgets trusting that the carriers would take care of everything.

That didn’t work out so well, and costs took a rocket ride to the moon. Across America, employers looked for help. Why would injured workers remain out of work long after it was medically necessary for them to do so. The answer, as we all know, was found in the mirror. Employers, themselves, were the key to getting injured workers back into the bosom of the workplace, but they’d never been taught how to do that. Didn’t know it was their job.

Thus was the workers’ comp management consulting industry born. My company, Lynch Ryan, was first out of the gate. We were the Pathfinders, and Peter Rousmaniere was Employee Number 3 in what was to become a 55 person firm. Peter – Groton School, Harvard BA, Harvard MBA – wanted to join us because he was looking for a challenge. I wanted Peter to join us because he was really smart, and his brain worked like nobody’s I’d ever met. Peter thought “outside the box” before there was an outside the box.

Peter still thinks like nobody else, and today Work Comp Central has published his Seismic Shifts: An Essential Guide for Practitioners and CEOs in Workers’ Comp, subtitled, How Technology and Demographics Will Impact Workers’ Comp From Today Through 2022. This self-funded, year-long venture looks out into the future and envisions another revolution, one that we ignore at our peril.

In Seismic Shifts, Rousmaniere catalogues the nearly unnoticed, but drumbeatingly steady, changes in workers’ compensation since the early 1990s. He shows that since 1991 lost time injuries have declined by 60% and projects that by 2022 there will be a further decline of at least another 35%. He is perplexed about how the insurance industry has missed this decline in injuries and claims, what he calls ‘the elephant in the room,” and suggests that it has done so because for more than a decade it has been obsessively fixated on medical costs, an observation with which I agree. Rousmaniere contends that the insurance industry does not understand how this has happened or why.

His thesis is that this sea change, this seismic shift, is the result of employer improvements in safety engineering, information technology, telematics, robotic design, predictive modelling analytics and the continuous yearning for enhanced productivity. And most important, this natural gravitational movement will continue inexorably. Further, he believes that the workers’ compensation insurance industry has not considered where all of this will lead, how it can be part of and optimize this transformational movement and what kind of workforce it will need to take advantage of this new paradigm.

In Rousmaniere’s view, workers’ compensation practitioners, as well as occupants of the C-Suite, would be well-advised to understand what’s happening and embrace, rather than resist, these evolutionary developments. In his mind, the embracers will succeed and control the future; the resisters will be swept away. It’s as simple as that. He describes, as example, the profound employer movement toward total absence management, rather than merely occupational absence. The move toward total absence management is gathering steam at larger employers, and workers’ comp insurers don’t know what to do about that. Neither do they have a plan for coping with the “opt out” phenomenon. First Texas, then Oklahoma, and just last Friday legislators in Tennessee filed opt-out legislation built on the Oklahoma model. This is becoming a trend.

But the workers’ compensation industry has never distinguished itself in the race to the future. It will be interesting, indeed, to see if Rousmaniere’s clarion call is even acknowledged by today’s potentates. To help it along Work Comp Central is hosting a 4-part webinar series during which Peter will lay out his thesis and try to persuade others in the workers’ comp community to join him in his effort to drag the industry kicking and screaming into the future. Check with Work Comp Central for dates of the Webinars.

Seismic Shifts is an important work, one deserving of your attention and consideration.

LexisNexis: Furthering the Workers Comp Community

Monday, December 22nd, 2014

I am not a lawyer, thank you very much, but I am married to one. So, you may imagine that I am familiar with more than a few members of the breed. I’ve heard every lawyer joke there is (but if you want to send me a couple of your favorites, that would be OK).

In the mid-1980s, the early days of Lynch Ryan, I often heard my attorney friends saying they had to search “Lexis” for one thing or another. Since they were occasionally charging me for doing that, I wanted to know a bit about “that Lexis thing.” Over lunch one day I was educated about this remarkable innovation for the legal community, an innovation that was actually saving me money.

The whole thing began as a searchable database experiment of the Ohio State Bar in 1967. In 1970, the Mead Corporation’s Mead Data Central took it over and named it Lexis. In 1973, Mead made Lexis’s full text search available for all cases in Ohio and New York. In 1980, after a 7-year key punch effort (you read that right), Lexis went nationwide for all federal and state cases. That same year, Mead launched the Lexis sister, Nexis, which allowed journalists to search news stories related to law.

In 1994, Mead sold LexisNexis to Reed Elsevier for $1.5 billion. Not a bad return on investment from those Ohio State Bar days.

Starting in 2000, LexisNexis began to get into the risk solution business, primarily by acquisition: Riskwise in 2000 and ChoicePoint, a data aggregator, in 2008. By the time of the ChoicePoint buy, LexisNexis had become profoundly involved in risk, especially workers compensation. It became a leading publisher of workers compensation material, including Larson’s Workers Compensation Law.
The LexisNexis Senior Editor for all things workers compensation is Robin Kobayashi, a ridiculously smart and talented person (Phi Beta Kappa from UCLA — by contrast, the closest I ever got to Phi Beta Kappa was admiring Gary Anderberg’s pin).

Robin is the visionary who decided to recognize workers compensation bloggers, beginning in 2009. That year there was only one winner, and I’m proud to say we were it. However, beginning in 2010, Robin expanded the award to the top 25 blogs, realizing that there was a wealth of insightful Web commentary that cried out for recognition.

Recently, LexisNexis announced the top 25 workers compensation blogs for 2014, a most distinguished list, and we congratulate everyone on it. However, during this time of recognition, I thought it might be a good idea to shine the Workers Comp Insider arc light on the far-sighted professional who made this award possible, thus deepening and expanding the workers compensation community in a meaningful and long-lasting manner.

For her vision and dedication, we salute Robin Kobayashi.