Posts Tagged ‘return to work’

Reader Reactions To Our Psychosocial Issues Series

Tuesday, February 7th, 2017

A number of readers wrote to us about last week’s two-part series on psychosocial issues and how they confound claim adjusters and increase costs. A few readers pointed out that we paid scant attention to the “social” in psychosocial. These adjusters and nurses wrote that too often they’d seen and handled claims where life and “societal issues” seemed to get in the way of recovery. Sue Separa, who has overseen workers’ compensation claims for more than 30 years in 40 states and jurisdictions, put it this way:

Employee loses car, loses license, loses driving privileges and can’t get to work, but still needs a source of income;

Employee is having daycare issues and needs to be home, but also needs a source of income;

Employee has a sick relative or child they need to stay with/watch, but still needs a source of income;

Employee is attending school to better themselves, has a heavy school schedule, but still needs a source of income;

Employee has a comorbid or health situation that requires medical care and possibly surgery or absence from work, and has not secured short term disability, or it is not available with the employer; 

Employee has asked for vacation time and it is denied due to no time left, or not eligible, or because someone else is off work at the same time.

And she’s right. Of course these real life situations occur. However, they’re present and happen all the time without injuries, too. They are non-physical, “social” comorbidities; things that can easily impede and delay return to work. Unless, that is, claim adjusters are trained and experienced enough, as Ms. Separa is, to dig a little deeper, find them and address them appropriately.

We also heard from our friend Robert Aurbach who wrote from Down Under to say, while he “applauds” our efforts and thinks “they are valuable,” he suggests “perhaps they don’t go far enough.” Rob believes the “problem is partly the system itself;” we create the harm I cited. As that great American philosopher, Pogo, opined on Earth Day, 1971, “We have met the enemy and he is us.” The system is iatrogenic (system caused).

Rob Aurbach also sent me a paper he authored in late 2015 for the Injury Schemes Seminar, put on bi-annually by the Australian Actuaries Institute. In the Paper (opens in pdf), titled “Better Recovery Through Neuroscience: Addressing Legislative and Regulatory Design, Injury Management and Resilience,” (bit of a mouthful that, but it won the Taylor Fry Award for the Seminar’s best paper) Rob explores Neuroplasticity, a theory dating from the 1800s and recently confirmed by functional Magnetic Resonance Imaging. Neuroplasticity is the process by which our brains continually rewire themselves throughout life due to environment, behavior, thinking and emotions. In short, it’s true; our brains are malleable. Rob writes that when work is disrupted through injury (or, through anything, really) for a long enough period, Neuroplasticity begins rewiring the brain to adapt to the new situation – being out of work. In other words, our brain creates a new “facilitated neural network.” This can happen in as little as 12 weeks, as Rob points out:

Timing is everything. There is a substantial research literature demonstrating that if a worker does not return to work within 12 -16 weeks, the probability of eventual return is reduced to 50% or less.

Rob Aurbach’s paper is a valuable contribution to understanding how easily a claim can deteriorate to the point where an injured person’s life is forever changed, and not for the better. I urge you to read it. It’s well-researched, well-written and profoundly thoughtful. Twenty-seven pages long, the last seven of which are endnotes and references. I found the first half of the text compelling and enlightening. His common sense recommendations that follow are pretty simple, but wickedly difficult to implement: Claim managers and adjusters should intervene early, demonstrate respect for the injured worker, promote early return to work, align incentives that encourage recovery, restrain negativity, listen attentively to the worker’s story, etc. In short, all the things managers, nurses and adjusters like Sue Separa know they should be doing, anyway. Trouble is, for these often overworked professionals, each managing a steamer trunkful of claims, there isn’t a lot of time to devote to Rob’s prescription. The iatrogenic system isn’t built to allow it.

And that’s where behavioral health clinicians and therapists, for the most part underused and undertrained, should be called on to help. Work Comp Psych Net, the New Jersey company I described last week, would be a good place to start.

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.

Annals of Aging: Return to Work at 80?

Wednesday, December 26th, 2012

As the New Year looms, the 100 year old workers compensation system continues its awkward foray into the 21st century, it encounters problems beyond its original design: the widespread availability of opioids, increasing sophistication in medical interventions, and an aging workforce. Today we examine a formerly inconceivable conundrum: can an 80 year old man be expected to return to work after an injury?
Kenneth Brunner graduated high school in 1949 and worked steadily all his life: From 1951 through 1993 he ran the family dairy farm with help from his wife, an accountant. Brunner raised crops; used a tractor, plow and other farm machines, kept track of feed and each animal’s output. He took milk samples from each cow and sent them for analysis; after receiving reports, he adjusted feed for each animal to maximize output. He supervised two to three individuals on the farm.
From 1954 through 1984 he supplemented his farm income by driving a school bus – work which, in the view of the Ohio workers comp commission, required the ability to work independently and use judgment.
From 1968 through 2000 Brunner also was employed as an insurance adjuster. He estimated crop loss for an insurance company, a job that required using scales, taking samples and writing reports. In 1990, at age 58, he was certified for insurance sales.
In January 2011, at age 77, he was working in a maintenance job, when he tripped on a drain pipe and fell face first onto pavement. His injuries were severe:bilateral frontal bone fracture; fracture lateral wall right maxilla; fracture bilateral paranasal sinuses; closed fracture bilateral nasal bone; open wound of forehead; abrasion face; closed fracture C2 vertebra.
He received workers comp benefits. A couple of years into his recovery, he filed for permanent total benefits (PTD). Brunner was 80 years out and had had enough of working.
Brunner’s treating doctor concluded that he would never work again:

This claimant has an injury that is permanent and for which there is no curative therapy. This claimant has progressively suffered loss of function and has had to endure progressively more pain. The exam above shows that there is so little functional capacity and that the claimant is so affected by his condition and its required care, that there is no capacity for sustained remunerative employment and that there is no reasonable employer that would ever hire the claimant expecting any work capacity.
Based on the examination above, review of documents, and based on sound medical reasoning I find that the allowed physical conditions, independently and by themselves, render the claimant permanently and totally disabled and unfit for all sustained remunerative employment.

Once a Worker, Always a Worker?
The Ohio workers comp commission reviewed Brunner’s claim for PTD benefits. They took into account his age, as well as his resume in determining that he was still capable of working. While most of his living involved physical labor, throughout his working life Brunner had displayed skills that at least theoretically were transferable to sedentary work. As a result, they rejected Brunner’s request for PTD benefits. The commission did not address the likelihood of anyone offering Brunner a sedentary job.
An appeals court upheld the denial of the claim, finding that the commission did not abuse its discretion: (1) in weighing Brunner’s age in assessing the non-medical factors; and (2) in determining that Brunner has some transferable skills.
It appears that Brunner’s longevity worked against him. He labored well into his 70s and displayed unusual fortitude in recovery from serious injuries. Because the premise of PTD payments is protection for disabled workers who are available for work but no longer able to do it, Brunner finds himself ineligible for benefits. In a supreme irony, his ability to work as an older worker precluded the conclusion that he was unable – even at 80 – to continue working.
Brunner’s dilemma is by no means unique. As the workforce ages, as more and more workers continue labor late into their seventies and even 80s, a paradox emerges: the point where one is too old to work recedes into the haze of the future, leaving injured older workers in a gray zone where their permanent injuries may or may not be compensable and where their (theoretical) ability to work mitigates against their being paid not to work.
In the months and years ahead we will see more and more litigation involving the claims of “older” workers with ages far beyond what was contemplated in the original workers comp system. State by state, the system will have to respond, becoming the focal point of economic, social and even psychological forces that are far larger than workers, comp stakeholders and state policy makers combined. This is an evolving narrative of surpassing interest. Stay tuned.

Tools: video presentations on RTW, disability management & more

Thursday, July 28th, 2011

The Disability Management Employer Coalition is a non-profit dedicated to advancing strategies and resources that improve workforce productivity by minimizing the impact of absence and disability. The organization offers a variety of tools and research materials – and we’ve just discovered a stash of video clips on a variety of topics from recent presentations. We think they are well worth checking out – here’s an index:
Best Practices in Return to Work
This presentation is from the Leadership Series, an employer-only, focus group approach to the investigation of high-profile issues. This 6/23/2011 session (Length: 1:16) deals with Return to Work. Employers share best practices in both work-related and non work-related situations that can be easily incorporated into a company’s culture. it also explores common characteristics of several programs and identifies the pros can cons of plan design.
Stress & Resiliency: Applying Research of Employer Best Practices @ Your Workplace
From the “Tools & Tactics” webinar series, 6/09/11, length 1:01
A report on research conducted in collaboration with DMEC, the Partnership for Workplace Mental Health, and other organizations. Study participants included multidisciplinary representatives from 40 different workplaces, and offers specific examples from employers and strategies for applying best practices at your company.
What If There Were a Money Pill? Financial Security & Workplace Wellness
From the “Tools & Tactics” webinar series, 5/26/11, length 49:42
Dr. Ron Leopold explores both the financial and wellness aspects of disability and how it affects recovery and RTW. Learn how you can implement small changes to make the process run smoother and insure employees avoid costly disability events.
Absence, Wellness and Engagement: A Critical Link
From the “Tools & Tactics” webinar series, 5/12/11, length 57:27
What do patterns in absence and disability tell us about the health status of our workforce? And what can we do it about it? This talk Explores the results of research done at Nationwide Better Health to quantify the true impact of costly health risks and tells how several employers are getting results from a proactive management approach.
Johnny’s Not Back at Work?: Corporate Strategies for the Less Than Motivated
From the Virtual Education Forum, 5/10/11, 1:12
The Virtual Education Forum is a series of web-based sessions where employers and service providers share their knowledge and first-hand experience in developing and running a successful disability and absence management program. This session deals with calibrating the likelihood of a successful RTW will be presented along with corporate worker’s compensation and disability case studies applying a unique motivational model.
Managing Absence in Recessionary Times: Research Update
From the “Tools & Tactics” webinar series, 4/28/11, length 1:04
This session offers findings from Mercer’s 2010 Absence Management Survey
I thought it could never happen to me
From the “Tools & Tactics” webinar series, 4/21/10, length 49:47
Dr. Ron Leopold on the emotional and financial impact of disability.
ADAAA Update: What the First Cases and New Regulations Tell Us
From the “Tools & Tactics” webinar series, 3/31/11, length 1 hour
This annual update provides insight into the implications of recent case law as well as offering suggestions on how to insure your program is set to respond appropriately.
Upcoming events
To learn about upcoming DMEC events, check the DMEC Virtual Education Forum events and the Tools & Tactics Webinars. Events are free to members; nonmembers can also attend for a reasonable fee.

Health Wonk Review’s Spring Training edition & assorted news items

Thursday, March 17th, 2011

Health Wonk Review – What do baseball and healthcare have in common? Find out – Glenn Laffel of Pizaazz hosts a fresh helping of the best of the health policy blogosphere: Health Wonk Review: Spring Training Edition
Does an anti-immigrant climate affect workers comp costs? – At Comp Time, Roberto Ceniceros discusses a recent news story in which Tom Hensley, president of Fieldale Farms Corp, testifies before the Georgia General Assembly about the detrimental impact that anti-immigration measures are having on his business. The impact included higher turnover and higher workers comp costs. Roberto is interested in hearing if anybody else has witnessed a similar trend of Latinos fleeing a state because of anti-immigrant sentiment and then claims trending upward – drop him anot if you have something to add.
Can you hear me now? Musicians and other workers who are exposed to loud music in their workplace are typically given short shrift in the occupational safety and health literature. Recent studies at nightclubs show that all employees (waiters, bartenders, DJs, etc,) were exposed to noise levels above internationally recommended limits and were at a higher risk of early hearing loss and tinnitus. The NIOSH Science Blog discusses music-induced hearing loss.
Giffords covered by work comp – Stephanie Innes of the Arizona Daily Star reports that federal workers’ comp is footing the recovery bill for Gabrielle Giffords and two of her employees who were shot in January. Because they were working, it’s an on-the-job injury. The federal law has no cap on medical payments, which is fortunate since the story reports that, “The Brain Injury Association of America says inpatient rehabilitation costs can range from $600 to $8,000 a day depending on services, and outpatient rehabilitation can cost $600 to $1,000 a day.”
Shrinking employer appetite for RTW? – Joe Paduda looks at how the economy may impact workers comp in 2012. Is higher severity in the offing? Joe talks about why that might be the case.
What makes a good claims organization? – At PropertyCasualty360, Carl Van, president and CEO of the International Insurance Institute, Inc., has posted the first in a three-part series on The Five Standards of Great Claims Organizations. See how your organization or your vendor stacks up.
Complex care – the folks at TMS continue to demonstrate that in complex care cases, the devil is in the details – and those details may be impeding an injured worker’s recovery and costing you money. See Pressure mapping: The underwear case for another example of how a small problem can become a big one.
Cool tool – Calculate your injury and illness incidence rates for your organization and compare them with national, state-specific, or industry-specific averages: Incidence rate calculator and comparison tool
Jobs of yesteryearPtak Science Books features a series of photos of Pennsylvania Coal Boys on the job in 1895 excerpted from an issue of Scientific American.
JapanHR Web Cafe has posted various resources, including options for donations. The interactive before and after satellite images are very dramatic, giving some sense of scope.

Record workers comp-related ADA payout

Wednesday, February 17th, 2010

An employer’s failure to to accommodate an injured worker to return to the workplace can be costly – just ask Sears Roebuck & Co., who learned the hard way. The U.S. Equal Employment Opportunity Commission (EEOC) just announced that Sears will distribute $6.2 million to 235 former employees, the result of Americans With Disabilities Act (ADA)-related litigation. The monetary distribution stems from a September 2009 consent decree which resolved a class lawsuit against the retail giant. It is the largest ADA settlement in a single lawsuit in EEOC history.
This case began in 2001, when appliance technician John Bava injured his knees, wrist, and back after falling down the stairs while on a service call at a customer’s home. The injuries required two surgeries and physical therapy.

“Afterward, he tried to go back to work under restricted conditions in which he would not be required to kneel or squat for a prolonged period. “They wouldn’t let me come back,” he said.
Bava, 58, said he applied for several other jobs at Sears, including a service manager position that he claims went to someone younger and less qualified. He said he learned he had lost his job when his wife tried to use his employee discount card and found it had been canceled.
Bava obtained a copy of his personnel file from Sears, and found a memo saying he had been fired for medical reasons.
Bava said he now works as a repairman for another employer and stays busy despite the restricted conditions that his injuries make necessary.”

Bava filed a discrimination charge through the EEOC. A subsequent investigation by EEOC turned up 235 other employees who sought return to work with an accommodation, but were fired by the company; more than 20 other claimants’ situations were investigated and found to be ineligible.
The average award is approximately $26,300. According to reports in the National Law Journal via Law.com, employees will receive between $2,500 and $122,500 each, depending on their individual circumstances. As with all EEOC litigation, none of the settlement fund will retained by the EEOC; all of it will be distributed.
Employers would do well to examine their own return-to-work policies and programs in light of the other provisions that the three-year consent decree prescribes beyond monetary relief: an injunction against violation of the ADA and retaliation, a requirement that Sears amend its workers’ compensation leave policy, and train its employees regarding the ADA. Sears must also provide written reports to the EEOC detailing its workers’ compensation practices’ compliance with the ADA and post a notice of the decree at all Sears locations.
Besides compliance with the ADA, there are several other lessons to be learned by the stunning lack of communications evidenced in this case:

  • When an employee is out on disability, stay in frequent communication to monitor their recovery progress
  • Have a return-to-work goal and plan for all injured workers
  • If you fire employees, tell them! They shouldn’t have to learn about it through canceled benefit cards.

New Health Wonk Review posted; other noteworthy news

Thursday, October 1st, 2009

For another biweekly issue of the best of the health policy blogs, Brady Augustine hosts The Boys (and Girls) of October edition of Health Wonk Review at medicaidfirstaid. Get a little baseball nostalgia with your health policy. For our neighbors in the Boston area, Brady recalls the era of Carlton Fisk, Carl Yastrzemski, Fred Lynn, Jim Rice, and Luis Tiant.
Other news notes…
ADA, RTW and the law – Failure to accommodate an injured worker as they return to the workplace can be costly. Sears is setting a $6.2 million bias case over just such an issue. Sears refused to reinstate a recovering injured worker with reasonable accommodations when he sought to return to work, and subsequently fired him. An investigation turned up more than 100 other employees who sought return to work with an accommodation, but were fired by the company.
New Mexico – “Thirty-three states, including neighboring Colorado and Arizona, already require workers’ compensation for farm workers, although some limit coverage or exempt small farms. But New Mexico’s agricultural workers fall into a job category not protected under state law.” New Mexico agricultural laborers sue for workers’ comp coverage.
PresenteeismIs presenteeism worse than absenteeism? Roberto Ceniceros looks at new research on the issue at CompTime.
Veteran issuesRisk and Insurance has been running an excellent series on issues facing vets on their return from Iraq and Afghanistan, authored by Peter Rousmaniere. The third and most recent installment: Dealing With Scar Tissues. If you haven’t been following, catch up here:
Part 1: Wounded Back Home
Part 2: Frayed Obligations
H1N1 Virus – Jon Gelman makes the case for the urgent need for workers compensation pandemic planning, noting that in the case of emergency, the Federal government has sweeping powers under the Public Health Service Act (PHS) that could disrupt employment throughout the country. He cites a recent Harvard School of Public Health study reveals that 80% of businesses foresee severe problems in maintaining operations if there is an outbreak, and looks at what this might mean to workers comp.
Flu.gov has issued Guidance for Businesses and Employers for the Fall Flu Season. Consumer resources are available at the Consumer Insurance Blog.

Brendan Doyle: Return-to-Work Person of the Year

Friday, June 20th, 2008

You probably have never heard of Brendan Doyle, a Rhode Island state trooper, but his story, as told by Amanda Milkovits in the Providence Journal, belongs in the hearts and minds of anyone involved in disability management. He exemplifies what great medicine, combined with ferocious determination and discipline, can accomplish.
Just over a year ago, he was punched to the ground by a low life named James Proulx, hitting his head on the pavement. His injuries were so severe, doctors discussed organ donation with his family. He was comatose, hooked up to a respirator, his skull shattered.
But he held on. Eventually, he was moved to Spaulding Rehabilitation Center in Boston, where doctors dismissed any notion that he would be able to return to work. He was paralyzed on his right side and suffered from double vision. But by the fall of last year, after doctors reattached a piece of his skull, Doyle noticed that his fine motor skills started to return. The double vision disappeared and he regained feeling and mobility in his right side.
Against All Odds
By this past spring, Doyle said he wanted to return to his job as a trooper: not a modified duty, desk job in the back of some precinct, but full duty. His supervisors, who supported him from day one, put him through rigorous retraining in firearms, pursuit driving, use of force techniques and through “shoot – don’t shoot” scenarios to test his reaction times. He endured the standard three week course of 13 hour days in the police academy. He passed every test with flying colors, even earning a master pin for firearms.
So against all odds, with no small element of luck, Brendan Doyle is back on the job. From the beginning of his ordeal, this was his one goal. By all rights he should have become permanently and totally disabled, drawing 100 percent of his trooper pay tax free for the rest of his life. No one would have questioned it. But Doyle refused to bow to this fate. In doing so, he exemplifies what the human spirit can accomplish despite ridiculous odds.
I would like to see a picture of Doyle, with his humble smile and crescent moon-shaped scar, posted over the desk of every ER and occupational doctor, every nurse case manager and claims adjuster – and every employer – to remind us that the goal of treatment for injured workers is return to full duty. Forget the odds. Look beyond the trauma of the incident itself and the dire prognosis. Anyone seeing Doyle in the days and weeks following his injury would have scoffed at the notion that he would ever be in uniform again. But that is exactly where he is today.
I hope never to meet Trooper Brendan Doyle: to do so would probably mean I was involved in an accident or going a little too fast on I-95 outside of Providence. Nevertheless, I will try to keep his image in mind. For all of us who work in risk management, cost control and safety, who focus on doing the right thing for injured workers, Trooper Doyle embodies the spirit and goal of our work. He is the Insider’s Return-to-Work Person of the Year.

The Best Health Care in the World: Part Five: A recap, a few questions, a conclusion and a modest proposal

Monday, March 31st, 2008

This series is meant to paint a realistic, well-sourced and objective portrait of American health care early in the 21st century as compared with that of our 29 partners in the Organization for Economic Cooperation and Development (OECD, all of us comprising the most developed democracies in the world), and to examine how workers’ compensation fits into that mix. We’ve done a lot of the former and some of the latter. Now it’s time to finish the job.
First, a bullet-point recap. In Parts One through Four we saw that:

  • American per capita health care spending is two and a half times the average in the OECD and 25% higher than our closest competitor, Switzerland.
  • American per capita health care spending on pharmaceuticals is double that of the average in the OECD.
  • We perform more sophisticated testing and surgeries than any other country.
  • Our physicians earn double the compensation of their OECD counterparts.
  • Our hospital stays are 25% shorter and our doctor visits 42% fewer than other OECD citizens.
  • Despite all the spending, we don’t live longer and are no healthier than the average among OECD countries.
  • There has been explosive growth in the incidence of Type 2 Diabetes, much of it caused by an epidemic of obesity, and 27% of the per capita increase in our spending on health care since 1987 is attributable to obesity.
  • At nearly 31%, the percentage of obese adults in the US is the highest in the OECD and 25% higher than Mexico, the country that wins obesity’s OECD silver medal, yet we been unable either to halt or reverse the growth of obesity in America.
  • Thirty-one percent of our total health care expenditures go toward insurance administrative costs, far more than any other OECD country.

Meanwhile, over on the workers’ comp side of things…
It is indisputable that health care costs in America far exceed those for any other OECD country and have been sharply and steadily rising over the last 20 years. Bleak as that portrait is, the situation with health care costs in workers compensation is even more dire:

  • Since 1996, worker’ compensation medical treatment costs, representing only 3% – 4% of total US spending on health care, have been rising at twice the rate of those sharply and steadily rising group health costs.
  • We spend significantly more to treat worker injuries than similar injuries in group health, principally because of over-utilization of medical services.
  • Pharmaceutical costs, representing 18% of total incurred losses at the fifth service year, are a large chunk of the ice beneath the water line, the costs that are often hidden and unknowable (When have you ever seen prescription drugs itemized on a loss run?). If you are an employer, ask yourself these questions: Do you have any idea of the prescription drugs your injured workers are taking? Do you have any idea of the extent to which your injured workers are being prescribed narcotics, such as OxyContin, Actiq, Fentora, Duragesic, even Vicodin? If not, you need to have an immediate talk with your insurer and your Pharmacy Benefit Manager. It’s that important.

None of us can do much about the ridiculous costs of health care in America today. To quote Hercule Poirot, the problem is “a many-headed Hydra.” But employers and insurers can do something about the ridiculous costs of health care in workers’ compensation. What, you say?
At the end of this five-part series, here is a conclusion and a modest proposal, which to many will seem trite, even pedestrian, but 24 years working with more than 4,000 clients guarantees it works:
Conclusion: medical costs grow as indemnity costs grow, because injured workers stay out of work longer than is medically necessary.
The modest proposal: A caring, aggressive, systemic, performance-oriented and measured program that focuses on a) preventing injuries from occurring in the first place and b) if injuries do occur despite your best efforts, bringing injured employees back to work in some medically approved capacity of temporary modified duty as quickly as possible. This early return to work will keep injured workers connected to the workplace and the ingrained routine of getting up, getting dressed and going to work every day. Absent that, the injured worker will stay at home where he or she will create a new routine of staying out of work and making up his or her own, stay-at-home modified duty program. If I were injured and could not go to work because my employer had nothing for me to do, that’s what I would do, and so would you. And that does not have to happen.
It’s a lot of work, but it’s as simple as that.
I’ve enjoyed writing this series. I hope it’s given you something to think about.

RTW resources from Australia

Friday, March 14th, 2008

The RTW Knowledge Base Website is a free service from Australia providing research based information and links to external resources on work disability prevention. We received a notice about this site from Mary Wyatt, an Occupational Physician based in Melbourne Australia. She offered a good overview of the site’s features, so we will take the liberty of using her description of the site:
The Return to Work Knowledge Base was developed by ResWorks (a small Australian nonprofit) with the support of the WorkSafe Victoria RTW Fund. The site has been endorsed by the Australasian Faculty of Occupational & Environmental Medicine.
The website is designed to help with return to work. The site includes:

  • Research papers translated into plain language. The articles can be browsed in interest group collections – employee, employer etc. Alternatively all articles can be seen via the ‘View all Articles’ tab. On the summary pages the article title is the link to the full text. A search facility is available on all pages.
  • Resources – links to useful information on work disability such as patient handouts, work disability reports, treatment guidelines. The link to the Resources Page for each group is at the top of the left navigation menu on the summary pages. Most links are to patient handouts, guidelines, or reports on the topic. Other links are to webcasts or videos relevant to the field.

Research is often difficult to access and for most people research is hard to read. The site translates individual research papers into a format that can be understood and houses the information in a readily accessible format. Topics include consequences of being off work in the long term, medical issues, workplace factors, system factors, and people issues.
There are two broad ways the site can help:
1. Increasing peoples’ knowledge and understanding of the area through reading the information provided on the site.
2. Influencing others. Many working in this area practice best evidence care. However it can be difficult to influence others with a less enlightened approach. The site is designed for sharing of information with the ability to send links to colleagues or print articles (eg for patients, HR managers, supervisors).