Finding the right Rx
for your Workers’ Compensation program
Those who oversee safety in the workplace have every right to be proud.
There is no doubt that today’s workplace is safer than ever. Since
1991, the frequency of workplace injuries is down approximately 50%, thanks
to the hard work of safety professionals and engineers, the advent of OSHA
in the 1970s, safe workplace practices, cordless tools, modular construction,
even robotics, which has lessened human interaction with potentially dangerous
machinery.
So if this increased attention to safety has led to a decline in the number
of workplace accidents—which
has resulted in fewer claims and lower rates—then why has the cost
of claims risen dramatically over the years? Why have some workers fallen
through this safety net? The answer is simple: higher medical costs
are the direct result of alarming increases in utilization of medical services.
According to a recent study by the NCCI, the factor driving medical severity
is the growth in the number of medical treatments and the different mix
of treatments. The study took a look at the years 2001-2002 as compared
to 1996-1997, and found that the number of treatments for all diagnosis
increased 45%, while with such injuries as knee and leg sprains, the increase
was as high as 80%.
Through negotiations, doctors have been cajoled into accepting lower fees,
and to counteract these losses, medical treatments have increased. Think
of it like squeezing a balloon; when you pinch in on one end, it expands
on the other. Doctors are for the most part not following evidence-based
treatment protocols as set forth by the American College of Occupational
and Environmental Medicine (often referred to as the ACOEM Guidelines).
And by not doing so, we are witnessing medical treatment plans that are
misdirected and unnecessary, coupled with increased levels of treatment,
additional testing, and the high cost of doctors to run the tests.
What we aren’t seeing is anyone challenging these recommendations.
The reason is quite simple; no claims adjuster has ever been fired for agreeing
with a doctor’s recommendation. And nobody wants to be the first.
The bottom line is that the only thing more costly than a good doctor is
a bad doctor.
Another major danger with over-utilization is that the steady stream of
doctor’s visits, MRIs, prescriptions, therapy sessions, etc., creates
in the employee a mindset that says, “If I’m undergoing all
this treatment, I must really be hurt.” The injured employee
then slips into a deep mental chasm referred to as “secondary gain
behavior,” where his decisions are driven more by his emotions than
his economic well being, often resulting in litigation and the loss of a
valuable employee.
Another negative by-product of over-utilization has been the recent introduction
into the Workers’ Compensation system of narcotics, once solely prescribed
for individuals in their last months or weeks of life. Where years ago an
employee might be given a couple of Advils for a backache, today it is not
uncommon for doctors to prescribe drugs such as Oxycontin for the same ailment.
The overuse of narcotics in the workplace causes bad things to happen. New
problems are created. But if the injured worker doesn’t get the prescription
from one doctor, they may simply find another. It’s not a stretch
to say you can easily pick up a magazine and find an advertisement for a
doctor willing to prescribe narcotics.
If over-utilization is wreaking havoc on the medical costs associated with
the Workers’ Comp system, then why would an overwhelmingly high percentage
of doctors suggest treatment that is not evidence-based? Simply put, doctors
have been trained this way throughout their professional lives. Since the
day they picked up their first medical book, it’s been ingrained in
them that their judgment is what’s best. That thinking is
not going to change anytime soon.
The key to solving this problem is to be sure every effort is made to select
the right doctor, one who will follow evidence-based treatment protocols
and work towards returning the injured employee to the workplace in the
appropriate time, even if in a modified position. And evidence supports
the view that workers get better quicker when they are back on the job.
To find the right doctor, engage in dialogue with other companies and businesses
in your area, looking specifically for those trained in occupational medicine.
And once you find the right physician, remember —communication
is key. Doctors shouldn’t have any doubt that their recommendations
and restrictions will be respected. Furthermore, they need to fully understand
the return to work possibilities that exist. The steady flow of information
between the doctor, the employer, and the claims adjuster is the first step
in changing a system that is severely eroding the good work being done by
safety officials. |