What employers need
to know about the recovery of injured workers
The Workers Comp problem
Workers’ Compensation rates have been trending downward, as have the
number of job-related injuries. Even injuries totaling $50,000 or more dropped
for the first time in 2005.
But before we let loose the balloons and congratulate ourselves on what
is clearly a notable achievement for American business, there’s another
side of the story that deserves serious attention.
Since the advent of managed care, Workers’ Compensation medical costs
have been going up. This may seem counter- intuitive since a major objective
of managed care was to control medical expenses. Although managed care helped
contain and even reduce medical fees, the positive benefits were eroded
by increased utilization of medical services.
At the same time, companies continue to send injured workers to hospital
emergency rooms where they may wait for hours to be seen by those who are
not familiar with occupational medicine. Too many times, they are dropped
off or accompanied by a worker. They can also be sent to the emergency room
alone in a cab. It is quite possible that they will not hear from a company
until they return to the job.
Since 90% of job-related injuries are first-time occurrences, workers don’t
realize they can get caught between a couple of obstacles: a cost-driven
medical system on the one hand and a business culture that isolates them
on the other.
Is it any wonder that injured workers are often confused and turn to friends
for advice and counsel that lead to feelings of resentment and then to litigation?
If this all-too-common scenario is to change, employers must exert leadership.
They have a major stake in making sure injured workers are cared for properly
and know they are wanted back on the job as quickly as possible. It’s
also the employer who has the most to gain from controlling Workers’
Compensation costs.
The total care solution
What is needed is a total care approach to work-related injuries. In
effect, what every injured worker deserves is the right physician delivering
the right treatment at the right time to facilitate the employee’s
return-to-work as quickly as possible.
While this seems like a worthy objective, it can be illusive. For example,
Ohio employers are required to sign up with a managed care organization
as part of a reform program to reduce Workers’ Comp costs. Has it
worked? Not according to a report in the Cleveland Plain Dealer. Over the
years since the requirement has been in place, costs have not gone down.
In fact, the newspaper pegs the cost of reform at $1.6 billion. While the
number of claims has dropped by 48%, the annual cost to manage the system,
including managed care, has gone up by $167 million.
1. Evidence-based medical treatment
The Ohio experience is quite different from what has happened elsewhere.
For example, the Louisiana Workers’ Compensation Corporation, a private,
tax-exempt mutual insurance company, working with the Johns Hopkins University
School of Medicine, set up a small, state-wide health care provider network
that was based on the premise that “quality medical management aggressively
applied by empowered, yet, accountable physicians trained and disciplined
in common occupational care management methods and unencumbered by pre-certification
requirements, will minimize or eliminate disability in the shortest time
possible.”
At the heart of this type of approach are evidence-based medical treatment
guidelines that help reduce excessive utilization of medical services, identify
counter productive procedures and focuses on clinical medical care that
has the objective of returning the injured worker to full functionality
as quickly as possible.
The results in Louisiana are significant. For example, the program is estimated
to have saved 6,500 working days over a 12-month period and the dollar savings
amounted to more than $915,294, less a small management fee.
“A Preliminary Investigation of the Effects of a Provider Network
on Costs and Lost-Time in Workers’ Compensation” by Bernacki,
Tao and Yuspeh in the Journal of Occupational and Environmental Management,
January 2005 summarizes the success of the Louisana network:
• The average and median costs of a non-network claim was $12,542
and $5,793 compared to $6,749 and $3,015 for a network claim.
•The average and median lost-time days for non network claims was
95 and 58 compared to 53.4 and 34 for network claims.
The use of treatment benchmarks or guidelines provide an objective basis
for evaluating job-related injuries and help keep attention focused on a
return to full functionality.
2. Evidence-based return to work
Even with such positive medical results, proper medical care is only one
component of a total care program. There must also be recovery support at
the workplace, one that involves an evidence-based return-to-work program.
It’s worth pointing out that many return-to-work programs have not
been successful, from either the perspective of employers and injured employees.
Employers often view return-to-work as “make-work” and employees
can be leery since they feel co-workers and supervisors will view them as
slackers. In all honesty, these perceptions can be all-too- accurate.
The failure to see the workplace as having an active role in recovery from
a job-related injury may help explain why return-to-work has not been embraced
more fully by employers and employees. It is more appropriate to view them
as two sides of the same coin, as does the American College of Occupational
and Environmental Medicine.
The College describes the physician’s role in return-to-work this
way, “Successful return-to-work involves primarily the employee and
his or her employer with the attending physician providing detailed recommendations
for graded work and activity resumption.”
It goes on to suggest that “the employer’s role is to ensure
that the workplace culture supports a timely return to meaningful work,
for example, by ensuring that flexible work is available and that any restrictions
and limitations recommended by the patient’s physician are observed.”
When return-to-work is designed around evidence-based guidelines, there’s
a solid basis for mutual understanding between the injured worker, the medical
provider and the employer. The Official Disability Guidelines 2006 (ODG)
of the Work Loss Data Institute contains information based on more than
10 million cases from the Centers for Disease Control and OSHA and provides
“evidence-based disability duration and benchmarking data on every
reportable condition.” These serve to identify return-to-work opportunities
to get injured workers back on the job in a time frame based on medical
evidence.
It should be pointed out that when taken together, effective medical care
and a beneficial return-to-work program may very well require more physician
involvement than is authorized by a third party provider. The prudent employer,
recognizing the value the right physician brings to facilitating the recovery
at work process may well recognize the value of offering payment for additional
services, as well as using the physician or clinic for employee physicals,
drug testing and other services.
The goal is to is to provide every injured worker with the right physician
delivering the right medical treat at the right time to facilitate the employee’s
return-to-work as quickly as possible. With this evidence-based process,
the Workers’ Compensation costs go down. |