Can we agree on one thing...? Variance between providers' RTW recommendations

In a 2010 study of healthcare providers’ agreement related to return to work (RTW) capabilities, researchers found some areas of consistency and some, well, not so consistent (Ikezawa, Battie, Beach & Gross, 2010).  The aim of the study was to determine if there are differences between providers as it relates to the information providers use to make RTW determinations, and what their RTW determinations were for three different case scenarios:  fracture, dislocation, and low back pain.  The survey focused on collecting three types of information.  Participants were asked to determine the following:  if the person was fit to return to work, assess the physical demands of their job, address any restrictions due to injury, determine the injured workers’ work capacity, and make any other recommendations if they were deemed unfit to work.  The second part of the survey focused on what type of information the participants used to make their decision, as well as commentary on what type of information would have improved their ability to make these determinations.  The final section of the survey focused on demographic information about the participants (specialty, gender, age, years of practice, etc.).

Inquiring minds want to know! 

The results indicate that 97% of the providers were in agreement with each other regarding the RTW readiness case of the fracture (p. 370).  This is likely due to fractures being of clear cut pathology.  Similarly, 94% of the providers agreed with each other related to RTW readiness for the dislocation scenario (p. 370).  For the low back pain case (a nurse who had back pain for eleven months), providers were basically split as to whether the injured worker should return to work or not – 55.6%.  Of note, however, with regards to the back pain case, 56% agreed that RTW with restrictions was appropriate; whereas 44% believed RTW full duty was appropriate. 

What did the providers rely upon to make these determinations?

Not surprisingly, experience and training will influence a provider’s recommendations.  In this study, researchers found the providers relying mostly upon physical examination, current functional status, and occupational status (pp. 370-371).  Providers stated that functional capacity exam (FCE) results, information on availability of modified duties, and patient participation in an occupational rehabilitation program would help improve their ability to accurately address RTW opportunities (p. 371).

Another interesting point made in this study is that only a small percentage of providers considered the sustainability of RTW, motivation to RTW, recovery expectations, and guarding movements.  Not until more recently are practitioners focusing on the biopsychosocial, or multi-dimensional, aspects of RTW.  These differences in approach will more than likely yield differing RTW recommendations and should be considered when evaluating a provider’s recommendations for RTW (p. 372).

 Regardless of their agreement, the majority of providers gave some type of RTW recommendation involving restrictions –so no matter their perspective (biomedical vs. biopsychosocial), we can expect some type of restrictions from an injury and prepare for them accordingly. 

 As noted above, the availability of modified duty was emphasized as being one of the factors providers are looking at when determining the injured worker’s release to RTW.  If you have modified duty, be sure that the providers are aware of it!  For those employers that utilized a panel of physicians or a providers list, send them copies of your modified duty jobs to keep on file in the event one of your employers visits there.  If that’s not the case, it would behoove you to provide the treating physician with a pre-injury job description and/or a modified duty job description to keep in the injured worker’s file.  The more informed provider will more than likely make a more accurate RTW recommendation.

References:

Ikezawa, Y., Battie, M. C., Beach, J., & Gross, D. (2010).  Do clinicians working within the same context make consistent return-to-work recommendations?.  Journal of Occupational Rehabilitation, 20, 367-377. doi:10.1007/s10926-010-9230-z

Have a RTW program? Think your employees know about it? Think again!

Why put all of the time, energy, effort and resources into developing a RTW program, if no one knows about it?  If your injured workers don't know about it, it probably means no one is telling them about it, let alone utilizing it.

In a study of over 4,000 disability insurance recipients, only 20% of them (or, 800) knew that they had access to a work trial program. Why is this a big deal?  The 800 or so people who knew about the program were 2 times more likely to return to work.¹

If you offer RTW, make sure EVERYONE knows about it.  Make it ridiculously clear.  From the top to the bottom and anyone who is responsible for treating your injured workers, regardless if they are on a physician panel or not, be sure that they know you have modified duty.  As you may have read, one of the number one reasons physicians don't release injured workers is because the injured worker tells their doctor that their employer doesn't have modified duty. 

This brings me to another point -- Doctors should be commenting on ability to RTW regardless of whether work is available or not -- if the injured worker shouldn't lift more than 20 lbs., they shouldn't be hoisting a 30 lbs. toddler or a 30 lbs. bucket of cement.  Restrictions aren't just for work!

Communicate your RTW policy to employees at hire, at time of injury, and at the time of annual benefit renewals. 

Why is this so important?
Having a modified duty program sends the message to employees that their employer is going to help them recover – physically, financially, and vocationally if they sustain a work-related injury.  It also sends a message to an employee that getting injured does not mean that they are going to be out of work.  While the overwhelming majority of work injuries are legitimate, having a modified duty program will take any motivation to file an illegitimate claim off the table.

How can I communicate our RTW program?
As previously mentioned, explain it in conjunction with your company’s annual benefit renewal process, include it in the company newsletter, send out a company-wide email or flyer, post it along with your other mandatory postings, discuss it at employee meetings. 

Make sure that you are using it!
Unless a RTW program is consistently used, it will be worth little more than the paper it is written on.  Some of the best RTW programs we’ve seen aren’t formal, shiny programs, they are a strong commitment from the employer to do whatever it takes to bring someone back to modified duty when medically appropriate.  It’s like a gym membership, you can say you have one, but it’s usually fairly obvious those who utilize it and those who fail to take advantage of the opportunity.

References:

1.       Krause, N., Dasinger, L. K., & Neuhauser, F. (1998). Modified work and return to work:  a review of the literature. Journal of Occupational Rehabilitation, 8(2), 113-139.

Struggling with WC costs? -- Focus on what you CAN control!

It's easy to focus on what you can't control.  Sometimes we do this to avoid accepting responsibility for our own situations or simply because we've never stepped back and taken an objective look at the situation.

As an employer there are many things that we can't control -- the weather, the laws the govern how you must conduct business, as well as the restrictions that a physician places on an injured worker as a result of a work related injury. 

So, let's take a look at what we can do to influence the outcome of a workers' compensation claim.

Offer modified duty
As written in our last post -- there's no condition so disabling that there's not someone in the US with that condition working full time today.  If you say that you don't have modified duty, you're likely not going to look for it.  Keep an open mind and use the resources available to help you identify modified duty options.

Modified duty wages
The rate at which you pay an injured worker for modified duty impacts the amount of any temporary partial disability benefits (TPD) the injured worker may be entitled to.  Obviously, the more they are paid for modified duty, the less they receive under their workers' compensation claim.  In most states, the TPD rates are 66 2/3 of the difference between the injured worker's pre-injury wages and their modified duty wages.

Safety and Injury Prevention
While injuries may occur that are out of your control, there is much that you can do to prevent injuries from occurring, and to reduce the severity of the injuries if they do occur.  Providing a safe work environment is one element of injury prevention, enforcing safety rules, providing appropriate personal protective equipment (PPE), and appropriate training for new hires are just a few suggestions.  Injuries can still occur if we're being safe drivers, but if the employee is wearing their seatbelt at the time of injury, this safety measure can greatly reduce the severity of the injury.  Also, having employees properly trained to administer first aid can help minor injuries from developing into something worse.

Organizational Culture that Supports Safety and RTW
While this may be the most challenging aspect of safety and RTW, creating buy-in at all levels of the organization is paramount in influencing your workers' compensation program before an injury even happens.  If employees know that they will be offered modified duty, they may be less likely to file a false injury claim.  It also communicates that employers care about the wellbeing of their most valuable assets -- their employees.

Appropriate Medical Treatment
Providing prompt and appropriate medical treatment can have a significant impact on the injured worker's recovery.  If your state allows direction of medical care, having a physician panel that complies with state regulations is an important step towards helping the injured worker recover and RTW.

Maintain Contact with the Injured Worker
Too often an employer files a claim and assumes that they should let the insurance carrier maintain all contact with the injured worker -- this is incorrect (unless of course the employee retains an attorney who prohibits contact with the injured worker).  One of the best ways to keep an injured worker focused on returning to wellness is to stay in contact with them.  Send a get well card, give them a call once a week or every other week to check in, invite them in for employee meetings, and keep them in the loop so that they feel connected with the workplace.

This turned into a lengthy post, but the length (and content) hopefully communicate just how much an employer can influence the outcome of their WC claims.

Study: Physician panels reduce duration of lost time claims

Frequently, the first question after a work injury is reported is, where do I go for treatment?  Each state has its own provisions regarding physician panels, including whether they are permitted, what types of providers must be on the panel, and rules governing the change to a new provider.

The treating physician plays a very important role in the direction and duration of a WC claim.  Physicians influence the injured worker's return to work, permanency rating, frequency and cost of care, as well as their eligibility for WC benefits by giving an opinion as to whether the injury is work-related or not.

Neumark, Barth and Victor (2007) utilized data collected from 750 interviews with employers and injured workers in California, Massachusetts, Pennsylvania and Texas, as well as data from the WCRI database of over 16 million workers' compensation claims.  They focused on the impact of provider choice.  In this study, provider choice is defined as by the employer or employee.  More specifically, it looks at outcomes when an employee chose to treat with someone they've previously treated with, or when they choose a new provider.

So, how do you think that an employee's choice of a new provider or a provider that they have previously treated with impacts the following issues? Take a minute to jot down your answers.  I gave you a freebie with the title of this post.  The results may or may not surprise you.