Risk Management/Pre and Post Loss Medical Programs INJURY PREVENTION INJURY MANAGEMENT CONSULTATION & ANALYSIS.

Risk Management/Pre and Post Loss Medical Programs

INJURY PREVENTION

INJURY MANAGEMENT

CONSULTATION & ANALYSIS

Job Security

Outline

• Worker’s Compensation/OSHA• Traditional Approach to Case Mgt• A New Approach• Expected Benefits• Case Studies• Suggestions

Worker’s Compensation Costs

• Costs for worker’s compensation have risen dramatically over the last four years.

– Mercer Oliver Wyman estimates U.S. worker’s compensation exposure to be $64 - $104 billion.

• For every $1.00 an employer spends on payroll, 15 cents is spent on paid absences. Is this an acceptable cost?

• 15% of your payroll!!

What are Injuries Costing You?

• Increasing costs– Average cost of a recordable injury

$25,000.– Average Time Away from work for a lost

time injury- 7 days– For five employees in your organization

this is Approx $10,000 in one week

Think about this in terms of daily (or hourly) cost of running your business.``

Are You Asking These Questions?

• How do your worker’s compensation program costs compare to others?

• What are steps that I can take to make it “the best”?– Do we have a pre- and post-loss program?– Do we have an effective transitional duty or

early return to work program?– Is our work environment one that encourages

productivity i.e., appreciated employees?– Are we tracking occupational and non-

occupational absences (they can be related)?

– Do we have a Fitness For Duty program?

Programs in Place?

• Pre- and Post-Loss Programs can make a dramatic difference in lowering worker’s compensation costs i.e, EMR, OSHA stats, company profile.

Pre Loss Programs

Pre-Loss Program

• Hiring should be consistent and documented across your system

• Develop a Post-Offer employment screening program

• Once a conditional job offer is made– Most use a physical demands program– Screening, H&P, background checksNote: A conditional offer of employment may be

withdrawn if the applicant cannot functionally do the job, or if the applicant or others would be exposed to serious risk of imminent injury.

Pre Loss ProgramPost Offer Testing is Effective

• Study by University of Massachusetts found that 10% of worker’s hired are unable to perform their jobs safely

• Up to 37% of injuries filed by employees are in the first year of employment

• Littleton Study of a major university hospital showed an 18% decrease in lost day cases and 78% decrease in injury costs with a post offer screening program in place.

Pre Loss ProgramMedical Review by Physician

• Most Important Part of Post Hire Screening process.– Review of medical records– Review of worker’s compensation records– Determination of Direct Threat– Quality Control – review your clinics

Post Loss Programs

Post-Loss Program

• Our vision or goal is zero incidents• One reason this is hard to achieve is

because we are people being managed by people– Our people work in remote areas

(autonomous)– They work in unforgiving environments with

unforgiving energy sources– There are ample opportunities for error

Traditional Case Management• Small companies may run their case

management through an employee• Monopolistic States• Larger companies may use A 3rd party

administrator such as A pinnacol, zurich, liberty, etc. – It’s easy to slip through the cracks– Care is not individualized– Employees tend to stay away from work longer– OSHA recordability is not a priority

Weigh the Options

OSHA REOCRDABLE

AVG CM INTERVENTION COST OF $750

OSHA Recordable Injuries

• Affect– TRIR– LTIR– EMR (Experience Modifier Rating)– Potential Business – ISNetworld/PEC Premier– Public Relations– Employee Morale

A New Way to Think About It

• Internalize your case management with an Advocate– Company and relevant job knowledge

• AOE/COE –Arising out of Employment/Course of employment

– WC knowledge– OSHA regulations– Builds relationships with healthcare providers

• Provider profiling

– A customized (personalized) process– Know the organization’s culture, jobs, internal

processesWRCI Study:The Impact of Provider Choice on– Workers’ Compensation Costs and Outcomes

A Better Case Management Process

• Case Manager (CM) called for any employee leaving site for care– EARLY INVOLVEMENT IS KEY– Engagement with supervisor and employee is

CRUCIAL• CM coordinates care with hospital/clinic

– Pre- and Post-visit• CM follows up through MMI• Operations and CM coordinate light duty and return to

work program• Lets Operations focus on Operations AND keeps

them informed

Aspire Medical Management works closely with your supervisors to provide injury management solutions for your company.

Fitness For Duty Programs

• Policy should address cases where:– Employee has been hospitalized– Exhibiting difficulty performing job safely – Off work for more than 10 days for a medical

issue– Surgeries– FMLA Reviews

Expected Benefits

• Grateful employees!• Better care• Back to work sooner• Lower costs • Fewer recordable/lost time injuries

Case Studies

• OTC vs. Prescription meds• Steri-strips/buddy tape vs. splints• Light duty releases• ER/Clinics

Case Study #1: Prescriptions

Joe Roughneck has incident at work where he has a severe back strain.

• He is taken to ER• ER physician goes by protocol and

prescribes pain meds/muscle relaxers• Prescribes therapy• Orders follow-up in one week if not better,

further testing will be done at that time• Result – recordable injury

Case Study #1 with CM Intervention

• Contact made with ER physician• Discuss that we will attempt OTC anti-

inflammatories• Light duty work• Have employee seen with either

chiropractor or accupuncturist for soft tissue work only

• Follow-up in one week if no relief• Result- First Aid

Case Study #2: Buddy Taping

Joe Doughnut injures finger by hammer strike to hand. He feels it is broken and would like to be seen.

• Employee taken to clinic, x-rays negative for fracture

• Physician places rigid splint to protect hand while at work

• Result - recordable injury

Case Study #2 with CM Intervention

• CM contacts clinic and discusses injury with physician

• Inquires if buddy taping two fingers would suffice in protection of finger

• Physician agrees• CM discusses employee working regular

job with fingers taped• Result - First Aid

Case Study #3: Light Duty Release

Jane Piperacker has a contusion to the knee and is taken to a clinic for x-rays

• X-rays are negative for any fracture • Testing negative for any other

anomaly• Physician writes on rx, no bending for

two days. (Dr. is unaware she is scheduled off for the next two days)

• Physician writes order for home rest• Result – Lost Time

Case Study #3 with CM intervention

• CM contacts physician, discusses that the employee is off work for the next two days

• CM requests physician write a full duty release. Ensures that CM will contact employee in two days and if not better will schedule a follow-up.

• Physician agrees and writes full duty• Result – First Aid

Case Study #4: Prescriptions Given

• Peter Pusher has a finger laceration and taken to the ER – Peter is taken to the Urgent Care center – PA-C says no sutures needed.– PA-C prescribes antibiotics just to be safe.– Follow-up in one week– Recordable injury

Case#4:with CM involvement

• CM contacts employee prior to being seen at urgent care clinic to discuss tetanus.

• CM contacts PA-C and states she will follow the patient each day for signs of infection.

• PA-C states return to clinic if signs of infection occur.

• PA-C writes an addendum note to state antibiotic prescription was returned and OTC antibiotic cream can be used.

• Result, First Aid

In all of these cases

• The employee was involved and taken care of.

• NOTE: All medical advice is reviewed with the Medical Director.

• Proper care was provided – care was not denied or withheld.

• Operations could focus on Operations yet maintained an active role in the case.

Recommendations For Improving Your Process

Explore your current program now and ask…..

• Have a checklist for supervisors and office staff to go by

Have Your Programs in Place

• Post Hire employment Screenings• Transitional Duty Policy• Fitness For Duty Policy• Quarterly Medical Review Meetings• Medical Director• Dedicated Case Manager

• Profiling - Identifying good clinics/physicians that fit your needs

• Have the CM/Advocate build the relationship before the injury occurs.

Know Your Clinics/Physicians

1. Is the physician’s specialty appropriate for the employer’s workers?

1. Is the physician board certified in that specialty?

1. What postgraduate education and training in occupational health has the physician had?

1. Is the physician a medical director of any other companies?

1. Is the physician familiar with the hazards in the company’s industry (e.g., long-term care, trucking, warehousing)? If yes, ask the physician to identify the top two or three hazards and describe the injuries most often associated with them.

1. Is the physician familiar with the medical surveillance required in the employer’s industry?

1. What is the physician’s philosophy about returning injured employees to work in a modified capacity?

1. Is the physician willing to spend time at the employer’s site every week or every month? If yes, how many hours?

1. If applicable, is the physician willing to provide standing orders for and supervision of an on-site occupational health nurse?

1. What is the physician’s malpractice record? Ask for an explanation of malpractice judgments that seem high, frequent, or unusual.

1. Does the physician carry malpractice insurance? If yes, what are the limits of the policy?

1. Is the physician fluent in the native language spoken by more than a handful of company employees (e.g., Spanish, Creole, Vietnamese)?

Collection of Data

• Finally, accurate collection and STRATEGIC use of the wide variety of data collected during the workers compensation claims process can help companies develop and monitor loss-control programs.

Risk Review meetings

Angela Bailey-Flatten, M.Ed., PHR, CPDM, CCM abailey@aspiremm.com

303-502-4362

Thank You! Any Questions?