The Role of the Occupational Medicine Provider in Managing Risks Melinda E. Wagner RN, BSN, MS, MBA.

The Role of the The Role of the Occupational Medicine Occupational Medicine

Provider in Provider in Managing RisksManaging Risks

Melinda E. Wagner RN, BSN, MS, Melinda E. Wagner RN, BSN, MS, MBAMBA

AgendaAgenda

The Employee Risk ContinuumThe Employee Risk Continuum Designing the Right WorkplaceDesigning the Right Workplace ““Getting the Right People on the Bus”Getting the Right People on the Bus” Managing Work Place SafetyManaging Work Place Safety Managing Workers’ Compensation InjuriesManaging Workers’ Compensation Injuries Managing Employee ProductivityManaging Employee Productivity Managing Health BenefitsManaging Health Benefits Managing Post Employment/Retirement ProgramsManaging Post Employment/Retirement Programs Motivating Your Occupational Provider into your Motivating Your Occupational Provider into your

Business PartnerBusiness Partner

““The first step in the risk management The first step in the risk management process is to acknowledge the reality of process is to acknowledge the reality of

risk. risk. Denial is a common tactic that Denial is a common tactic that

substantiates deliberate ignorance for substantiates deliberate ignorance for thoughtful planning.”thoughtful planning.”Charles Tremper, CIO AAHSACharles Tremper, CIO AAHSA

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

Workplace Design Workplace Design ConsultationConsultation

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

Value of Employment Value of Employment ScreeningScreening

Improved Job-Worker MatchImproved Job-Worker Match Establish Organizational CultureEstablish Organizational Culture Improve Employee RetentionImprove Employee Retention Improve Risk ManagementImprove Risk Management Reduce Costs Reduce Costs Eliminate One Back Injury---Pays for Eliminate One Back Injury---Pays for

Program for Years!Program for Years!

Helping you Helping you “Get the Right People on the “Get the Right People on the

Bus”Bus” Pre-Employment ScreeningPre-Employment Screening

Substance AbuseSubstance Abuse Cognitive Levels Cognitive Levels Background Checks Background Checks

Post Offer ScreeningPost Offer Screening Substance AbuseSubstance Abuse Functional/Medical EvaluationsFunctional/Medical Evaluations

Pre-Placement ScreeningPre-Placement Screening Honesty/Integrity testing Honesty/Integrity testing

Functional/Medical EvaluationsFunctional/Medical Evaluations

ReportingReporting

What to Expect from Your Post What to Expect from Your Post Offer Functional Testing Offer Functional Testing

ProgramProgramExpectExpect

ADA/EEOC ComplianceADA/EEOC Compliance ProcessProcess Job Job SpecificSpecific Testing Testing

ProtocolsProtocols SafetySafety Initial Pass/Fail ReportInitial Pass/Fail Report Statistical Analysis Statistical Analysis On-going UpdatesOn-going Updates Better Job-Worker MatchBetter Job-Worker Match Accommodation Accommodation

GuidanceGuidance

AvoidAvoid ““Cookie Cutter” Cookie Cutter”

ProgramsPrograms Job Job Category or Category or

StandardizedStandardized Testing Testing ProtocolsProtocols

Copy of Complete Test Copy of Complete Test ResultsResults

Impairment RatingsImpairment Ratings Programs without Programs without

MaintenanceMaintenance

Role of the Occupational Role of the Occupational ProviderProvider

Program Program DevelopmentDevelopment

Program Program ImplementationImplementation

On-going Program On-going Program Evaluation & Evaluation & UpdatesUpdates

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

Workplace SafetyWorkplace Safetyand the Role of the Provider and the Role of the Provider

Physician & PT Physician & PT Worksite Evaluations Worksite Evaluations

Medical SurveillanceMedical Surveillance Review of injury Review of injury

trends by job typestrends by job types EducationEducation Safety committeeSafety committee Selling safety to Selling safety to

leadershipleadership

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

Managing the InjuryManaging the Injury Goals - Quality Care, Prevent Disability, Goals - Quality Care, Prevent Disability,

Expedite Recovery, Eliminate Unnecessary Expedite Recovery, Eliminate Unnecessary CostsCosts

SPICE Treatment ModelSPICE Treatment Model SimplicitySimplicity - Base treatment on objective - Base treatment on objective

findings-- most cases should be resolved in 2-3 findings-- most cases should be resolved in 2-3 weeks weeks

ProximityProximity - Keep the worker mentally and - Keep the worker mentally and physically engaged in workphysically engaged in work

ImmediacyImmediacy - Set timeframes based on clinical - Set timeframes based on clinical guides guides

CentralityCentrality - Lots of agenda’s, but everyone must - Lots of agenda’s, but everyone must focus on the same goals – use the Provider to focus on the same goals – use the Provider to help you control all other providershelp you control all other providers

ExpectancyExpectancy - Create the expectation on day one - Create the expectation on day one for the employee to fulfillfor the employee to fulfill

Involve the Provider in Involve the Provider in Effective Return to Work Effective Return to Work

ProgramsPrograms Policies promoting RTW can improve Policies promoting RTW can improve

outcomes by as much as 15 weeksoutcomes by as much as 15 weeks WCRI Study on return to work factors:WCRI Study on return to work factors:

Age impacts RTWAge impacts RTW Education level impacts RTWEducation level impacts RTW Most consistent predictors--Patient’s Most consistent predictors--Patient’s

perception of the initial severity of the perception of the initial severity of the injury and effectiveness of their recovery injury and effectiveness of their recovery - which include RTW- which include RTW

Managing by TOTAL CostManaging by TOTAL Cost

Evaluate cost based on total costs and Evaluate cost based on total costs and outcomeoutcome

Workers’ Compensation Direct Medical Costs Workers’ Compensation Direct Medical Costs are rising 9-12% are rising 9-12% NCCI Study suggests workers’ compensation pays NCCI Study suggests workers’ compensation pays

more than group health to treat comparable injuriesmore than group health to treat comparable injuries Utilization differences dominate price differences Utilization differences dominate price differences

explaining 80% of the cost varianceexplaining 80% of the cost variance Evaluation & management codes, radiology and PT Evaluation & management codes, radiology and PT

costs are higher due to utilizationcosts are higher due to utilization

Understanding the System Understanding the System Variances to Understand the Cost Variances to Understand the Cost

VariancesVariances Work CompWork Comp

Focuses on pre-Focuses on pre-injury productivity injury productivity

Management of Management of entire claim entire claim

State mandated State mandated benefitsbenefits

Employer is the Employer is the payerpayer

Patient Patient disincentivesdisincentives

Multiple partiesMultiple parties

Group HealthGroup Health Focuses on Focuses on

termination of caretermination of care Management of Management of

medical onlymedical only Benefits controlled Benefits controlled

by policy by policy Employee is a payerEmployee is a payer Patient incentivesPatient incentives Provider & patientProvider & patient

Understanding the CostsUnderstanding the Costs

Work Comp Total Costs Work Comp Total Costs Medical Medical Wage ReplacementWage Replacement Settlement Settlement Lost Productivity Lost Productivity FraudFraud Workplace Changes Workplace Changes Administrative CostsAdministrative Costs Employee RetentionEmployee Retention Employee Morale Employee Morale Lost BusinessLost Business OSHA issuesOSHA issues

Group Health Total Group Health Total Cost Cost Total Medical CostsTotal Medical Costs

Communications with Your Communications with Your Occupational Provider Occupational Provider

CommunicationCommunication Measure Results on Total Costs and OutcomesMeasure Results on Total Costs and Outcomes More CommunicationMore Communication

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

For Profits You Need For Profits You Need People Who PerformPeople Who Perform

Cost of absenteeismCost of absenteeism $30.5 billion due to just asthma, $30.5 billion due to just asthma,

diabetes and hypertensiondiabetes and hypertension Cost of “Presenteeism” Cost of “Presenteeism”

Estimated to cost as much as $180-250 Estimated to cost as much as $180-250 billion billion

Lost Productivity is estimated 7.5% Lost Productivity is estimated 7.5% greater than absenteeismgreater than absenteeism

In study of 800 managers 76% report In study of 800 managers 76% report Low Productivity as their #1 challenge Low Productivity as their #1 challenge

Incorporating the Occupational Incorporating the Occupational Provider into Resource Provider into Resource

ManagementManagement Developing CultureDeveloping Culture Developing Management Programs Developing Management Programs

Medical Monitoring ProgramsMedical Monitoring Programs Public Safety Positions Public Safety Positions VoluntaryVoluntary

Return to DutyReturn to Duty Fit For DutyFit For Duty

Knowledge of a medical condition linked to Knowledge of a medical condition linked to performance or “direct threat”performance or “direct threat”

Managing by the dataManaging by the data

Incorporating the Occupational Incorporating the Occupational Provider into Resource Provider into Resource

ManagementManagement Family Medical Leave ActFamily Medical Leave Act

About 62% of all workers are qualified for FMLAAbout 62% of all workers are qualified for FMLA Over 50 million have taken FMLAOver 50 million have taken FMLA 80% take over 40 days80% take over 40 days

Provider RoleProvider Role Review of certificationReview of certification Consideration of second opinionsConsideration of second opinions Benefit & Preventive Health Program Benefit & Preventive Health Program

development based on datadevelopment based on data

Incorporating the Occupational Incorporating the Occupational Provider into Resource Provider into Resource

ManagementManagement DisabilityDisability

7.5 million on 7.5 million on disabilitydisability

Average age 52Average age 52 90% are disabled 90% are disabled

workersworkers Obese adults Obese adults

almost twice as almost twice as likely to become likely to become disableddisabled

Red Flags In DisabilityRed Flags In Disability

Inconsistent symptoms Inconsistent symptoms & physical finding& physical finding

Exaggerated pain Exaggerated pain complaints absent complaints absent physical findingsphysical findings

Restrictions inconsistent Restrictions inconsistent with diagnosiswith diagnosis

Significant discrepancies Significant discrepancies between multiple between multiple treating providerstreating providers

Certifying physician Certifying physician outside scope of outside scope of practicepractice

Non compliance with Non compliance with treatmenttreatment

Doctor shoppingDoctor shopping Pending life change: Pending life change:

divorce/layoffs/job lossdivorce/layoffs/job loss No objective testingNo objective testing

Incorporating the Occupational Incorporating the Occupational Provider into Resource Provider into Resource

ManagementManagement Occupational Provider’s RoleOccupational Provider’s Role

Medical Record ReviewMedical Record Review Independent Medical ExamIndependent Medical Exam Functional Capacity EvaluationsFunctional Capacity Evaluations Productivity StudiesProductivity Studies Consultation with the Attending Consultation with the Attending

Physician to get an accurate and Physician to get an accurate and complete statementcomplete statement

Identify and address “Red Flags”Identify and address “Red Flags”

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

Incorporating the Occupational Incorporating the Occupational Provider in Health Benefits Provider in Health Benefits

PlanningPlanning Analysis of health care trendsAnalysis of health care trends Education programsEducation programs Implementation of benefitsImplementation of benefits Focused preventive health programsFocused preventive health programs

Designing programs that generate Designing programs that generate returnsreturns

Disease management programsDisease management programs

The Occupational Provider ImpactThe Occupational Provider Impact

Workplace Design

Hiring/Placement

WorkplaceSafety

Workers’ Compensation

Employee Productivity

HealthBenefits

Exit/Post Employment

The Employee Risk Continuum

Incorporating Your Incorporating Your Occupational Provider into the Occupational Provider into the

Exit ProcessExit Process Exit PhysicalsExit Physicals Retirement Retirement

BenefitsBenefits Prevention/Health Prevention/Health

Management Management ProgramsPrograms

EducationEducation Connection to your Connection to your

workplaceworkplace

Engaging Your Provider Engaging Your Provider to Be Your Partnerto Be Your Partner

Provider SelectionProvider Selection CommunicationCommunication FeedbackFeedback Ongoing Ongoing

InvolvementInvolvement ReimbursementReimbursement Policy Policy

DevelopmentDevelopment

Questions and DiscussionQuestions and Discussion