-
Western Occupational and Environmental Medical Association
Webinar June 17, 2010
PLEASE STAND BY
WEBINAR WILL BEGIN AT 12:00pm (PDT)
For Audio:
Call: 866-740-1260
Access Code: 7644915#
To Work or Not to Work:
The Costs of Presenteeism and Absenteeism
Speaker: Constantine Gean, MD, MS, MBA, FACOEM
Regional Medical Director, Liberty Mutual Group
Faculty Disclosure:
Constantine Gean, MD, MS, MBA, FACOEM has no conflict of interest
to disclose.
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To Work or Not To Work
The Costs of Presenteeism and Absenteeism
Constantine Gean, MD, MS, MBA, FACOEM
Regional Medical Director, Liberty Mutual Group
WOEMA Webinar - June 17, 2010
-
Learning Objectives
Understand absenteeism, presenteeism, and differences between the
twoDescribe why absenteeism and presenteeism are important concepts
for occupational health practiceObtain a general concept of the
origins of presenteeism.Appreciate absenteeism and presenteeism as
they relate to the Workers Compensation and Group Health
arenas.Review the economic consequences of absenteeism and
presenteeism.Obtain an understanding of program approaches to
monitoring and limiting costs from absenteeism and
presenteeism.
-
The Big Picture
The Solar System
-
Ideas rather than materials or physical brawn have been by far
the greatest contributors during the past half-century to our
average annual increase of 3-1/4 percent in real gross domestic
product.
Alan Greenspan, March 11, 2004
(Before the Committee on Education and the Workforce, U.S. House
of Representatives)
-
WORKING PAPER NO. 50 - European Central Bank, 2001
http://www.ecb.int/pub/pdf/scpwps/ecbwp050.pdf
Levels of labor Productivity in 1990 US Dollars
WHAT IS PRODUCTIVITY?
-
Hang On! I just got another nibble!
The Perils of Fishing
-
Intel income statement - analysis of the value of human
capital
Estimated cost of human capital
36% of revenues
24% of book value of Companies
Because of this high cost human capital warrants significant
investment
On a par with fixed capital costs
Sending on human capital (some overlap):
Group health (47%)
Turnover (37%)
Unscheduled absences (8%)
Non-occ disability (5%)
Workers Comp.(3%)
- Dr. Marc L. Berger VP of Merc Outcomes Research
- Validated by R. Howell, Dean of Dartmouths Bus. School
*
-
Cost Drivers
Disability Costs Exceeded $340 million
(Wall St. Journal)
Disability Costs 8-10% of payroll
(Unum 2002 Study)
Disability Costs can exceed $2,500 per employee
(DOL/COREl)
*
National, randomized telephone survey; >28,000 worker
National, randomized telephone survey; >28,000
households, conducted over 12 month period (2001 households,
conducted over 12 month period (2001--2002) 2002)
Lost productive time Lost productive time (LPT) comprised
absence and reduced (LPT) comprised absence and reduced
work performance due to personal or family health work
performance due to personal or family health
Within a 2 Within a 2--week recall period, personal health
caused 10% of week recall period, personal health caused 10% of
workers to be absent, and 38% to report unproductive time
workers to be absent, and 38% to report unproductive time
On average, workers lost 2 hours/week LPT; 66% of this was On
average, workers lost 2 hours/week LPT; 66% of this was
through reduced work performance due to personal health through
reduced work performance due to personal health
Aggregate LPT for US workforce $226 billion in 2002, or an
Aggregate LPT for US workforce $226 billion in 2002, or an
average of $1685/employee/year.
-
PRESENTEEISM
AND
ABSENTEEISM
What are they?
How Measured?
Examples?
-
Presenteeism Origins
Presenteeism is the opposite of absenteeism Presenteeism discusses
the problems faced when employees come to work in spite of illness,
which can have similar negative repercussions on business
performance Issue has existed in some form or another for centuries
Name is relatively newFactors and History40-50s EE-sponsored Health
CareGDP Growth + Managed care Cornell Study, ACOEM, Dartmouth Cost
of Human capitalIncreased US LongevityDownsized workforces
(increases relative contribution from each EE)
Workforce Optimization
-
Presenteeism and Absenteeism Unions and Employers
Perspectives
Presenteeism often cited cause
Fear of loss of income or employment on the part of the
employee
Over 59 million American workers (nearly half of the workforce) do
not have access to paid sick daysNearly 80% of low-income workers
do not have access to paid sick daysOn average, workers need 1.8
sick days/year to care for themselves and 4 days/year to care for
sick childrenTrade Unions Perspective
Presenteeism has developed as a result of a gradual relaxation
of employment protection laws and reductions in benefits, most
notably sickness benefits
Employers' Perspective
Other factors are contribute to presenteeism, including an
increase in health care costs, which has rendered employees more
reluctant to seek medical attention when it is necessary
Lovell, 2004 - IWPR publication B242
-
Most Relevant Conditions Impacting Productivity Change Based on
POV
(Top 10 Medical Conditions From Various Perspectives )
JOEM Volume 49, Number 7, July 2007
-
Medications Can Compound Problems
-
Est. Annual Cost of Presenteeism
(employed Population @ $23.15/hour)
Goetezel, et. Al., JOEM Volume 46, Issue 4, pp398-412 (April
2004)
-
Absenteeism
DEFINITION: A habitual pattern of absence from a duty or
obligationTraditionally viewed as poor individual performance
Seen as a management problem
Framed in economic or quasi-economic terms
More recently seen as an indicator of psychological, medical, or
social adjustment to workShort Term DisabilityGenerally 50% of
absences are < 2 weeks, and 50% are > 2 weeks
Frequent absence from the workplace may be indicative of poor
morale or other issues.
Many employers have implemented absence policies which make no
distinction between absences for genuine
Bradford factor, which only takes the total number and frequency
of absences into account, not the kind of absence.
Many employees feel obliged to come to work while ill, and
transmit communicable diseases to their co-workers.
No call" or "no show." According to Nelson & Quick (2008)
people who are dissatisfied with their jobs are absent more
frequently.
The psychological model that discusses this is the "withdrawal
model," which assumes that absenteeism represents individual
withdrawal from dissatisfying working conditions.
Absenteeism is linked with smoking, problem drinking, low back
pain, and migraines.[
Absence ascribed to medical causes is often still, at least in
part, voluntary
The line between psychological and medical causation is blurry,
given that there are positive links between both work stress and
depression and absenteeism.[4]
Depressive tendencies may lie behind some of the absence
ascribed to poor physical health, as with adoption of a "culturally
approved sick role." This places the adjective "sickness" before
the word "absence," and carries a burden of more proof than is
usually offered.
Evidence indicates that absence is generally viewed as "mildly
deviant workplace behavior. people tend to hold negative
stereotypes of absentees, underreport their own absenteeism, and
believe their own attendance record is better than that of their
peers)
*
-
Commonly used Days Away from Work
(DAFW) Approach
CONCLUSION: Find low hanging fruit just by adding up DAFW.
*
2
Basic Ideas Underpinning
Absence ControlUpstream clinical data collection can lower
costs.STD management lowers LTD disability costs Productivity costs
hard to define-but data valued.Different company departments have
different goals and need different levels of
responseChart13524635246352463524635430354303543035430355823558235582355823579535795357953579535960359603596035960Oper.
STD Direct CostMaint STD Direct CostOper OT CostMaint. OT CostSix
Month Period EndingTMW Dollars SpentCombined Operations &
Maintenance Absence Costs - 1996 - 1998$ 99,244*$
13,612*182918.251987922207066.242008782203421.56430066.9162899.831398872200253.032856732200907.013525368.75162352.089979731127062.79719385225344.73219230818395.25185840.162361869139541.940013652260605.97119138.5129419.38985639199244.1972853814188099.401513611.5713280211MNT3GRPHToyearsDATESTD
ABS DOLS PAID ($)ST DOLLARS PAID ($)OT DOLLARS PAID ($)COMBINED ABS
COSTSOper. STD Direct CostMaint STD Direct CostOper OT CostMaint.
OT CostOT CostHalf Year EndingOper. STD Direct CostMaint STD Direct
CostOper OT CostMaint. OT
Cost6/1/93175,52327,7146/30/96207,066182,918203,42230,0671/1/9130,623686,098142,9730.044632,2694,59312/31/93208,46130,66112/31/96200,253162,900200,90725,3692/1/9137,304577,969157,8400.064546,6635,5966/1/94135,73324,7886/30/97127,063162,352225,34518,3953/1/9127,287627,532176,4150.043531,4374,09312/31/94169,98924,65612/31/97139,542185,840260,60619,1394/1/9116,328679,980170,3460.024017,3602,4496/1/95150,17823,7206/14/98129,419188,0995/1/9142,701676,669386,4790.063145,6226,40512/31/95172,01625,047SUMAve
96-97Ave6/1/9149,3621,884,050866,5330.026218,9427,4046/1/96182,918207,066203,42230,067623,473587,79612/28/97185,840260,606446,4467/1/9115,926634,168113,3590.025118,1562,38912/31/96162,900200,253200,90725,369589,4298/1/9116,887656,370159,4660.025718,6002,5336/1/97162,352127,063225,34518,395533,1559/1/9117,780593,225197,4380.030021,6692,66712/31/97185,840139,542260,60619,139605,12710/1/9122,119862,761376,6450.025618,5353,3186/1/98129,41999,244188,09913,612430,37511/1/9114,721604,714241,0060.024317,6002,20812/1/9112,665615,348153,8310.020614,8801,9001/1/9219,976736,753345,4720.027119,6022,9962/1/9223,704645,761390,6790.036726,5383,5563/1/9220,949790,402567,2200.026519,1623,1420.71121411440.71121411444/1/9232,790703,043417,3730.046633,7194,9195/1/9233,616637,580178,8960.052738,1185,0426/1/9218,858727,053166,3390.025918,7522,829Six
Months EndingOper. STD Direct CostMaint STD Direct CostOper OT
CostMaint. OT
Cost7/1/9212,462728,954144,3650.017112,3601,8696/30/96182,918207,066203,42230,0678/1/9210,967692,738170,3020.015811,4461,64512/31/96162,900200,253200,90725,3699/1/9219,039660,47796,4430.028820,8402,8566/1/97162,352127,063225,34518,39510/1/9217,806742,203112,5420.024017,3442,67112/31/97185,840139,542260,60619,13911/1/9210,783601,511216,5940.017912,9601,6176/14/98129,41999,244188,09913,61212/1/9218,805668,856183,8110.028120,3262,8211/1/9312,128438,809493,1230.027619,9821,8192/1/9340,854940,683342,4780.043431,3986,1283/1/9338,401990,650208,0230.038828,0255,7604/1/9336,313705,67076,2790.051537,2035,44736695/1/9328,508666,60470,8720.042830,9184,276446836/1/9328,554737,35668,0570.038727,9974,283369687/1/9333,282677,89382,9450.049135,4954,99277858/1/9325,365724,70583,6360.035025,3043,80595339/1/9327,335683,352146,6390.040028,9204,1007611110/1/9328,818669,23981,5270.043131,1314,3236439611/1/9355,560813,815154,4770.068349,3588,33413176712/1/9334,046643,443136,2090.052938,2545,1071505781/1/9443,937707,411205,5800.062144,9036,591136212/1/9444,5181,068,102282,6790.041730,1336,6784766953/1/9429,413917,629186,6230.032123,1734,412448364/1/9417,270788,796113,6720.021915,8292,5914565/1/9415,7641,155,605139,4790.01369,8622,36571036/1/9414,351876,795121,9750.016411,8332,153592737/1/9417,231669,57495,1480.025718,6052,585281318/1/9425,991751,305117,4190.034625,0113,89911556059/1/9419,281727,428120,4260.026519,1632,89210/1/9432,230745,664114,9800.043231,2494,83511/1/9436,855657,986128,2280.056040,4955,52812/1/9432,783668,247177,5900.049135,4674,9171/1/9530,866769,520184,3790.040128,9994,6302/1/9517,584717,784345,4990.024517,7112,6383/1/9525,322863,266471,3180.029321,2073,7984/1/9519,856661,34853,3680.030021,7062,9785/1/9537,332782,36945,8820.047734,4975,6006/1/9527,175753,94241,0850.036026,0584,0767/1/9516,862649,75751,3340.026018,7622,5298/1/9522,108769,69599,1260.028720,7663,3169/1/9529,062693,95779,3930.041930,2774,35910/1/9533,323787,766111,5160.042330,5824,99811/1/9540,433678,818136,1970.059643,0636,06512/1/9525,194637,601144,8550.039528,5673,7791/1/9632,242770,918536,1130.041830,2364,8362/1/9641,122638,612128,5670.064446,5546,1683/1/9633,471736,583114,2780.045432,8525,0214/1/9640,582705,529102,4760.057541,5856,0875/1/9630,041708,74593,8310.042430,6444,5066/1/9622,988659,63081,7160.034825,1953,4487/1/9631,263664,518127,3570.047034,0134,6898/1/9626,134693,540192,3010.037727,2433,9209/1/9622,183679,015159,0490.032723,6193,32710/1/9637,328478,956123,8300.077956,3455,59911/1/9631,115626,783127,7240.049635,8904,66712/1/9621,102659,181331,2910.032023,1443,1651/1/9734,316731,037122,5240.046933,9375,1472/1/9719,830693,360468,4720.028620,6772,9753/1/9719,584659,673326,1620.029721,4632,9384/1/9721,020711,50689,8230.029521,3593,1535/1/9711,914669,50876,5490.017812,8651,7876/1/9715,971688,83977,9200.023216,7622,3967/1/9720,819683,53153,4800.030522,0203,1238/1/9722,236667,82368,3610.033324,0723,3359/1/9715,404680,58150,8250.022616,3632,31110/1/9721,997744,85652,3850.029521,3513,30011/1/9726,902589,48999,8250.045632,9934,03512/1/9720,232643,15356,5560.031522,7433,035Ave
Salary(93-97)722,966TMW MAINTAINENCEYearly Raw Totals - Jan 1, 1991
to Dec 31, 1997DATESTD ABS DOLS PAID ($)ST DOLLARS PAID ($)OT
DOLLARS PAID
($)1991303,7039,098,8843,142,3311992293,0569,149,5393,344,8301993279,4569,217,3313,577,6691994273,1189,380,2013,968,4741995289,5809,403,2644,215,5011996280,4959,364,1754,007,9181997249,9918,207,1783,307,724TMW
MAINTAINENCEMonthly Averages ( from Raw Totals divided by 12) - Jan
1, 1991 to Dec 31, 1997DATESTD ABS DOLS PAID ($)ST DOLLARS PAID
($)OT DOLLARS PAID
($)199125,309758,240261,861199224,421762,462278,736199323,288768,111298,139199422,760781,683330,706199524,132783,605351,292199623,375780,348333,993199720,833683,932275,644Off
BaseOff
Peak203,2366/30/93203905237,133239,12212/31/93160,5216/30/94194,64512/31/94173,8986/30/95197,06312/31/95237,1336/30/96225,62212/31/96145,4586/30/9758,44791,675158,68012/31/9745,22578,45351835.756396248685063.7563962486623,473587,796589,429533,155605,127623,473587795.75712343589,429533,155605,127430,375157,421&CMedical
Department - Business Costs of Absence
Report&LMaint5gr.XLS&C&P&RC:\Gean\ACP\8_98anyl\Maint5gr.xlsMNT3GRPH00000000000000000000&APage
&PMaintenance Absence Control Prgm Started 11/96$203,905 / six
mo. = Ave Baseline CostPeak Cost#REF!#REF!Half Year EndingDollars
SpentTMW Maintenance - Absence
Cost$158,680$145,458$225,622$237,133$197,063$173,898$194,645$160,521$239,122$203,2360000000000000000000000000000000000000000&APage
&P* Maint. Projected for '98Oper. STD Direct CostMaint STD
Direct CostOper OT CostMaint. OT CostSix Month Period EndingTMW
Dollars SpentCombined Operations & Maintenance Absence Cost -
1996 - 1998$ 99,244*$ 13,612*00000000000000000000$587,795 / six mo.
= Ave Cost (Base Yrs.: 1996 - 1997)$623,472$ 589,428$ 533,154$
605,126$ 430,374
-
Spine Pain, Depression and Fatigue Top List
Top 10 Overall Most Costly Medical Conditions
(Annual medical + drug + Absenteeism + Presenteeism costs per 1000
EE)
JOEM Volume 49, Number 7, July 2007
-
PRESENTEEISM
AND
ABSENTEEISM
What to do to limit?
How Managed?
Examples?
-
Productivity management
Health & Productivity Management
Value-based health care provision
Approaches to Absenteeism and Presenteeism Management
Disability management
Wellness & Health promotion
Footnotes:
a, b - 2001 Unscheduled Absence Survey. CCH Inc.
c - 2001 Health Value Initiative, Hewitt Associates
*
-
MANAGEMENT OF RESOURCES
-
Plan approaches
Appropriate Benefit mixPharmaceutical restrictionsDefined
Contribution PlansReduction/Attenuation of benefits
Clinical Management approaches
Pharmaceutical Management Utilization analysis (Medstat)
Pre-Authorization ReviewsClinical Concurrent Review Case Management
Demand Management Disease Management Specialty Case Management
Population Health Management Unreasonable utilization Redundant
benefits Non Evidence-based Treatments Multiple Health programs
Pharmacy spend & misuse Per-EE abs cost = $755 in 01a Provider
RTW role ignorance Older workers (LTD incr 4x fr. 42 to 57 yo.)b
Multiple Health programs
Commonly used
Absence/DAFW mgt. pgms Modified Duty pgms Rapid medical assmt.
& triage Preventive Programs
Less commonly used
formal supervisor RTW training setting RTW expectations supers
& EE certainty: + training keeping in touch with EE ALOD
Variation, analys & interven.
Productivity management
Health & Productivity Management
Value-based health care provision
Expanded View
Disability management
Wellness & Health promotion
Issues
Approaches
RTW and Stay at Work programs Scope of Work Health Promotion
Modifiable health risk/HRA pgms.
Approaches
Issues
Approaches
Approaches
Footnotes:
a, b - 2001 Unscheduled Absence Survey. CCH Inc.
c - 2001 Health Value Initiative, Hewitt Associates
*
-
Backache and Depression Most Prevalent Conditions (Focus on the
most common conditions)
*
HighlightsGold Medal Highlights:Percentage of overall cases with
surgical procedure = 27%Percentage of cases with neither diagnosis
or procedure = 3%Percentage of cases with a procedure but without a
diagnosis = 1 review = 22%Overall:# of Extensions% of
Cases062%121%29%34%42%51%Overall % of cases with modified or
part-time days = 15%.AllGold Medal ProjectTable of Statistics For
Most Common Diagnosis. (includes medical and surgical
cases)Includes ICD9CODE With At Least 100 Observations (Frequency
>=100)Approved only cases at first review episode=1, request=A,
extension=0PercentilesCases With >1 ReviewICD9CODEAverage #Range
(in days)Range (in days)%
With#Total50thDescriptionICD9CODEFrequencyof
Days10th25th50th75th90thModefrom 25th - 75thfrom 10th - 90th> 1
Review>1ReviewALODCasesPercentileDELIVERY IN A COMPLETELY NORMAL
CASE650275341.42424242424242007%19414294712PREGNANT STATE,
INCIDENTALV22.2113415.825914212814122337%669918037ACUTE
BRONCHITIS46685811.14681013171051132%4031012617LEIOMYOMA OF UTERUS,
UNSPECIFIED218.982136.95213042424242122140%53811135910CESAREAN
DELIVERY, WITHOUT MENTION OF
INDICATION669.767045.23424242565642141440%44213111214NORMAL
PREGNANCYV2266232.79101442424242283224%213168759BACKACHE,
UNSPECIFIED724.558717.15791421308122360%89117147814DISPLACEMENT OF
LUMBAR INTERVERTEBRAL DISC WITHOUT
MYELOPATHY722.150727.5391525414842263965%93119143815TEAR OF MEDIAL
CARTILAGE OR MENISCUS OF KNEE,
CURRENT83647321.66101421283514142557%62815110113LUMBAR
SPRAIN847.246316.527914212914122257%62416108713NECK
SPRAIN84739517.858121521301492258%5521594713MAJOR DEPRESSIVE
DISORDER, SINGLE
EPISODE296.237823.62111521303614152566%71820109616CARPAL TUNNEL
SYNDROME35437623.13101421303914162968%81218118814EARLY OR
THREATENED
LABOR64435824.9771424324330183648%3351969314CHOLELITHIASIS57435415.528111418231471542%25996137PNEUMONIA,
ORGANISM UNSPECIFIED48634715.278101318241481638%213125608DEPRESSIVE
DISORDER, NOT ELSEWHERE
CLASSIFIED31133822.87101421303614162664%6142095217ACUTE UPPER
RESPIRATORY INFECTIONS OF UNSPECIFIED
SITE465.92759.785791115741025%91113667BUNION727.124930.94142129424242212856%3171356612MAJOR
DEPRESSIVE AFFECTIVE DISORDER, RECURRENT EPISODE, SEVERE DEGREE,
WITHOUT296.3324626.76121726324230153069%5592080517LUMBAGO724.224019.0881115.52433.514132654%2842052414THREATENED
PREMATURE LABOR64423925.44111425304230163146%2021944116HALLUX
VALGUS (ACQUIRED)73523529.78142128424242212856%2941352912MAJOR
DEPRESSIVE AFFECTIVE DISORDER, SINGLE EPISODE, SEVERE DEGREE,
WITHOUT ME296.2323226.251418.526.530.53930122569%5092074117UTERINE
LEIOMYOMA21822536.93213042424242122142%1641238910UNSPECIFIED SITE
OF SPRAIN AND
STRAIN848.922416.3481014202710101951%2341545814INGUINAL HERNIA,
WITHOUT MENTION OF OBSTRUCTION OR
GANGRENE550.921321.25111421283614142545%172123859ACUTE SINUSITIS,
UNSPECIFIED461.920610.315791216851127%78102847DEVIATED NASAL
SEPTUM47020513.018101314181441041%14083456MAJOR DEPRESSIVE
AFFECTIVE DISORDER, SINGLE EPISODE, UNSPECIFIED
DEGREE296.219724.7581422314230173478%7182091517CORONARY
ATHEROSCLEROSIS41418833.7971534.5476042325350%1852337317INFLUENZA
WITH OTHER RESPIRATORY
MANIFESTATIONS487.11869.34579111494926%64102506MAJOR DEPRESSIVE
DISORDER, RECURRENT
EPISODE296.318124.84101622303821142876%5822176317SCIATICA724.318120.39101318253514122561%2781845914DISPLACEMENT
OF CERVICAL INTERVERTEBRAL DISC WITHOUT
MYELOPATHY72217634.36122131.5425642214463%2991947516OTHER HAMMER
TOE (ACQUIRED)735.417323.24111522303521152455%2151338811INGUINAL
HERNIA55017019.56101417263014122040%114122849INFLUENZA4871679.56579121485919%40112077CHEST
PAIN786.516714.044712182810112450%1651633212MALIGNANT NEOPLASM OF
BREAST (FEMALE),
UNSPECIFIED174.916626.29101422364242223266%3222848825ABDOMINAL
PAIN78916616.377101321299112249%1601332610ACUTE
APPENDICITIS54016519.41101317263115132135%8892537NEUROTIC
DEPRESSION300.416322.45101420303915162967%3382050117OTHER AND
UNSPECIFIED OVARIAN
CYST620.216325.63101428404242263248%149113129OTHER BACTERIAL
PNEUMONIA48216016.7881014202714101938%991525910EDEMA OR EXCESSIVE
WEIGHT GAIN IN PREGNANCY, WITHOUT MENTION OF
HYPERTENSION646.115719.1961116243417132839%102102597ROTATOR CUFF
(CAPSULE) SPRAIN840.415231.99121630.5424842263663%2572040916OTHER
AND UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND
COLITIS558.914812.2957101519881442%1081825612ACUTE
CHOLECYSTITIS57514716.605121521281492341%101102487CERVICALGIA723.114718.318101525338152556%1901733714LUMBOSACRAL
(JOINT) (LIGAMENT)
SPRAIN84614715.56781420278122052%1601530714CALCULUS OF GALLBLADDER
WITH ACUTE
CHOLECYSTITIS57414414.517101418221481564%25994037UNSPECIFIED
SYMPTOM ASSOCIATED WITH FEMALE GENITAL
ORGANS625.914222.216917424242333638%86132288GENERALIZED ANXIETY
DISORDER300.0214122.43101520283714132765%2591940016ACUTE MYOCARDIAL
INFARCTION41014129.9891629425142264255%1692231017UNILATERAL OR
UNSPECIFIED INGUINAL HERNIA, WITHOUT MENTION OF OBSTRUCTION OR
G550.914121.09111421283214142137%84102257MALIGNANT NEOPLASM OF
PROSTATE18513639.6521304247.5564217.53549%1312026716MENORRHAGIA626.613633.68102842424242143237%79112159HYPERTROPHY
OF BREAST611.113420.99131421282828141548%125102598ANKLE
SPRAIN84513314.29791317231281646%115122489MALIGNANT NEOPLASM OF
FEMALE BREAST17413230.73121528424742273560%1992533120ACUTE
SINUSITIS46113211.41681114181161239%851321710UNSPECIFIED ESSENTIAL
HYPERTENSION401.913117.938101420308102251%1372426818EXCESSIVE OR
FREQUENT
MENSTRUATION626.212932.1182742424342153539%81102108OBESITY27812734.53212835424942142851%1311725814TRANSIENT
HYPERTENSION OF
PREGNANCY642.312618.7771119233020122332%601818614UMBILICAL HERNIA
WITHOUT MENTION OF OBSTRUCTION OR
GANGRENE553.112320.28101419282828141845%99112229THREATENED
ABORTION64012017.936.59.516.522.53217132647%1061822614MAJOR
DEPRESSIVE AFFECTIVE DISORDER, SINGLE EPISODE, MODERATE
DEGREE296.2211725.68131622314230152965%2131933016ACUTE MYOCARDIAL
INFARCTION OF UNSPECIFIED
SITE410.911633.1281830465642284852%1242424018CALCULUS OF
KIDNEY59211313.2158111624881946%96132099ANXIETY STATE,
UNSPECIFIED30010920.1681418283314142558%1491925817OTHER TEAR OF
CARTILAGE OR MENISCUS OF KNEE,
CURRENT836.210820.589142127.5331413.52458%1501525813ACUTE, BUT
ILL-DEFINED, CEREBROVASCULAR
DISEASE43610737.89132636486328225064%1893129627ADJUSTMENT REACTION
WITH MIXED EMOTIONAL
FEATURES309.2810524.25101522303320152361%1631826815MILD OR
UNSPECIFIED
PRE-ECLAMPSIA642.410418.925916283214192733%52151569MAJOR DEPRESSIVE
AFFECTIVE DISORDER, RECURRENT EPISODE, UNSPECIFIED
DEGREE296.310324.57121522304214153085%5822068516ASTHMA49310315.3781014202511101756%131132349DxOnlyGold
Medal ProjectMTable of Statistics For Most Common Diagnosis
(Medical Only).Includes ICD9CODE With At Least 100 Observations
(Frequency >=100)Approved only cases at first review episode=1,
request=A, extension=0PercentilesCases With >1
ReviewICD9CODEAverage #Range (in days)Range (in days)# of Cases
With% of Cases50thDescriptionICD9CODEFrequencyof
Days10th25th50th75th90thModefrom 25th - 75thfrom 10th - 90th> 1
ReviewWith >1 ReviewALODPercentile0DELIVERY IN A COMPLETELY
NORMAL CASE650267741.29424242424242001696%131028463BACKACHE,
UNSPECIFIED724.558116.98791421308122385960%171414403LUMBAR
SPRAIN847.246316.527914212914122261757%161310803NECK
SPRAIN84739417.858121521301492254958%15139433LUMBAGO724.223318.6281115233214122426753%19145003UNSPECIFIED
SITE OF SPRAIN AND
STRAIN848.922116.3681014202710101922250%15144433SCIATICA724.318020.3810131825.53514132527360%18144533LUMBOSACRAL
(JOINT) (LIGAMENT)
SPRAIN84614715.56781420278122016052%15143073CERVICALGIA723.114417.918101524328142418256%161432623631MAJOR
DEPRESSIVE AFFECTIVE DISORDER, RECURRENT EPISODE, UNSPECIFIED
DEGREE296.310324.57121522304214153032676%20164291MAJOR DEPRESSIVE
AFFECTIVE DISORDER, SINGLE EPISODE, MODERATE
DEGREE296.2211725.68131622314230152921365%19163301NEUROTIC
DEPRESSION300.416322.45101420303915162933867%20175011MAJOR
DEPRESSIVE DISORDER, RECURRENT
EPISODE296.318124.84101622303821142858276%20167631MAJOR DEPRESSIVE
AFFECTIVE DISORDER, SINGLE EPISODE, UNSPECIFIED
DEGREE296.219724.7581422314230173442568%20176221MAJOR DEPRESSIVE
AFFECTIVE DISORDER, SINGLE EPISODE, SEVERE DEGREE, WITHOUT
ME296.2323226.251418.526.530.53930122550969%20177411MAJOR
DEPRESSIVE AFFECTIVE DISORDER, RECURRENT EPISODE, SEVERE DEGREE,
WITHOUT296.3324626.76121726324230153055969%20178051DEPRESSIVE
DISORDER, NOT ELSEWHERE
CLASSIFIED31133822.87101421303614162661364%20179511MAJOR DEPRESSIVE
DISORDER, SINGLE
EPISODE296.237823.62111521303614152571866%2016109619552ADJUSTMENT
REACTION WITH MIXED EMOTIONAL
FEATURES309.2810524.25101522303320152316361%18152682ANXIETY STATE,
UNSPECIFIED30010920.1681418283314142514958%19172582GENERALIZED
ANXIETY
DISORDER300.0214122.43101520283714132725965%19164003554OTHER AND
UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND
COLITIS558.914712.1857101519881410441%1711251PREGNANT STATE,
INCIDENTALV22.2112415.515914202814112366537%971789ACUTE
BRONCHITIS46685811.14681013171051140332%1071261NORMAL
PREGNANCYV2262131.8291442424242283319724%169818EARLY OR THREATENED
LABOR64435824.9771424324330183633548%1914693PNEUMONIA, ORGANISM
UNSPECIFIED48634715.278101318241481621238%128559DISPLACEMENT OF
LUMBAR INTERVERTEBRAL DISC WITHOUT
MYELOPATHY722.127920.1871118243318132654066%1914819ACUTE UPPER
RESPIRATORY INFECTIONS OF UNSPECIFIED
SITE465.92749.76579111574109025%117364THREATENED PREMATURE
LABOR64423925.44111425304230163120146%1916440ACUTE SINUSITIS,
UNSPECIFIED461.91879.98579121675116125%117248INFLUENZA WITH OTHER
RESPIRATORY
MANIFESTATIONS487.11859.3557911149496325%106248INFLUENZA4871679.5657912148594019%117207OTHER
BACTERIAL PNEUMONIA48216016.788101420271410199838%1510258EDEMA OR
EXCESSIVE WEIGHT GAIN IN PREGNANCY, WITHOUT MENTION OF
HYPERTENSION646.115719.1961116243417132810239%107259CHEST
PAIN786.515113.364712172610102213547%1613286UNSPECIFIED ESSENTIAL
HYPERTENSION401.913017.9681014.520318102313651%1510266ANKLE
SPRAIN84512813.76791317221281511046%129238ACUTE
SINUSITIS46112711.1768111417116117637%1310203TRANSIENT HYPERTENSION
OF PREGNANCY642.312618.777111923302012235832%1814184ABDOMINAL
PAIN78912614.33691217241281813151%1410257THREATENED
ABORTION64011818.036917233217142610347%1814221CARPAL TUNNEL
SYNDROME35411723.2481319293928163136075%2116477ACUTE MYOCARDIAL
INFARCTION41011728.1881628424842264012952%2217246ACUTE, BUT
ILL-DEFINED, CEREBROVASCULAR
DISEASE43610637.82132634.5486328225018463%3127290MILD OR
UNSPECIFIED
PRE-ECLAMPSIA642.410418.92591628321419275233%159156ASTHMA49310315.3781014202511101712855%139231CPT4OnlyGold
Medal ProjectTable of Statistics For Most Common Surgery. (surgical
cases only)Includes CPT4 With At Least 100 Observations (Frequency
>=100)Approved only cases at first review episode=1, request=A,
extension=0Cases With > 1 ReviewPercentilesCPT4Average #Range
(in days)Range (in days)Total Cases% of
Cases50thDescrip.CPT4Frequencyof Days10th25th50th75th90thModefrom
25th - 75thfrom 10th - 90th>1 ReviewWith >1
ReviewALODPercentileTotal abdominal
hysterectomy58150121839.9628424242454201786742%20851110Cholecystectomy5634069014.8910121417211451154744%123787Cesarean
delivery only5951468345.0642424242564201444439%11271414Repair
initial inguinal
hernia4950550822.30111421283914142832639%834109Arthroscopy (with
meniscectomy)2988136321.97111421283314142247156%8341311Vaginal
hysterectomy3052028513.258101414181441018439%46986Septoplasty or
submucous resection5826027636.12282842424242141420543%4811111Median
nerve at carpal
tunnel6472126623.36101421.5303914162942061%6861413Appendectomy4495024719.85101318273128142114337%390108Repair,
revision or reconstruction(with metatarsal
osteotomy)2829624629.47142128424242212825451%5001413Laminectomy
(one interspace,
lumbar)6303020939.11202842446042164031660%5251815Arthroscopy
(debridement / shaving of articular
cartilage)2987718022.2210.514212837141426.521154%3911512Myomectomy,
excision of fibroid tumor of
uterus5814017333.19212832424242142112342%2961111Reduction
mammaplasty1931816321.17141421282828141413245%295108Excision
(Cholecystectomy)4760016017.8310131622281491812343%283108Hallux
valgus(bunion)
correction2829015929.40142128424242212817853%3371211Hammertoe
operation2828514823.04121722303228132015351%3011210Repair of
complete shoulder2342014135.18142631435642174219758%3381915Repair
umbilical hernia4958513720.4011142028282814179942%236109Laparoscopy
(with vaginal
hysterectomy)5630813533.5321283342424214219642%231109Routine
obstetric care including antepartum
care5951013451.7042425656565614146733%2011514Percutaneous
transluminal coronary balloon
angioplasty9298212822.5991318303714172812048%2481714Arthroplasty,
acetabular and proximal femoral (hip
replacement)2713012647.33304242.5596042173017158%2971916Exploratory
laparotomy4900012632.29152329424242192713752%2631513Arthroscopically
aided anterior cruciate ligament
repair2988812527.11131828354242172914153%2661614Arthrodesis,
anterior interbody
technique2255411744.02283742515642142816559%2822017Arthroscopy
(with meniscus
repair)2988211722.85121421303521162315257%2691412Repair initial
incisional
hernia4956011026.8113.519283542421628.512353%2331211Colectomy,
partial; with
anastomosis4414010335.35212841424642142512054%2231814
-
OVERALL UTILIZATION TRENDS - Circulatory Case Types
(ALOD = Average Length of Disability)
Result: 12% ALOD decrease.
-
*
HIGH IMPACT UTILIZATION TRENDS
- Psychiatric Case Types
(ALOD = Average Length of Disability)
*
-
Manufacturer - Location Analysis
- ALOD by Location and type (Medical vs MH*)- 4 Qtr Summary(Q3
00-Q201)
Savings Potential: Whats up with San Jose and Orchard Park?
*MH=Mental Health ICD-9s
-
So What Does this Mean from the Clinicians POV?
Oh, the Pain!
-
Implications for the Practitioner
(ID problems and be a good doctor)
Understand the continuum of Absenteeism and Presenteeism can
help the care of the individual
Do aggressive treatment of common conditions (depression,
respiratory illness, hypertension)
Understand/find possible company resources (EAPs, wellness
programs, special benefits, etc.)
Encourage employers to use transitional work and focus on
defining employee functional level
-
Chronic Pain (Biopsycosocial Model)
Loeser J.
Managing the Chronic Pain PatientD,, 1989
-
Implications for the Practitioner
Understand basic disability prevention/management
Understand the Biopsychosocial Model (e.g., emotional reactions
accompany temporary disability and should be managed to prevent it
becoming permanent).
Understand that a diagnosis alone (without demonstrable
functional impairment) may not justify work absence
ID and treat psychiatric issues and teach patients about the
interaction of psychiatric and physical problems.
Understand Functional Recovery Programs and use them in cases of
delayed recovery
-
WRAP UP AND QUESTIONS
?
-
Presenteeism and Absenteeism Literature
Preventing Needless Work Disability by Helping People Stay
Employed ACOEM Position Paper - J Occup Environ Med - 01-SEP-2006;
48(9): 972-87http://www.acoem.org/guidelines.aspx?id=566
Healthy Workforce/Healthy Economy: The Role of Health,
Productivity, and Disability Management in Addressing the Nation's
Health Care Crisis
J Occup Environ Med - 01-JAN-2009; 51(1): 114-9
Health and Productivity as a Business Strategy
J Occup Environ Med - 01-JUL-2007; 49(7): a712-21
Health, Absence, Disability, and Presenteeism Cost Estimates of
Certain Physical and Mental Health Conditions Affecting U.S.
Employers
J Occup Environ Med - 01-APR-2004; 46(4): 398-412
*
A facilitated early return to work program at a large urban
medical center.
Bernacki EJ, Guidera JA, Schaefer JA, Tsai S.
Division of Occupational and Environmental Medicine, Johns Hopkins
University, School of Medicine, 600 N. Wolfe Street, Billings
Administration 129, Baltimore, MD 21287-1629, USA.
An Early Return to Work Program was initiated at The Johns Hopkins
Hospital and Associated Schools of Medicine, Hygiene and Nursing in
Baltimore, Maryland, in April 1992 as part of a comprehensive
effort to control the incidence and costs of work-related illnesses
and injuries. The program was similar to others that incorporate
employee and supervisory training and job accommodation, but it
also included an industrial hygienist trained in ergonomics to
facilitate the placement of individuals with restrictions. The
return to work program was studied over a 10-year period, comparing
the number of lost workday cases, lost workdays, and restricted
duty days before (1989 to 1992) and after (1993 to 1999) initiation
of the program. A significant decrease (55%) was observed in the
rate of lost workday cases before versus after the return to work
program. Furthermore, the number of lost workdays decreased from an
average of 26.3 per 100 employees before, to 12.0 per 100 employees
after, the return to work initiative, and the number of restricted
duty days went from an average of 0.63 per 100 employees to 13.4
per 100 employees (a twentyfold increase). The study suggests that
a well-structured early return to work program is an integral part
of a comprehensive effort to control the duration of disability
associated with occupational injuries and illness. It also
indicates that to be most effective, an early return to work
program must include participation by medical providers, safety
professionals, injured employees, and supervisors. Our work
suggests that even with these elements in place, the effectiveness
of return to work programs may be increased by including an
individual trained in ergonomics to facilitate the job placement
process.
-
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