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Enhancing Provider-Employer Communication for Effective Return-to-Work Practices

This report presents insights from the COHE Advisory Group on optimizing provider-employer interactions to promote best practices in return-to-work processes. Key topics discussed include historical best practices, implementation challenges, and the importance of two-way communication. The report emphasizes the need for timely accident reporting, effective care coordination, and the use of performance metrics to track compliance with best practices. Ultimately, the goal is to enhance recovery to work for injured employees through better collaboration and continuous quality improvement.

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Enhancing Provider-Employer Communication for Effective Return-to-Work Practices

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  1. Provider Network Advisory Group COHE Expansion July 25, 2013

  2. Provider/Employer Contact Topics for Discussion • History of Best Practice • Lit Review, Provider Focus Groups • Use of Best Practice • COHE • Top Tier • Implementation Challenges • Measurement Challenges • Modification of Best Practice • Process • Results

  3. Provider/Employer Contact COHE Best Practices • Learning and Using Best Practices • Report of accident (ROA) in 2 days • Quick start to claim initiation/adjudication and employer notification • Activity prescription form • Communication between injured worker, provider, and employer • Provider call to employer • Discussion about restrictions and modified work • Barriers to recovery • Injured worker assessment typically at 2 to 4 weeks of time loss • Health Services Coordination • Assistance with return to work

  4. Provider/Employer Contact Top Tier Criteria • Experienced Attending Providers • Average of ≥ 12 claims annually • In good standing • Higher certification • Committed to quality improvement • Include patients with complex claims in practice • Demonstrated best practices • Exceeding benchmarks in best practices: ROA, APF, Provider/Employer contact • Care coordination • Knowledge and expertise in core competencies: • Collaboration & communication • Pain management • Workers’ Compensation knowledge

  5. Provider/Employer Contact Definition of this best practice:two-way communication about return to work between provider and employer

  6. Provider/Employer Contact Implementation Challenges • Identifying appropriate claims • Finding the correct employer contact • Playing “phone tag” with employer • Knowing what information to share • Responding to employer questions about claim adjudication

  7. Provider/Employer Contact Measurement Challenges • Using billing data • Time lag • Providers’ billing staff remembering to bill and use modifier • Providers using methods for contact other than telephone call • Developing a benchmark • Knowing when a claim needs this best practice • Recognizing that some providers do not bill for service or do not use modifier

  8. Provider/Employer Contact Modification Process • Review original intent of best practice from focus groups • Review alternatives/options with COHE Medical Directors and L&I staff • Agree on alternatives that meet original intent • Identify opportunities to explore in future • OHMS risk factors and identification of claims • OHMS documentation of appropriate employer contacts

  9. Provider/Employer Contact Results-How can best practice be met? • Attending provider telephone call to employer of injury • Billing code with modifier, or • OHMS documentation (in future) • Care Coordinator Initial Evaluation and Coordination (IEC) • IEC billing code, or • IEC notes in OHMS • Job description signed by provider • Billing code • Stay at Work benefit paid to employer within 1st 12 weeks • Signed job description required

  10. Provider/Employer Contact Provider Adoption of COHE Practices:

  11. Provider/Employer Contact COHE and Top Tier Goals • Increase provider use of best practices. • Add methods to facilitate provider/employer contact • Test benchmark for provider/employer contact • Increase number of high and medium adopters of best practices • Identify opportunities for Occupational Health Management System (OHMS) to improve use and measurement of best practices

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