Coming to our senses...

1. Coming to our senses... HOW we can rise above the differences of our perspectives... and help Californians get BACK TO WORK

2. Presented by: Robin Nagel, MS, Disability Management Specialist for further contact, call (510) 421-1427 or e-mail: rmnagel@pacbell.net Integrated Pain Management Medical Group, Inc. 2485 High School Ave., Suite 201, Concord, CA 94520 (925) 691-9806

3. A familiar complaint? “There are so many things for me to do here at the hospital. Everything is changing. Now… our whole relationship to the [patients] is different. Now there are elaborate forms to be filled out for the administration. Each patient who wants worker’s compensation has to have detailed information supplied about him…”

4. But…where have you heard this? “... Formerly, I would just dash off a short note, sign my name to it, and that was that. Now it’s endless. And if I say that a patient has been treated and is ready to go back to work, he may become outraged for he would like to stay away from his job yet get paid for it. Little by little, all the joy is going out of our work.” Source, see: Acknowledgements

5. The Impact of Workplace Injuries: (old news…) • 5.3 Million Work-Related Injuries in USA Bureau of Labor Statistics, 1999 • Approximately 55% of Annual Workers’ Compensation claims are MSDs* • MSDs in America Cost $45 to $54 Billion Per Year Bureau of Labor Statistics 1999 • Repetitive Motion Injury reporting has increased 190% since 1983 *Musculo-Skeletal Disorders

6. The Mandate of AB 749: The Return to Work Program(LC 139.47b) • DIR Policy & Education on RTW Goal: Inform, show & assist employers & injured workers to experience the mutual benefits of early & sustained return to work within medical work restrictions • Develop & distribute educational materials • Easily understandable; print & electronic materials • Useful for employers, health care providers, employees, labor unions • Discuss early RTW, assessing function abilities & limitations, appropriate work restrictions, job analyses, work-site modifications, assistive devices, resources available

7. The Mandate of AB 749: The Return to Work Program(LC 139.47b) • Develop training programs • For employer & employee organizations & health care providers • Address accommodation of injured worker and prevention of re-injury • Develop tools & resources for assessing work capacity and work restrictions • Ensure provider time required to assess & report work capacity is appropriately compensated

8. CHSWC’s Recommendations, July ’01 “RTW In CA: Listening to Stakeholders’ Voices” • Provide Info about Roles and Responsibilities • Providers of Services to Injured Workers and Employers -- • who are they? • what do they do, what must they do? • how are they trained? • how are they paid? • Promote “Respectful Attitudes Toward Injured Workers” -- and practice respectful attitudes “at home” … in employer risk management & HR departments, our claims offices, our medical clinics, and in our manner of doing business TOGETHER

9. CHSWC’s Recommendations, July ’01 “RTW In CA: Listening to Stakeholders’ Voices” • Model Practices -- treating physicians, employers, claims administrators • Based on ethical “Codes of Conduct” • Evidence-based standards of care • Advisors from business, health & law • Strategies to Overcome Systemic Problems Reduce delays in medical treatment -- BUT HOW???

10. The “WIN*” Program, Carle Clinic, Illinois special project for small (<500) businesses to join in a partner-ship to promote a safe, healthy and productive work force larger mission is to improve community health and focus on injury and illness prevention four half-day training sessionsfocusing on practical aspects of managing workplace disability *Workplace Injury Network Kaiser’s Occ. Medicine’s “Employer Forums” hosted by Occupational Medicine Department(s) for local employer-subscribers focus on critical medical issues in prevention of occupational injuries networking/problem-solving opportunity for similarly concerned employers Emerging models in our midst:medical provider groups that are reaching out

11. IPM, Inc. of Concord has invited employers, insurers & TPAs (whose covered employees it treats in significant numbers) to come to the table with questions, concerns and opportunities for improvement. We must learn to admit that We probably share a communication problem. If we’re not part of the solution, we’re part of the problem. Emerging models in our midst:medical provider groups that are reaching out

12. Employer/third party payer groups are invited to lunchtime roundtable discussions with physicians, at the clinic: To personally explain their particular needs, requests, concerns; To propose some of their own RTW solutions, introduce their programs; To ask for what they would like from the physicians, and To join in negotiating more successful processes for authorizing medical treatment and securing work status (restriction & capacity) information. GOAL: Acknowledge that concerns often differ, but are better known & understood than presumed & dismissed. Needs of patients: (AKA claimants, or employees) will vary; Needs of employers: mainly focus on stemming preventable disability-related costs, and keeping their workforce productive. Roundtable discussions at IPM, Inc. --Outreach by one multidisciplinary medical group

13. ASSERTING OUR COMMON NEEDS & OBJECTIVES: TO PROMOTE TIMELY MEDICAL AND FUNCTIONAL RECOVERY of disabled workers (including the permanently partially disabled) TO PROMOTE SAFE, HEALTHY AND PRODUCTIVE WORKPLACES for all Californians (prevent new injuries, avoid aggravations of old injuries) TO SUPPORT REASONABLE ACCOMMODATIONS in the workplace (based on medically indicated temporary and/or permanent work restrictions) TO KEEP WORKING CALIFORNIANS (whether they are called patients, employees, or injured workers -- these are all working people) SAFE, HEALTHY & PRODUCTIVE Medical Providers Can Begin to Define a Collaborative Solution by...

14. TAKE THE LEAD in facilitating educational forums with business partners: Provide PERSONAL ACCESS to physicians in a respectful learning environment -- identify differences; zero in on common interests & shared objectives Prepare to LISTEN and respond constructively to frustrations of employers and claims personnel Prepare to LEARN about employer-initiated programs to prevent injury, promote workplace productivity Make time to INTEGRATE new knowledge in your day-to-day medical practice What can medical providers offer?

15. SPEAK UP at CA educational forums: Identify business and professional groups that want information about the role of medical providers in disability management (DMEC) Offer to partner in panel presentations with employer-payer groups (PARMA) Collaborate with other medical provider organizations in addressing disability prevention/mgmt. solutions at public or membership forums (COA) What else can California medical providers contribute?

16. In conclusion... “Everything should be as simple as possible - BUT - not any simpler.” -- Albert Einstein

17. Acknowledgements • Albert Schweitzer, MD,: from an Encyclopedia Britannica article. Born 1875; died 1965; Ph.D. in philosophy - 1899; Doctorate in theology - 1900; 1905 -wrote a book on Bach; 1905 - resigned from university (seminary?); announced that we wanted to be a mission doctor. MD - 1913. Went to Gabon Provence of French Equatorial Africa soon afterwards, about 1914; Nobel Peace Prize - 1952 • Barbara Wleklinski, MS, WIN (WORKPLACE INJURY NETWORK) Program, Carle Clinic, Champagne-Urbana, Illinois • Kaiser Permanente Medical Group/Diablo Valley Service Area • CA CHSWC’s “RTW In California: Listening to Stakeholders’ Voices” July 2001 report