Return to Work Strategies

1. Return to Work Strategies James M. Anthony, M.D. Medical Director Community Health Partners Occupational Health Services

2. What Employers Know Medical only claim (7 or fewer days off) $717 average cost Lost time claim (8 or more days off) $44,000 average cost

3. 100% Resolution of claim vs. time 75% Percent resolution 50% 25% 0% 0 6 12 18 24 36 Time, in months

4. The Kroger Co. “You don’t get a person well to get them back to work. You get them back to work to get them well.”

5. Strongest predictors of RTW outcomes • Functional and psychosocial factors • Workplace constraints and responses • Personal coping strategies

6. Clinical Trials • There is some consistency in the limited results: • Successful interventions combine credible medical care while promoting active collaboration with patients on ways to resume normal function and workplace activities • Others receive quality medical care with excellent clinical results, yet the patients struggle to return to their normal work routine

7. Psychosocial Factors that Predict Return-to-Work • Perceptions of employer support • Perceptions of employer’s willingness to accommodate • Belief that pain is transient not catastrophic • Belief that most physical and social activities can be maintained throughout the recovery period

8. Expectations of Injured Workers • Providers will understand their jobs • Providers will offer personalized guidance • Home exercises • Work modifications • Prevention of re-injury

9. Communication • A recent review found strong evidence that contact between the health care provider and the workplace improved RTW outcomes after work injuries

10. Redefining Practices • Employers and practitioners who are implementing these principles are consistently achieving very good results, but there are few of them. • These issues will become increasingly urgent as the workforce ages.

11. Another Study Showed • Patients who had negative expectations for RTW before seeing a medical provider were less likely to have resumed normal work 1 and 3 months later

12. From the same study … • Some patients feel overwhelmed and limited by pain and doubt that physical demands of work can be modified • The doctor looks at the same things but also adds a physical examination of the injured area

13. Louisiana special “network” • Occupational physicians were selected for this role because of their experience in treating workers’ compensation claimants and their knowledge of the physical demands of work • The network physicians were exempt from utilization review • Supporting these network physicians in the treatment of an injured worker are orthopedic surgeons, neurosurgeons, physiatrists, chiropractors, and physical therapists among other specialized healthcare providers

14. Study Results • Claim costs for similar length of claim and lost time were about the same inside and outside this specialized network • The network’s ability to reduce cost and disability was in the early management of a claim, particularly the ability to return employees back to gainful employment earlier than non-network providers

15. Study Results • The pace of the network method is aggressive, and occupational health nurses help ensure the pace is kept • The fast pace helps ensure lost time cases are monitored intently and treatment does not lag

16. Study Results • Medical care costs were significantly lower among network providers • This would suggest that utilization review seems to have little impact on the behavior of preselected experienced healthcare providers

17. Study Results • As claims developed there was less ability to influence time lost from work or medical and indemnity costs • Resources should be applied early on (particularly in lost time cases) by payers (casualty insurance companies, self-insureds, and state funds) to facilitate early diagnosis, prompt treatment, and expedited return to work.

18. Important Considerations -The Injured Back • Occupational back pain is one of the most prevalent and least understood of the illnesses and injuries covered by workers’ compensation • Occupational back pain is a prime target for disability management

19. Results from one back injury study.. • The worker’s satisfaction with their employers’ responses to their claims is the most important single influence on maintaining employment subsequent to the onset of back pain, and roughly comparable to the severity of back pain

20. Study Results • Although satisfaction with healthcare is influential, it is a much less important influence on patterns of employment than is a worker’s perception of the actions of his/her employer • Findings suggest unrealized opportunities for reducing the costs of occupational back pain by developing improved strategies for managing the relationships between employers and workers who file back claims

21. Report From the Stay-at-work & Return-to-work Committee • Our contention – that a considerable amount of work disability can be prevented or reduced by finding new ways of handling important non-medical factors that are fueling its growth

22. Report From the Stay-at-work & Return-to-work Committee • More successful employers and providers do exist and can serve as a model • In most instances, the formula is simple: • Kindness • Straightforward communication • Common sense practicality • Good management

23. Report From the Stay-at-work & Return-to-work Committee • Acknowledge the powerful contribution that motivation makes to outcomes and make changes to improve incentive alignment • Support appropriate patient advocacy by getting treating doctors out of a loyalties bind. Focus on functional abilities and not return to work dates • Increase availability of on-the-job recovery and transitional work programs – STATE OF OHIO CITED AS A “BEST PRACTICE” in this area

24. Essentials for the return-to-work team • Convey optimism, hope and reassurance to the injured worker • Actively promote benefits of early return to work • Set timeframes/expectations for recovery The injured worker’s physician AND employer play pivotal roles in these “ESSENTIAL” functions. Without them, these are much more difficult to achieve.

25. What is the most important tool or strategy that results in successful return to work?

26. Communication • Cooperation • Collaboration

27. Employer Strategies for Return to Work and Lower Injury Costs • Develop a prevention force field: • Design and implement a Drug Free Workplace Program • Develop and implement an ergonomic safety program • Develop and implement a Transitional Work Program • Develop and use “Functional Job Descriptions”

28. Employer Strategies for Return to Work and Lower Injury Costs • Develop a prevention force field: • Proactively invest in return-to-work policies and procedures and injury reduction policies and procedures that work • Develop a relationship with an experienced occupational medicine provider and full service occupational health program • Consider developing an on-site medical presence (such as an occupational health nurse) when your workforce size justifies this or you can partner with a healthcare provider that will share a nurse for only limited times that fit your needs

29. Employer Strategies for Return to Work and Lower Injury Costs • Develop an injury action plan: • Set expectations for your employees early and often. An initial letter with those expectations and explaining company policies is an excellent idea • Use your functional job descriptions as communication tools with providers and employees before and after an injury • Especially if your employee chooses to go to your recommended providers, strongly consider rapid approvals for needed treatment and diagnostic tests

30. Employer Strategies for Return to Work and Lower Injury Costs • Develop an injury action plan: • Focus your efforts on encouraging proper diagnosis and rapid treatment of your good employees and, only if you strongly believe or have evidence the employee is acting inappropriately, use the method of deny, delay, and defend • Keep the lines of communication open with your injured worker’s provider and promote your company’s transitional work and ability to accommodate restrictions • If a lost time claim develops, send a formal written restricted duty job offer to your employee and her provider. Design a job you think might be acceptable to the provider given the injury type and area.

31. Employer Strategies for Return to Work and Lower Injury Costs • Develop an injury action plan: • Create a culture where your injured worker is welcomed back into the workplace and given, when possible, meaningful work in their normal area even when restricted • Train your supervisors to avoid being down and negative when welcoming an employee with restrictions back into their area. Don’t punish your supervisors with “productivity demerits” when they are forced to accommodate a restricted employee

32. Employer Strategies for Return to Work and Lower Injury Costs • Remember these things suggested by the studies: • In general, if you develop an adversarial relationship with your employee, you will experience the consequences of lawyer representation of your employees, IME costs, company lawyer costs and multiple hearings and appeals • Workers often will take on the personality of their employer in these areas and slow approvals = slow recoveries. Believe that you have control over these approvals even when you are not responsible to review the requests. Remember who hires the MCO and the TPA!!

33. Occupational Health Center