The Role of the Occupational Medicine Provider in Managing Risks

1
The Role of the Occupational Medicine Provider in
Managing Risks

• Melinda E. Wagner RN, BSN, MS, MBA

2
Agenda

• The Employee Risk Continuum
• Designing the Right Workplace
• Getting the Right People on the Bus
• Managing Work Place Safety
• Managing Workers Compensation Injuries
• Managing Employee Productivity
• Managing Health Benefits
• Managing Post Employment/Retirement Programs
• Motivating Your Occupational Provider into your
  Business Partner

3
The first step in the risk management process is
to acknowledge the reality of risk. Denial is a
common tactic that substantiates deliberate
ignorance for thoughtful planning.

• Charles Tremper, CIO AAHSA

4
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
5
Workplace Design Consultation
6
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
7
Value of Employment Screening

• Improved Job-Worker Match
• Establish Organizational Culture
• Improve Employee Retention
• Improve Risk Management
• Reduce Costs
• Eliminate One Back Injury---Pays for Program for
  Years!

8
Helping you Get the Right People on the Bus

• Pre-Employment Screening
• Substance Abuse
• Cognitive Levels
• Background Checks
• Post Offer Screening
• Substance Abuse
• Functional/Medical Evaluations
• Pre-Placement Screening
• Honesty/Integrity testing Functional/Medical
  Evaluations
• Reporting

9
What to Expect from Your Post Offer Functional
Testing Program

• Expect
• ADA/EEOC Compliance
• Process
• Job Specific Testing Protocols
• Safety
• Initial Pass/Fail Report
• Statistical Analysis
• On-going Updates
• Better Job-Worker Match
• Accommodation Guidance

• Avoid
• Cookie Cutter Programs
• Job Category or Standardized Testing Protocols
• Copy of Complete Test Results
• Impairment Ratings
• Programs without Maintenance

10
Role of the Occupational Provider

• Program Development
• Program Implementation
• On-going Program Evaluation Updates

11
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
12
Workplace Safetyand the Role of the Provider

• Physician PT Worksite Evaluations
• Medical Surveillance
• Review of injury trends by job types
• Education
• Safety committee
• Selling safety to leadership

13
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
14
Managing the Injury

• Goals - Quality Care, Prevent Disability,
  Expedite Recovery, Eliminate Unnecessary Costs
• SPICE Treatment Model
• Simplicity - Base treatment on objective
  findings-- most cases should be resolved in 2-3
  weeks
• Proximity - Keep the worker mentally and
  physically engaged in work
• Immediacy - Set timeframes based on clinical
  guides
• Centrality - Lots of agendas, but everyone must
  focus on the same goals use the Provider to
  help you control all other providers
• Expectancy - Create the expectation on day one
  for the employee to fulfill

15
Involve the Provider in Effective Return to Work
Programs

• Policies promoting RTW can improve outcomes by as
  much as 15 weeks
• WCRI Study on return to work factors
• Age impacts RTW
• Education level impacts RTW
• Most consistent predictors--Patients perception
  of the initial severity of the injury and
  effectiveness of their recovery - which include
  RTW

16
Managing by TOTAL Cost

• Evaluate cost based on total costs and outcome
• Workers Compensation Direct Medical Costs are
  rising 9-12
• NCCI Study suggests workers compensation pays
  more than group health to treat comparable
  injuries
• Utilization differences dominate price
  differences explaining 80 of the cost variance
• Evaluation management codes, radiology and PT
  costs are higher due to utilization

17
Understanding the System Variances to Understand
the Cost Variances

• Work Comp
• Focuses on pre-injury productivity
• Management of entire claim
• State mandated benefits
• Employer is the payer
• Patient disincentives
• Multiple parties

• Group Health
• Focuses on termination of care
• Management of medical only
• Benefits controlled by policy
• Employee is a payer
• Patient incentives
• Provider patient

18
Understanding the Costs

• Work Comp Total Costs
• Medical
• Wage Replacement
• Settlement
• Lost Productivity
• Fraud
• Workplace Changes
• Administrative Costs
• Employee Retention
• Employee Morale
• Lost Business
• OSHA issues

• Group Health Total Cost
• Total Medical Costs

19
Communications with Your Occupational Provider

• Communication
• Measure Results on Total Costs and Outcomes
• More Communication

20
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
21
For Profits You Need People Who Perform

• Cost of absenteeism
• 30.5 billion due to just asthma, diabetes and
  hypertension
• Cost of Presenteeism
• Estimated to cost as much as 180-250 billion
• Lost Productivity is estimated 7.5 greater than
  absenteeism
• In study of 800 managers 76 report Low
  Productivity as their 1 challenge

22
Incorporating the Occupational Provider into
Resource Management

• Developing Culture
• Developing Management Programs
• Medical Monitoring Programs
• Public Safety Positions
• Voluntary
• Return to Duty
• Fit For Duty
• Knowledge of a medical condition linked to
  performance or direct threat
• Managing by the data

23
Incorporating the Occupational Provider into
Resource Management

• Family Medical Leave Act
• About 62 of all workers are qualified for FMLA
• Over 50 million have taken FMLA
• 80 take over 40 days
• Provider Role
• Review of certification
• Consideration of second opinions
• Benefit Preventive Health Program development
  based on data

24
Incorporating the Occupational Provider into
Resource Management

• Disability
• 7.5 million on disability
• Average age 52
• 90 are disabled workers
• Obese adults almost twice as likely to become
  disabled

25
Red Flags In Disability

• Inconsistent symptoms physical finding
• Exaggerated pain complaints absent physical
  findings
• Restrictions inconsistent with diagnosis
• Significant discrepancies between multiple
  treating providers

• Certifying physician outside scope of practice
• Non compliance with treatment
• Doctor shopping
• Pending life change divorce/layoffs/job loss
• No objective testing

26
Incorporating the Occupational Provider into
Resource Management

• Occupational Providers Role
• Medical Record Review
• Independent Medical Exam
• Functional Capacity Evaluations
• Productivity Studies
• Consultation with the Attending Physician to get
  an accurate and complete statement
• Identify and address Red Flags

27
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
28
Incorporating the Occupational Provider in Health
Benefits Planning

• Analysis of health care trends
• Education programs
• Implementation of benefits
• Focused preventive health programs
• Designing programs that generate returns
• Disease management programs

29
The Occupational Provider Impact
Employee Productivity
Workplace Design
Workplace Safety
Exit/Post Employment
Workers Compensation
Health Benefits
Hiring/Placement
The Employee Risk Continuum
30
Incorporating Your Occupational Provider into the
Exit Process

• Exit Physicals
• Retirement Benefits
• Prevention/Health Management Programs
• Education
• Connection to your workplace

31
Engaging Your Provider to Be Your Partner

• Provider Selection
• Communication
• Feedback
• Ongoing Involvement
• Reimbursement
• Policy Development

32
Questions and Discussion