Transcript The Role of the Occupational Medicine Provider in

The Role of the Occupational
Medicine Provider in
Managing Risks
Melinda E. Wagner RN, BSN, MS, MBA
Agenda
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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
“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
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
Workplace Design Consultation
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
Value of Employment Screening
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Improved Job-Worker Match
Establish Organizational Culture
Improve Employee Retention
Improve Risk Management
Reduce Costs
Eliminate One Back Injury---Pays for
Program for Years!
Helping you
“Get the Right People on the Bus”
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Pre-Employment Screening
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Post Offer Screening
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Substance Abuse
Functional/Medical Evaluations
Pre-Placement Screening
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Substance Abuse
Cognitive Levels
Background Checks
Honesty/Integrity testing
Functional/Medical Evaluations
Reporting
What to Expect from Your Post
Offer Functional Testing Program
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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
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Avoid
“Cookie Cutter” Programs
Job Category or
Standardized Testing
Protocols
Copy of Complete Test
Results
Impairment Ratings
Programs without
Maintenance
Role of the Occupational Provider
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Program Development
Program
Implementation
On-going Program
Evaluation & Updates
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
Workplace Safety
and the Role of the Provider
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Physician & PT
Worksite Evaluations
Medical Surveillance
Review of injury
trends by job types
Education
Safety committee
Selling safety to
leadership
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
Managing the Injury
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Goals - Quality Care, Prevent Disability, Expedite
Recovery, Eliminate Unnecessary Costs
SPICE Treatment Model
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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 agenda’s, 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
Involve the Provider in
Effective Return to Work Programs
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Policies promoting RTW can improve
outcomes by as much as 15 weeks
WCRI Study on return to work factors:
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Age impacts RTW
Education level impacts RTW
Most consistent predictors--Patient’s
perception of the initial severity of the injury
and effectiveness of their recovery - which
include RTW
Managing by TOTAL Cost
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Evaluate cost based on total costs and outcome
Workers’ Compensation Direct Medical Costs are
rising 9-12%
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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
Understanding the System Variances to
Understand the Cost Variances
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Work Comp
 Focuses on pre-injury
productivity
 Management of entire
claim
 State mandated
benefits
 Employer is the payer
 Patient disincentives
 Multiple parties
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Group Health
 Focuses on
termination of care
 Management of
medical only
 Benefits controlled by
policy
 Employee is a payer
 Patient incentives
 Provider & patient
Understanding the Costs
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Work Comp Total Costs
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Medical
Wage Replacement
Settlement
Lost Productivity
Fraud
Workplace Changes
Administrative Costs
Employee Retention
Employee Morale
Lost Business
OSHA issues
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Group Health Total Cost
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Total Medical Costs
Communications with Your
Occupational Provider
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Communication
Measure Results on Total Costs and Outcomes
More Communication
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
For Profits You Need
People Who Perform
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Cost of absenteeism
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$30.5 billion due to just asthma, diabetes and
hypertension
Cost of “Presenteeism”
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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
Incorporating the Occupational Provider
into Resource Management
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Developing Culture
Developing Management Programs
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Medical Monitoring Programs
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Return to Duty
Fit For Duty
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Public Safety Positions
Voluntary
Knowledge of a medical condition linked to performance or
“direct threat”
Managing by the data
Incorporating the Occupational Provider
into Resource Management
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Family Medical Leave Act
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About 62% of all workers are qualified for FMLA
Over 50 million have taken FMLA
80% take over 40 days
Provider Role
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Review of certification
Consideration of second opinions
Benefit & Preventive Health Program development
based on data
Incorporating the Occupational Provider
into Resource Management
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Disability
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7.5 million on disability
Average age 52
90% are disabled
workers
Obese adults almost
twice as likely to
become disabled
Red Flags In Disability
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Inconsistent symptoms &
physical finding
Exaggerated pain
complaints absent
physical findings
Restrictions inconsistent
with diagnosis
Significant discrepancies
between multiple treating
providers
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Certifying physician
outside scope of practice
Non compliance with
treatment
Doctor shopping
Pending life change:
divorce/layoffs/job loss
No objective testing
Incorporating the Occupational Provider
into Resource Management
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Occupational Provider’s Role
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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”
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
Incorporating the Occupational
Provider in Health Benefits Planning
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Analysis of health care trends
Education programs
Implementation of benefits
Focused preventive health programs
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Designing programs that generate returns
Disease management programs
The Occupational Provider Impact
Workplace
Design
Workplace
Safety
Hiring/Placement
Employee
Productivity
Exit/Post Employment
Workers’
Compensation
Health
Benefit
s
The Employee Risk Continuum
Incorporating Your Occupational
Provider into the Exit Process
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Exit Physicals
Retirement Benefits
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Prevention/Health
Management Programs
Education
Connection to your
workplace
Engaging Your Provider
to Be Your Partner
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Provider Selection
Communication
Feedback
Ongoing Involvement
Reimbursement
Policy Development
Questions and Discussion