Nicole Matoushek PT MPH CSHE CEES
Posts: 727
Joined: January 15, 2005
From: St. Petersburg, FL
Status: offline
|
Don’t Quit your Day Job
Work injury management programs keep the work force healthy and productive.
A few lost days on the job for a wrist strain or sore back don’t seem like much. But when viewed in the aggregate, the potential financial hit due to lost time, risk exposure and the costs associated with injury claims can be staggering. One striking estimate comes via the U.S. Department of Labor, which claims that workplace injuries cost U.S. industry $13 million to $20 million a year.1
In the interest of getting a handle on these exploding numbers, work injury management programs are becoming popular options. Their objective is to resolve workers’ compensation claims as quickly as possible to minimize losses. Employers and insurance carriers are continuously evaluating the cost and effectiveness of various rehabilitation programs to better contain costs and improve their return to work outcomes.
Two major trends are working in the favor of the worker’s compensation market. First, in most states, reimbursement for rehabilitation services under worker’s compensation remains significantly higher than sources such as Medicare and private group insurance. Rehab providers are finding more opportunities to provide ergonomic and specialized work injury management programs in the workers’ compensation sector.
Second, recent changes in workers’ compensation laws in some states have had a negative impact on the rehabilitation industry. In 2004, California passed several workers’ compensation reform laws in an effort to limit costs. Senate Bill 899 capped OT visits and Senate Bill 228 and Assembly Bill 227 capped PT visits.
Also, physicians treating workers’ compensation patients in the state are required to follow guidelines established by the American College of Occupational and Environmental Medicine (ACOEM), which are used by both physicians and insurance carriers to authorize rehabilitation services.
These reform laws have had an adverse effect on the rehab industry in California, resulting in fewer rehab treatments, more denied claims and longer waiting times for treatment.2 Furthermore, a study performed by the American Occupational Therapy Association reports that the number of OT treatments dropped by 35 percent from January to June of 2004, denied claims increased from 1,030 in 2003 to nearly 15,000 in 2004, and average waiting time for approvals increased from 6 days to 15 days.
In addition, the California Physical Therapy Association reports many therapy requests were denied in 2004, based on a narrow interpretation of the ACOEM guidelines. Other states are expected to follow California’s lead.
The Four Types of Work Programs
On a positive note, as rehabilitation providers, we have the unique opportunity to refine our clinical management skills, improve functional outcomes, and provide additional work injury management programs that are recognized by the ACOEM guidelines as important in the management of the injured worker.
In fact, the ACOEM guidelines provide only general references to therapy provisions, but focus heavily on worksite evaluations, person-job fit, work design, work modifications and return to work outcomes.
These are the areas in which a specialized work injury management program can fill the expanding market need. Generally, there are four types of specialized work injury management programs.
Job task analyses. The JTA is a methodical evaluation of ergonomic risk factors in a particular occupation. The JTA is performed as a one-time visit at the worksite. When a worker is injured, a JTA is typically performed in conjunction with other work injury management programs to provide detailed information regarding the physical demands and ergonomic risk factors of the job.
The physician, case manager, employer and rehabilitation professional use this information to develop treatment plans, provide work-specific training, identify appropriate work tasks and determine return-to-work readiness.
Functional capacity evaluations. The FCE evaluates an injured worker’s physical, functional, behavioral and work-specific abilities to help determine return to work readiness. It is often required when barriers to return to work are present, requiring further testing of functional capabilities.
The FCE measures endurance and activity tolerance, and provides objective documentation that estimates the individual’s ability to perform physical demands at different levels over periods of time. An FCE is a one-time service at the clinic or worksite, and can be job-specific, including work simulations.
Work injury containment. Injury containment is based on the premise that if ergonomic issues are not addressed when an injured worker returns to work, the current injury and associated costs will continue to escalate. The injury containment program enables the evaluator to control some of the factors that can result in the progression or exacerbation of an injury.
Work injury containment programs are divided into several components: work task data, musculoskeletal assessment, injury characteristics, description of the observed job tasks, ergonomic risk factors, injury risk factors, recommendations and an overall summary.
An example of work injury containment is as follows. A worker sustains a wrist strain injury through exposure to ergonomic risk factors—high repetitions, forceful grasping, and repeated wrist flexion and extension. If he immediately returns to full work duty with these risk factors still in place, he may be more susceptible to further injury, such as carpal tunnel syndrome, which could require a carpal tunnel release and extensive rehabilitation. Time away from work and the cost per injury increase.
Work integration programs. These specialized return-to-work programs are performed, at least in part, at the workplace. A plan of care establishes a structured and progressive return to work, by evaluating injury factors, ergonomic risk factors, functional deficits and work tasks of an injured worker who can not easily return to his prior work level.
Work integration programs can be a very effective method in injury management, as they address the factors that significantly influence the overall cost of the injury claim. They require the cooperation of the ordering physician, insurance carrier, the employer and the worker.
An example of a work integration program is as follows. A warehouse worker injures his back performing a lift. He undergoes a laminectomy and is now in a post-op rehab program. His critical job duties entail material handling of objects from 25 to 100 pounds, driving a forklift and performing product logging duties. At six weeks post-op, the physician returns the worker to his job, with a lifting restriction of 50 pounds and request for a follow-up in one month.
The employer is concerned about reinjury and lost production, and contacts the rehabilitation professional to develop a work integration plan of care. The rehabilitation professional evaluates the functional limitations of the worker, which include: maximal lift of 50 pounds and limitations in standing, walking, twisting and forklift driving. Injury characteristics include a post-surgical condition in the sub-acute stages of healing, and no prior medical history or medical complications. Job risk factors include whole-body vibration, postural stress, forceful exertions and repetitive material handling.
In order to facilitate a safe and productive return to work, the rehabilitation professional develops a plan of work that includes a short period of forklift driving, followed by a short period of material handling and long periods of product logging, then repeating the work cycles. The plan also includes continued skilled therapy, which is focused on functional restoration and reconditioning.
This work task schedule is progressed during the next four weeks, until the worker next sees the physician, when the plan will be modified as needed. The objective is to progressively increase the duration of material handling and forklift driving to allow for a period of reconditioning.
In addition, the rehabilitation professional limits lifting to 25 pounds during week one, 35 pounds during week two, 45 pounds during week three, and 50 pounds during week four. The plan continues until the worker is back at full duty.
Marketing the Program
Abundant marketing options for these programs abound. Communicate with primary referral sources under workers’ compensation—the ordering physician, employer, insurance adjuster, case manager and the patient. Represent yourself as specially trained and experienced in work injury management, and provide evidence of quality functional outcomes in worker rehab.
Establish a level of expertise in work injury management by developing competencies in the specialized services mentioned above. Continuing education, training and specialty certifications will identify a rehabilitation professional who has specialized in the issues, objectives and clinical practice standards within this specific sector.
There are ample opportunities to contribute and prosper as a rehabilitation provider in the workers’ compensation industry today. Developing and implementing specialized work injury management programs allows the rehabilitation professional to better manage worker’s compensation patient care and return to-work criteria.
The key to work injury management is a strong understanding of ergonomics and how work demands affect human performance and the development of disease. Core competencies in ergonomics, clinical management of work-related injuries and ergonomic risk control are essential for success in this field.
References
1. Occupational Safety and Health Administration. “Safety Pays.” U.S. Department of Labor. Accessed via [URL=http://www.osha.gov]www.osha.gov[/URL]
2. LaGrossa, J. (2005, Jan. 24). Work hardening: Changes in workers’ comp regs are weighing heavily on OT. ADVANCE Magazine for Occupational Therapy Practitioners, 21(2).
3. ErgoRehab Inc: [URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
Nicole Matoushek, MPH, PT
_____________________________
Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
http://www.ErgoRehabBlog.com
http://www.ComputerAccessoriesOnlineStore.com
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Work Injury Management Programs: article 
Work Injury Management Programs: article - 
New Messages
No New Messages
Hot Topic w/ New Messages
Hot Topic w/o New Messages
Locked w/ New Messages
Locked w/o New Messages
Post New Thread
Reply to Message