A New Frontier in Workers’ Compensation

From the Spring 2010 issue of the Journal of Osteopathic Physicians and Surgeons of California

By Minh Nguyen, DO

Look around and you see signs of a troubled economy everywhere – businesses closing, high unemployment numbers, and fewer crowds around shopping malls. No doubt businesses are struggling, and keeping costs down is a priority for businesses.

One of the areas where businesses are looking to contain costs is in workers’ compensation claims. As occupational medicine physicians, we play a significant role in helping employers effectively manage the care of their injured workers. Today’s environment provides us with an opportunity to reduce cost for businesses in the area of workers’ compensation without compromising the quality of patient care by incorporating a stewardship model of care.

Occupational medicine physicians serve as the steward of care for the injured worker. We are in the best position to facilitate communication, education, and participation of all stakeholders through this process. Being a steward of care requires identifying causation, secondary issues, and contributing co-morbidities while recognizing the behavioral and circumstantial realities as well as social and workplace issues.

At the initial visit, the treating physician establishes expectations including participation and compliance with the treatment plan. The treatment plan is re-emphasized and reviewed at every subsequent visit. Effective communication with the injured worker and the employer regarding expectations, responsibilities, and treatment plan is essential to getting the person back to his/her usual and customary job quickly.

The injured workers also need to be aware of the basic functioning and process of the workers’ compensation system. Understanding that the system’s ultimate goal is returning them to their pre-injured state, as well as knowing their rights and the limitations and strengths of the system, will help to reduce medical legal costs which represent a significant portion of the cost in workers’ compensation.

Over the past several years, the rise in California’s workers’ compensation costs has been attributed mostly to nonmedical costs and administrative costs. According to the Workers’ Compensation Insurance Rating Bureau, from 2005 to 2007, medical containment costs such as utilization review and nurse case management are up 51 percent, and medical legal expenses are up 59 percent during the same period.

Developing trust between the occupational physician and the injured worker by communicating all aspects of the care with the patient and involving the patient in the decision making process will help to foster a positive relationship that can help reduce unnecessary medical legal costs. Many studies have shown that legal costs are reduced when patients feel that their physician is empathetic towards them and has their best interests in mind.

Educating employers is also an essential role of the treating physician. Evidence has shown that early intervention and treatment of the workplace injuries and illnesses can positively impact outcomes. The treating physician has an obligation as the steward of care to educate the employer about this positive impact. Understanding the importance of having a return to work program is crucial. An injured worker is much more motivated to get healthy whey they stay in the work environment through return to work programs.

However, it is imperative that the occupational medicine physician communicates effectively regarding specific work restrictions. Restrictions should clearly define the functional capabilities of the injured worker. This will ensure that the injured worker will not be endangered while enabling them to still meaningfully contribute to their work place.

The occupational medicine physician is in a favorable position to exert positive influence on all stakeholders in the process. The measure of success is heavily dependent on good outcomes, and therefore delivering high quality of care is of the uttermost importance.

Evidence based medicine should be the standard of care, with recognition that each patient is an individual and that variance from common treatment guidelines may be needed in some cases. Practicing occupational medicine consistent with the American

College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines as well as other established occupational standard of care provides the foundation for an effective treatment plan in accordance with best practices. Adjusting treatment plans as needed based on progression or regression of the condition through frequent communication and re-evaluation of patients is important.

The stewardship model for treating the injured workers seems simple, yet sometimes the simplest things can be the hardest things to accomplish. According to the Work Loss Data Institute’s 2010 State Report Cards for Workers’ Comp that was released March 15,

2010, California Workers’ Comp scored a grade “D” based on the state’s performance from 2000 to 2007. The report card provides five different outcome measures in the areas of incidence rates, cases missing work, median disability durations, delayed recovery rate, and on key conditions and compares the results among the states for each year.

There is room for improvement. The occupational medicine physician serves as the bridge between the health care sector and the business sector. This unique role of the occupational medicine physician can help reduce costs for businesses while maintaining the highest quality of care in this time of economic challenges.

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