Balancing Employee Health and Safety with Company

Goals

Balancing Employee Health and Safety with Company

GoalsMichael Erdil MD, FACOEMMichael Erdil MD, FACOEM

Occupational and Environmental Occupational and Environmental Health Network Health Network

Johnson Occupational Medicine CenterJohnson Occupational Medicine Center

Potential Challenges In Workers CompensationPotential Challenges In Workers Compensation Conflicting goals and multiple partiesConflicting goals and multiple parties

WorkerWorker Employer, supervisorEmployer, supervisor Treating providers (Primary WC and Treating providers (Primary WC and

specialty MD/DO, DC, PT/OT, PCP, other)specialty MD/DO, DC, PT/OT, PCP, other) Insurer / TPA, adjuster, case manager, Insurer / TPA, adjuster, case manager,

utilization reviewutilization review AttorneysAttorneys

Potential Challenges In Workers CompensationPotential Challenges In Workers Compensation Adversarial relationship among entitiesAdversarial relationship among entities Non evidence based care with suboptimal Non evidence based care with suboptimal

outcomes and excessive costoutcomes and excessive cost Delayed recovery and associated indemnity Delayed recovery and associated indemnity

and replacement costsand replacement costs Communication breakdowns and poorly Communication breakdowns and poorly

coordinated care and RTWcoordinated care and RTW Lack of effective efforts regarding preventionLack of effective efforts regarding prevention

Costs of Musculoskeletal DisordersCosts of Musculoskeletal Disorders LBP estimate $20-50+ billion annuallyLBP estimate $20-50+ billion annually

5-10% = 80-90% of costs5-10% = 80-90% of costs Upper extremity MSDsUpper extremity MSDs

25% = 89% total costs25% = 89% total costs Indirect costs perhaps up to 4x direct Indirect costs perhaps up to 4x direct

costcost Non-monetary considerationsNon-monetary considerations Impact of comorbiditiesImpact of comorbidities

Organizational Commitment to SafetyOrganizational Commitment to Safety Establish and communicate goalsEstablish and communicate goals Active health and safety committeeActive health and safety committee Effective reporting of injuries, etc.Effective reporting of injuries, etc. Consider injuries, non-acute MSDs, Consider injuries, non-acute MSDs,

near misses as opportunity for near misses as opportunity for improvementimprovement

Align Goals and EducateAlign Goals and Educate

Timely evaluation and effective Timely evaluation and effective treatmenttreatment

RTW goalsRTW goals Communication standardsCommunication standards Facilitate payment to workers and Facilitate payment to workers and

health care providershealth care providers Track outcomesTrack outcomes

New Employee OrientationNew Employee Orientation

Lifestyle issues: weight, smoking, etc.Lifestyle issues: weight, smoking, etc. Safety goals and preventionSafety goals and prevention Understanding timely injury reporting Understanding timely injury reporting

and WC systemand WC system How to obtain careHow to obtain care Most conditions respond to conservative Most conditions respond to conservative

carecare

New Employee OrientationNew Employee Orientation

Home exercise and PT / OTHome exercise and PT / OT Early imaging not needed in the absence of Early imaging not needed in the absence of

red flagsred flags Prolonged opioids and side effects, delayed Prolonged opioids and side effects, delayed

recoveryrecovery CDC Risk Mitigation StrategiesCDC Risk Mitigation Strategies

Excessive lumbar spine surgeryExcessive lumbar spine surgery 2/3 patients with lumbar fusion disabled at 2 years2/3 patients with lumbar fusion disabled at 2 years Opioid dose often increases post-opOpioid dose often increases post-op Opioids and post-op mortalityOpioids and post-op mortality

Death from Drug OverdosesDeath from Drug Overdoses

* Per 100,000 population. † Coded according to the International Classification of Diseases, Ninth Revision, during 1979--1998 and according to the Tenth Revision during 1999--2004. Additional information regarding classification of deaths according to intent and mechanism is available at http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_10.pdf.

Age-Adjusted Death Rates* for Leading Causes of Injury Death,† by Year

- United States, 1979--2004

Opioid Deaths vs Daily DoseOpioid Deaths vs Daily Dose

Bonhert JAMA 2011Bonhert JAMA 2011

New Employee OrientationNew Employee Orientation

Early RTW at modified duty often not Early RTW at modified duty often not harmful and can improve outcomesharmful and can improve outcomes Support from ACOEM, ODG, AAOS, AMA, Support from ACOEM, ODG, AAOS, AMA,

otherother

Low Back Pain at Work - Principal RecommendationsLow Back Pain at Work - Principal Recommendations Carter JT, Birrell LN (Editors) 2000.Carter JT, Birrell LN (Editors) 2000. ““Epidemiological and clinical follow-up Epidemiological and clinical follow-up

studies show that early return to work studies show that early return to work (or continuing to work) with some (or continuing to work) with some persisting symptoms does not increase persisting symptoms does not increase the risk of 're-injury' but actually reduces the risk of 're-injury' but actually reduces recurrences and sickness absence over recurrences and sickness absence over the following year”the following year”

Meet With Primary Occupational Health ProvidersMeet With Primary Occupational Health Providers Need for facilitated initial medical evaluation Need for facilitated initial medical evaluation

and follow-upand follow-up Clear description of treatment plan and apptsClear description of treatment plan and appts

Evidence based medicine guidesEvidence based medicine guides Describe work capabilities and estimated full Describe work capabilities and estimated full

duty RTW targetduty RTW target Evidence based LOD targetsEvidence based LOD targets

Real time communicationsReal time communications OutcomesOutcomes

Employer Expectations for WC ProvidersEmployer Expectations for WC Providers Rousmaniere 1999 J. Work Comp Rousmaniere 1999 J. Work Comp Ability to define and document work Ability to define and document work

restrictionsrestrictions ResponsivenessResponsiveness Appropriateness of referrals to specialistsAppropriateness of referrals to specialists Timeliness of reports from initial care Timeliness of reports from initial care

providersproviders Quality of cliniciansQuality of clinicians

Patient Satisfaction and Provider Communication re: LBPPatient Satisfaction and Provider Communication re: LBP Shaw et al 2005, Dasinger et al 2001Shaw et al 2005, Dasinger et al 2001 Took problem seriously Explained condition clearly Tried to understand my job Advised ways to prevent re-injury Discussed my behavior that might influence

recovery Discussed my readiness for RTW

Provider Factors and Increased Length of DisabilityProvider Factors and Increased Length of Disability Not knowing modified duty availableNot knowing modified duty available Provider unwillingness to cooperate with Provider unwillingness to cooperate with

case management and RTWcase management and RTW PCP concerns re: offending patientsPCP concerns re: offending patients Difference of opinion on RTW among Difference of opinion on RTW among

providersproviders

Worker Factors and Increased Length of DisabilityWorker Factors and Increased Length of Disability Short job tenureShort job tenure Lower job satisfactionLower job satisfaction Poor expectation on RTWPoor expectation on RTW Coping issuesCoping issues High pain levels and fear avoidanceHigh pain levels and fear avoidance Reporting delaysReporting delays

Worker Factors and Increased Duration of DisabilityWorker Factors and Increased Duration of Disability Perceived lack of coworker supportPerceived lack of coworker support Perceived lack of supervisor Perceived lack of supervisor

understanding and assistance on understanding and assistance on RTWRTW

Work Factors and Increased Duration of DisabilityWork Factors and Increased Duration of Disability No modified dutyNo modified duty No RTW coordinatorNo RTW coordinator Higher physical demand levelsHigher physical demand levels Supervisor supportSupervisor support

Employer OpportunitiesEmployer Opportunities

Train supervisors on responding to Train supervisors on responding to injured workersinjured workers Inform workers of efforts to improve safetyInform workers of efforts to improve safety Improve opportunity for worker injury Improve opportunity for worker injury

reportingreporting Express concern for reported symptomsExpress concern for reported symptoms Minimize blame and stigmaMinimize blame and stigma

Employer OpportunitiesEmployer Opportunities

Provide information to worker on obtaining Provide information to worker on obtaining treatmenttreatment

Develop temporary alternative work optionsDevelop temporary alternative work options May require communication with other May require communication with other

departmentsdepartments Involve worker in problem solving to address Involve worker in problem solving to address

barriers to RTW at same job, modified job, barriers to RTW at same job, modified job, other jobsother jobs

Overcoming fear of RTW and reinjury with Overcoming fear of RTW and reinjury with graded RTW and monitoringgraded RTW and monitoring

Employer OpportunitiesEmployer Opportunities

Monitor worker during RTW transitionMonitor worker during RTW transition Coping issuesCoping issues Dealing with heavy work demands with Dealing with heavy work demands with

alternative solutionsalternative solutions Provider communication, ergonomic Provider communication, ergonomic

evaluations, assistance with PT / OT if evaluations, assistance with PT / OT if questions regarding work demands and questions regarding work demands and worker abilitiesworker abilities

Worker with Prolonged LOD

Discuss RTW abilities/goals with Discuss RTW abilities/goals with worker, supervisor, provider, insurerworker, supervisor, provider, insurer

Encourage active worker participationEncourage active worker participation Return to own vs. any jobReturn to own vs. any job Use of FCE and IMEUse of FCE and IME Barriers of collective bargaining Barriers of collective bargaining

agreements, employer policiesagreements, employer policies