8 Ways One Doctor Can Reduce Workers Comp Costs Forever

Dr. Nathaniel Evans has been very successful in helping his employer-clients reduce their workers’ comp costs by 50%, and because I have been a huge proponent of using MD's to better manage workers' compensation programs, I thought I'd write about it to let others in on the secrets. These are the eight techniques he uses.

Doctors are noted for impatience. One study reported that, when listening to patients’ problems, doctors allow patients (on average) 17 seconds to speak without interruption. In occupational medicine, it is critical that the physician acquire an accurate understanding of what the patient is claiming to be the setting, the time, and the mechanism of injury. The patient must be allowed uninterrupted time to describe the injury and the circumstances (time, place, witnesses, etc.) of the injury.

It is so easy  for a busy doctor to be distracted by the pressures of the practice. It is very important the occupational medicine physician pay close attention to what is being said and what is being implied by the patient. The tone, content and “meta-messages” in the patient’s words can speak volumes about the patient’s motivation to get better, attitude towards work and impression of the co-workers and supervisors. Information picked up between the lines can help explain why a patient is presenting with symptoms in excess of what the stated mechanism of injury would cause the doctor to expect. Such an explanation can help the physician nudge the patient back to full productivity and help prevent unnecessary lost time.

Sir William Osler,  a professor of medicine who helped establish Johns Hopkins as a world-class medical school, taught that the patient’s history is the doctor’s key to the diagnosis. Dr. Osler practiced medicine before workers’  compensation became law. Occupational medicine physicians must know the patient’s history is subjective and may be the key to the diagnosis. Objective signs should be valued more highly than subjective data. Objective data includes swelling, redness, spasm, vital signs, X-rays, EKGs, lab reports, digital imaging, EEGs, etc. Presence or absence of objective signs can help establish a diagnosis and can help authenticate or invalidate a claim of work-related injury. Some objective signs can suggest that the injury is real but was not caused by work.

Sometimes,  patients present to occupational medicine physicians (intentionally or unintentionally) with problems not caused by work. Sometimes the described mechanism of injury just does not fit with the complaint, the symptoms and the signs. In those situations it is usually appropriate to consider the problem “not work-related” and refer the patient to their personal physician for examination and treatment. Having the patient sign a statement agreeing to see the personal physician ASAP is a useful way to document the referral.

Just as a well-prepared  lawyer does not ask a question without knowing the answer, the examining physician should have some idea (based upon the patient’s history of the injury) of what responses to expect from the patient at each phase of the physical examination. Specific validity tests can be used to assess the authenticity of a patient’s responses to physical examination. When discrepancies are noted, the physician should look for underlying non-physical causes of the complaint and should not just send the patient off to physical therapy hoping for improvement. Discrepancies are also a reason to reach out to the patient’s supervisor for information from another point of view.

The word “doctor”  originates from the Latin word for teacher. Very often, patients need to be taught about their injury. Patients often have unjustified fears and perceptions following minor injury. Patients’ questions need to be anticipated and answered. For example, typical (stated or unstated) questions about back pain include:

1.     Could this back injury make me paralyzed?

2.     Shouldn’t I stay home until ALL my pain goes away?

3.     Don’t I need an MRI?

When appropriate,  physicians should provide reassurance to patients and give clear, brief and succinct answers to patient’s questions. We should endeavor to acquaint patients with the basics of what to expect during the recovery process.  Even more importantly, we should give patients specific ways (e.g. exercise, stretching, ice, heat or injury care instructions) to expedite recovery. Instructions for wound care or medication usage should be stated clearly and should also be given in written form. Patients who understand their injury and who understand what they can do to expedite recovery generally feel empowered.

Workplace visits  give occupational medicine physicians understanding of the settings from which injured workers come for medical care. Such understanding can increase a doctor’s ability to appreciate the stresses and demands of the workplace. It can also help a physician evaluate the authenticity of patient complaints. I’ve noted that workplace visits also have the effect of causing injured employees to view the doctor as more informed and more credible because the doctor has some understanding of the workplace.

Of the injured workers  who cannot safely return to their regular duties, most can be accommodated in a modified duty position. Employers who do not offer modified duty miss a valuable opportunity to keep workers productive, keep them away from daytime TV, and keep them in the habit of reporting to work daily.   When employees spend extended time at home and away from work, some develop a reluctance to return to the workplace. (workersxzcompxzkit)

An experienced  occupational medicine physician can have a massive effect on the quality and the cost effectiveness of occupational medicine care. Unlike patients’ private or personal physicians, the occupational medicine physician cannot be a pure advocate for the interests of patients. Although committed to optimal medical treatment of the patient, the occupational medicine doctor also endeavors to maximize patients’ productivity, minimize lost time from work and limit testing and therapy to what is actually medically necessary. An experienced, attentive and skilled occupational medicine physician can produce great benefits for both patients and employers. The cost savings can be astounding.

 

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