WorkSafeBC’s Board of Directors reports it has approved amendments to Part 4 of the Occupational Health and Safety Regulation, regarding a third option to protect workers assigned to work alone in late night retail premises. The amendments become effective April 15, 2012.
The third option addresses implementation issues and challenges with the existing regulation. The implementation issues were confirmed in three pilot projects and by an independent evaluation. The conclusions were that options one and two in the current regulatory requirement — hiring additional workers or erecting a barrier — are not practicable for all late night retailers. [WCx]
This third option does not replace the existing two options in the late night retail safety regulation; it is an additional option, which provides a prescriptive list of engineering and administrative controls. Employers who choose the third option will be required to implement all of the listed controls. In addition, employers will be required to undertake regular security audits by a qualified and independent person to confirm that all the controls have been implemented.
Roberta Ellis, senior vice president of Corporate Affairs for WorkSafeBC says, “Our priority continues to be protecting late night retail workers from acts of violence.”
WorkSafeBC consulted with employers and worker representatives when considering the amendments to the regulation. A review of independent research, the results of the pilot project assessing barrier options, a report from an independent audit of the project and feedback from public hearings throughout B.C. were also considered.
If an employer chooses the third option, they must implement all of the following controls:
A time lock safe on the premises that cannot be opened during late night hours;
Cash and lottery tickets that are not reasonably required in order to operate during late night hours are stored in the time lock safe;
Good visibility into and out of the premises;
Limited access to the inside of the premises;
The premises must be monitored by video surveillance;
There must be signs on the premises indicating that the safe is a time lock safe that cannot be opened during late night hours, there is a limited amount of accessible cash and lottery tickets on the premises, and the premises are monitored by video surveillance. (WCxKit)
In addition, workers assigned under the third option to work late night hours must be at least 19 years of age and be provided with personal emergency transmitters that are monitored by the employer, a security company, or other person designated by the employer.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
There is always a bit of sticker-shock when receiving the amount of the MSA back from the company that provides the numbers. Depending on the age of the claimant, the younger the age of the person the MSA is being settled for, the more astronomical the amount can be. But the same can be said for older claimants as well, due to personal health issues and other conditions, both work related and not. The purpose of the MSA is to have the carrier pay the actual cost of needed treatment, until the Medicare coverage kicks in to pay. But the number received for the MSA may not be the actual costs the carrier has an obligation to cover. Frequently, there are errors that may be included in the costs, and those errors can be costly. So how can that cost be decreased and also the MSA be approved by CMS? How should these MSA cases be handled in general?
1. Check the prescriptions and if they are related
If it is preferable to settle the claim and an MSA is needed, it will include the cost of medications that are applicable to the claim. But when Medicare sees a person that has Medicare coverage and also a comp claim, they can lump everything together, instead of separating work related conditions from the non-work related ones. Older employees may be taking several medications for various conditions, and it is possible that few, if any, are related to the injury.
CMS does not necessarily take the time to sift through the file and sort it; they expect that to be done. Be sure to pay attention to all of the listed diagnoses, and if the costs included that do not pertain to the claim are seen then state the dispute in writing and get it to the MSA provider and CMS to modify the numbers. Since the majority of older patients do not get intense invasive treatment, most treat with medications to alleviate the conditions. This is where medications that do not pertain to your claim are seen. Prescription medications can amount to the largest cost of the MSA, so if correct figures of what is required to be covered can be assessed, there can be a significant decrease in the MSA cost. [WCx]
2. Settle the claim before the need for the MSA
The best way to save costs when dealing with CMS is to not deal with them at all. If legally the claim can be settled without having to report it to Medicare, that is much easier to resolve the exposure without the need for an MSA. When factoring in the costs of having to continue to pay wage and medical coverage for the injured worker while still working on negotiating the MSA, it could result in having to pay any decreased MSA cost in the form of coverage of wages and ongoing prescription/doctor costs. To avoid this break even scenario, just settle the claim! Big deal if there is $10,000 apart in the settlement negotiations! Think about these other costs and continued coverage, and in the end saving more money than if fighting for the MSA amount tooth and nail.
3. Try using an annuity to fund the settlement
If the carrier and claimant are still way off in what they think the value of the case is, consider using an annuity to increase incentive to the claimant. In an annuity setting, you will fund the annuity with a certain amount, and by the time the annuity has run its course the claimant may net more money than settling up front. Usually the claimant is only interested in a lump sum of money that is readily accessible, but every now and then there is someone that is interested in the annuity option and it can be beneficial to both parties.
There are a ton of vendors to choose from when figuring out how an annuity works, and it certainly can be worth the time and effort to check it out, especially if it means being able to settle a case on a full and final basis. Plus if this does intrigue the claimant, the claim may not have to be open forever. And every year that goes by is another year they are closer to possibly needing an MSA if wanting to settle on that full and final basis. Settling earlier may avoid the need for having an MSA.
4. Check the condition payment log for errors and duplicate charges
As mentioned earlier, CMS does not really go through every claim with a fine tooth comb. They expect the carrier to do a lot of the legwork in sifting out what is related, and what is not. There is no more exact proof of this than in the conditional payments log. CMS expects the carrier to reimburse them for any charges Medicare covered that were actually related to the comp claim. The problem with this is that instead of billing the carrier just for those occupational injury charges, CMS seems to bill the carrier for every charge they have had in the recent past. So the lesson here is to review that conditional payment log very closely, and find charges that are unrelated to the comp claim and pull those out to advise CMS in writing that those charges are not related. In this case, they can recalculate the payment log and resubmit it to the carrier for further review. This process can take months, if not years, and remember while this is going on ongoing wage loss and medical coverage still has to be provided. Time is of the essence so do not delay when receiving the payment log. If needing help decoding the paperwork ask a nurse case manager for assistance or use an outside vendor to help go through it.
5. Use an outside vendor or internal department to submit the MSA.
As just mentioned, the use of an outside vendor or internal department to help with the details of the MSA can be very cost effective. Adjusters have enough to do day in and day out, and these MSA issues themselves are a full time job to work on. They also carry very stiff legal fines if there are errors, and they need to be reviewed by people specially trained in MSA and CMS matters. Be thankful down the road that this is not an issue to tackle, and in the end it will save money on the claim as well. A professional MSA firm can help posture the claim to reduce MSA exposure. [WCx]
Summary
Medicare involvement in claims is becoming more and more prevalent, prompting the need for the adjuster to have to multitask even more. But there are ways to work with CMS and handle those outrageous MSA costs by using the advice we discussed above. Just because an MSA and CMS have to be dealt with does not mean that the claim cannot be settled. Use the resources available and delegate as needed.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) reports it has cited Exel Inc. for nine, including six willful, workplace safety and health violations at the Eastern Distribution Center III, a facility in Palmyra owned by the Hershey Co. and operated by Exel. Proposed penalties total $283,000. OSHA also has cited the SHS Group LP, doing business as SHS Staffing Solutions, for one violation with a proposed penalty of $5,000.
The agency's inspection was conducted in response to a complaint filed by the National Guestworker Alliance on behalf of a group of foreign students who were performing summer jobs at the Palmyra facility under the U.S. Department of State's J-1 visa program. Their visas were sponsored by the nonprofit organization Council for Educational Travel-USA. The complaint alleges a number of abuses of the visa program, which is designed to promote cultural exchange, as well as exploitative and unsafe conditions in the workplace.
Under a contract with Exel, SHS Staffing Solutions hired the students to work at the Palmyra site repackaging Hershey candies for promotional displays. Exel is a contract logistics provider headquartered in Westerville, Ohio, with more than 40,000 employees at more than 500 sites in North America.
Exel was responsible for record keeping in the Palmyra facility. OSHA has cited the six willful violations with penalties totaling $280,000 for failing to record injuries and illnesses on the OSHA 300 log for four years, evaluate the accuracy of the 300 logs before certifying them for three years, and develop and implement an effective hearing conservation program. A willful violation is one committed with intentional knowledge or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health.
"Nothing useful can be learned from an unrecorded injury," said OSHA Assistant Secretary Dr. David Michaels. "Accurate records provide critical information to employers and employees about the cause and prevention of work-related injuries. The law requires employers to maintain complete and accurate records because, without these, it is more difficult to prevent additional injuries and illnesses from occurring."
SHS Staffing Solutions, a temporary staffing provider headquartered in Lemoyne, has been cited with one serious violation for failing to provide training to employees on the lockout/tagout of energy sources. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.
Exel also has been cited for three other-than-serious violations carrying a $3,000 penalty related to inadequate record keeping. An other-than-serious violation is one that probably would not cause death or serious physical harm.
Additionally, the Labor Department's Wage and Hour Division is investigating potential violations of the Fair Labor Standards Act relating to the work performed by the CETUSA-sponsored foreign students. Because CETUSA has withheld documents from investigators, the secretary of labor filed a petition to enforce an administrative subpoena against CETUSA in the U.S. District Court for the Middle District of Pennsylvania in order to complete this investigation.
On Feb. 7, Judge William Caldwell ordered CETUSA to file a response within two weeks to explain to the court why the documents have not been produced. CETUSA has filed a response pursuant to the court's order, and further proceedings before Caldwell are anticipated.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
By David C. Radford, DC
David R. Seaman, DC
James F. Winterstein, DC
Robert C. Jones, DC
In Part I of this three-part series, we discussed the history of the chiropractic profession and the issue of primary care, both past and present (see ACA News, January 2012, Page 29). In Part II, we discussed the implementation of conservative primary care, the clinical methods we can use in daily practice to address co-morbidities and how to move our patients toward preventive medicine and wellness based upon the elements of a good patient history (see ACA News, February 2012, Page 28).
In Part III, we look at the physical examination in light of the patient’s history and expand on implementation of conservative primary care services that we can provide within our current scope of practice. The utilization of doctors of chiropractic (DCs) to coordinate patient care should help reduce our nation’s health care costs by preventing and managing chronic illness1. The importance of the interview process during the subjective history taking comes to light at the first encounter. The specific details we ferret out during the subjective history taking help us start to make a mental checklist of differential diagnoses and what we will need to consider so we may narrow the diagnosis into a rational hypothesis. This mental triage process helps direct us through the patient’s examination and to plan the diagnostic procedures we may want to perform or order. Let’s use the example of a fairly comprehensive office visit as a review exercise. [WCx]
The Office Visit
Every new patient encounter, change in condition or break in care should include the vital statistics in the office visit. These objective measurements include the height, weight, body mass index (BMI), heart rate or pulse, respiratory rate, blood pressure and pulse oximeter measurement of oxygen saturation. If any of the vital signs are not within normal limits, they should be tracked on a regular basis to determine if a specialist consultation and/or further medical intervention is needed, as this is part of our role. The health-promoting influence of primary care has been accumulating and holds true in both cross-national and within-national studies2. In some situations, we may be the only physician seeing the patient on a regular basis, making it even more important that we track abnormal vitals, direct our care to reduce illness, and prevent end-organ damage and premature death. Obesity, adult-onset diabetes, vitamin D deficiency, hyperlipidemia, hypertension, tobacco, alcohol, drugs, and use of excessive medications are co-morbidities that we see every day. Following the patient encounter, we should be able to describe the patient in detail, including his or her emotional state. It is helpful to note if the patient appeared to be pleasant and cooperative, if he or she was well groomed and what his or her mood was like: good, somber, anxious or depressed. Patients frequently present to a DC in pain, and are often seeking manual medicine. The understanding of the patient’s emotional state gleaned through the history and examination helps us grasp mental health in relationship to pain, which aids in our biopsychosocial approach to care of the patient.3 Assessing the mental health of our patients also gives indications of whether there may be symptom amplification, symptom modification due to mental overlay (i.e., depression often increases pain and creates avoidance patterns), co-dependence on a practitioner and the overall likelihood of whether the patients will engage successfully in our treatment plan.
Trauma
If there was trauma, did the patient hit his or her head? If there was head trauma, was there a loss of consciousness, blurred or double vision, an associated headache or changes in the ability to remember things or difficulty with concentration? Furthering the discussion, has there been any loss of sleep or sleep disturbance? Have there been unusual emotional changes or mood swings? Is the patient clearly oriented to time, place and person, and is the patient a good historian? Are short- and long-term memory, cognition and general fund of knowledge good? Are the attention span and concentration good? At this point, do you need to set aside time for a mini-mental status examination? Does examination of the head and cranial nerves suggest a need for imaging of the head or perhaps a neurological consult?
Cardiac/Thoracic
In general, can you describe the patient as being well developed and well nourished? If not, what is the patient’s appearance? A patient who is not nutritionally sound does not have the nutrient building blocks to respond to the physical changes your treatment plan may require. This is an opportunity to discuss diet and lifestyle changes. Based on the patient history, risk factors, vital statistics, appearance of the skin, color of the membranes and body build, do you suspect any cardiovascular problems or chest disease? When you listen, is the chest clear to auscultation in all lobes? Is there any tactile fremitus? Does the cardiac exam demonstrate normal S1 and S2 heart sounds? Are there S3 or S4 sounds? Are the heart rate and rhythm unremarkable, or are there murmurs, rubs or gallops? Is there any peripheral edema? If so, we need to describe the extent and severity in our notes. Based on the auscultation of the heart and lungs, do we need further testing or a specialty consultation? If the female patient is seen regularly by a gynecologist or internist, the breast examination can be discussed as being up to date, and charted as being deferred. Continuing with the thoracic/chest examination, is the trachea in midline? Is there thyroid enlargement or a palpable nodule? Is there hoarseness? Does the patient need an EENT consult? Does auscultation of the carotid arteries reveal good up strokes, and are they negative for bruit? Is there any jugular vein distention? Is there any indication that the patient would be at increased risk for spinal manipulation of the neck?
Abdomen
Before we palpate the abdomen of the patient, we should have determined through the history if there were any reported bowel, bladder, liver, gallbladder, spleen or pancreatic concerns? It is not at all uncommon for pathology of the abdomen to refer pain to the flank and back. Are the bowel sounds normal, or is there an absence of normal bowel sounds that could suggest an obstruction? Are the superficial reflexes present at the four quadrants? Is the abdomen non-tender or tender to palpation, and if tender, where? Is the liver or spleen enlarged? Are there any abnormal pulses or masses on abdominal palpation? If there is flank or chronic back pain, should we order a routine urinalysis, a CBC and ESR or imaging studies? If the patient is seen regularly by a family practice doctor or an internist, the male’s prostate and for both sexes the rectal examination, can be discussed and charted as being deferred, or the exam can be performed if necessary based upon the chief complaint. [WCx]
Gastrointestinal
A wide variety of abnormalities contribute to indigestion and to the development of gastrointestinal complaints. This is sometimes a complex issue, and the role of testing for H. pylori infection in GERD remains controversial. The implications of test results with false positive and false negative results remain incompletely understood. Patients with chronic digestive problems may have had diagnostic testing, including endoscopy and colonoscopy with biopsy. If these studies have been done, do we know that life-threatening pathologies have been ruled out? We suggest looking at the role of obesity, diet and lifestyle in our patients with gastrointestinal complaints, and refer the reader to the relevant patient education resources provided at eMedicine’s website for heartburn, GERD and reflux disease. In difficult cases that are non-responsive to conservative care, a referral to a gastroenterologist for co-management is most appropriate.
Pain/Posture
On your intake paperwork, did the patient complete a pain drawing? Was the severity of the pain indicated on the 11-point 0 to 10 centimeter pain scale, or did you simply ask the patient to rate the pain on a 0 to 10 scale for you? It is important to chart the description as to the nature and character of the pain problem, either using a key to types of pain on the pain diagram, or simply ask the patient to describe the nature and character of the pain. As you watched the patient move, did facial expressions during testing suggest pain; did he or she grimace, or show a facial expression of distress? As the patient sat still or moved, did he or she moan or cry out in pain? It is important to chart how pain was characterized by the patient for our record. Is the patient’s pain drawing anatomical; is it free from signs of embellishment? Do we see or suspect Waddell signs; are there any issues of secondary gain? Describe the patient’s standing or sitting posture and movement from sitting to standing. Is it normal or is there a Tripod or Minor’s sign? Is the stance and gait normal/abnormally wide, stable or unstable? Do we want our patient to do a tandem walk to better assess balance? Is he or she able to walk on his or her heels and toes and squat with good strength? To test proximal muscle strength, is the patient able to duck walk? Is Patrick’s figure four sign negative for hip disease? Palpate the area of concern for tenderness with appropriate pressure and percussion. Does the patient have a facial expression of distress with this type of provocative testing? Note the patient’s skin color and turgor. Are they normal? Is any lymphadenopathy noted? Is there any palpable mass or tenderness in the supraclavicular fossa, axilla or groin? It is helpful as a starting point in care to record all abnormal spine or joint motions using the appropriate measuring device, goniometer for joints and the inclinometer for the various regions of the spine. Based on the history and red flags, is imaging indicated? Are there signs of inflammation? Is the problem unilateral and focal, or is it bilateral and symmetrical, involving multiple joints and tissues? Is there an indication to look at the serum biomarkers for inflammation or autoimmune disease? The medications routinely used should be discussed, and while botanicals and more natural alternatives may be useful, we realize they are not all entirely free from side effects and they can interact with prescription medications and represent a good topic for further discussion.
Motor/Sensory
For the motor and sensory examination, we record muscle strength by the Medical Research or Kendall Scales (graded 0 to 5) (R/L). In the assessment, are the limbs symmetrical in bulk, strength and tone? If you record the grip strength by dynamometer, always indicate if the patient is right- or left-handed. Are the muscle stretch reflexes symmetrical at the deltoid, biceps, triceps, brachioradialis, wrist, patella, hamstring and ankle? Is the radioperiosteal reflex normal? Is side-to-side evaluation of sensation over the dermatomes using pinprick and light touch intact or altered? Are good joint position and vibratory sense observed distally at the great toes? Do the patient’s feet look healthy? Is there an indication for further testing, metabolic laboratory or electrodiagnosis? If these are abnormal, is an internal medicine consultation indicated? The number of specialist consultations has doubled over the past decade, from 4.8 percent in 1999 to 9.3 percent in 2009. While some policymakers are concerned about this added cost of specialization, many physicians in ambulatory primary care4,like chiropractic physicians, understand our expertise is primarily musculoskeletal medicine and manual therapies, and while we recognize our limits, we also understand our responsibilities as physicians. If there is a spine problem, is the Valsalva maneuver provocative for disc occlusion pain in the cervical, thoracic or lumbar spine? Is there evidence of nerve root tension in the arm or leg? The list of orthopedic and neurological tests can be long, and all examination findings help paint a picture that tells the patient’s story. If plain films or advanced imaging were deemed clinically necessary, how do they correlate with the chief complaint? If a trial of manual therapy and spinal manipulation is indicated, is the patient responsive? If it is essential to the examination, do the patient’s cranial nerves appear to be grossly intact? Are the sclera anicteric, and are the conjunctiva normal? Are the pupils equal and active? Are they reactive to light and accommodation? Is visual acuity corrected? Are the visual fields full? If a funduscopic examination was not performed, was it because there was no complaint to suggest increased intracranial pressure? If it was performed, was the funduscopic examination benign with no exudates? Is there hemorrhage or papilledema to suggest increased intracranial pressure? Are the teeth in good repair? Is a consultation needed with an eye specialist or a dentist? Are there any Long Tract signs? Is the plantar response flexor or extensor, and is Oppenheim’s sign negative? Is there any clonus, or a Hoffman’s sign? Are the finger- to-nose, finger-to-finger and heel-to-shin tests normal? Is there any evidence of downward drift? Is Romberg’s sign absent? Is the patient safe at home? Is the patient at risk of falling at home? If so, does the family know, and is further testing or assistance indicated? Are pulses present at the wrists, ankles and dorsum of the feet? Are the hands and feet warm and dry? Do you observe any cyanosis or clubbing of the distal digits? Do the nails appear smooth with good color and capillary refill? Are there any bruises or cutaneous rashes? Does the bruising reflect a trauma or a clotting problem? If present, does the rash represent a focal response, or is it a more generalized process? [WCx]
Plan Appropriate Care
You have given this patient a comprehensive physical examination, and based upon the patient’s history, your findings and any special tests, you should be able to plan appropriate care and make necessary referrals for secondary or tertiary care. Of course, not every patient being seen in chiropractic medicine needs a comprehensive evaluation, but if we happen to be the first-choice physician, we have an obligation in our role of primary care physicians to triage the patient and provide not only the best possible care, but make appropriate referrals when necessary. This obligation occurs not only at the point of an initial office visit but also when there is a change in symptoms, an additional chief complaint or an office return after a break in care. The accessibility of the nation’s chiropractic physicians for conservative primary care of non-institutional patients5 using the primary care model should enable the DC to become more involved in the discussion of cost-effective health care policy. It has been found that provider continuity is one of the most important explanatory variables related to the total health care cost.6
Dr. Radford is the director of the Chiropractic Clinic of Solon, Dr. Winterstein is the president of National University of Health Sciences, Dr. Jones is the president of New Mexico Chiropractic Association and ACA’s delegate to New Mexico and Dr. Seaman is a professor of clinical sciences at National University of Health Sciences’ Florida campus. Drs. James Lehman and Michael Taylor also contributed to this article. Contact for more information at
DCR8888@aol.com or phone: (440)-248-8888;
www.acatoday.org.
References
1) Kravet SJ, Shore AD, Miller R, Green GB, Kolodner K, and Wright SM. Health care utilization and the proportion of primary care physicians. American Journal of Medicine, 2008 Feb; 121(2): 148-6.
2) Starfield B, Shi l, Machiko J. Contribution of Primary Care to Health Systems and Health. Milbank Quarterly, 2005, 83: 457-502.
3) Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubner H, and Keefe FJ. Pain and Emotion: A Biopsychosocial Review of Recent Research. Journal of Clinical Psychology, 2011 September: 67: 942-968.
4) Barnett ML, Song Z, and Landon BE. Trends in Physician Referrals in the United States, 1999-2009. Annals of Internal Medicine. 2012;172 (2): 163-170.
5) Shi L, Starfield B, Politzer R, and Regan J. Primary care, self-rated health, and reductions in social disparities in health. Health Services Research. 2002 June; 37(2): 529-50.
6) De Maeseneer JM, De Prinis L, Gosset C, and Heyerick J. Provider continuity in family medicine: does it make a difference for total health care costs? American Family Medicine. 2003 Sep-Oct; 1(3): 144-8.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
The Occupational Safety and Health Administration (OSHA) recently reported it will extend for six months its temporary enforcement measures in residential construction.
The measures, extended through Sept. 15, include priority, free on-site compliance assistance, penalty reductions, extended abatement dates, measures to ensure consistency and increased outreach. Fatalities from falls are the No. 1 cause of workplace death in construction.
The National Roofing Contractors Association (NRCA) previously had voiced its opposition to OSHA's regulatory directive, believing it will hinder rather than improve workplace safety and make it more difficult for roofing contractors to operate their businesses.
NRCA also had urged OSHA officials to delay enforcement of the directive indefinitely while it works with the roofing industry to resolve roofing contractors' many concerns. To view a Special Report regarding NRCA's opposition to the directive, visit http://tinyurl.com/6qdeoav.
During the past year, OSHA has conducted more than 1,000 outreach sessions across the U.S. to help employers comply with the new directive. OSHA will continue to work with employers to ensure a clear understanding of the new policy and facilitate compliance. [WCx]
A variety of educational and training materials to help employers with compliance can be found at www.osha.gov.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) announced it has cited Coomes Oil & Supply Inc., doing business as the 5th Wheel BP gas station in St. Augustine, and Florida Rock & Tank Lines Inc. for safety hazards after an employee of the latter company was burned in an explosion at the station in August.
A Florida Rock & Tank Lines delivery driver was refilling an above-ground gasoline storage tank with a broken gauge. The tank overflowed, and the combination of vapors and heat from the running delivery truck caused an explosion. OSHA's inspection found that the gas station and Florida Rock & Tank Lines decided to refill the storage tank even though the liquid level gauging system was inoperable. [WCx]
Florida Rock & Tank Lines has been cited for one willful violation with a proposed penalty of $70,000 for failing to provide a means for the delivery driver to determine if the storage tank had enough capacity for additional gasoline. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health.
Coomes Oil & Supply has been cited for one serious violation with a proposed penalty of $7,000 for failing to provide employees and delivery drivers a means to determine the gasoline levels in the above-ground storage tank. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. [WCx]
"Despite the fact that safety gauges and devices were inoperable, the employers chose to proceed with the operation and risk the lives of their employees," said Brian Sturtecky, OSHA's area director in Jacksonville. "Unfortunately for the injured employee, the two companies involved in this explosion learned a safety lesson by means of a terrible incident instead of taking the steps they should have to protect their workers in the first place."
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
By Karen Wolfe, BSN. MA, MBA
President, CEO
MedMetrics, LLC
Workers' Comp is Different
While rating providers in group health is a long-practiced endeavor, its elements and parameters have not significantly migrated to workers compensation. Efforts to translate group health provider quality measures to workers’ compensation have fallen short of the mark because they omit several factors crucial to workers’ comp. Quality medical performance indicators in workers’ comp encompass medical treatment, outcome, and cost factors similar to those in general health, but they also include non-medical functions. In workers comp, those non-medical elements can be primary drivers of cost, quality, and outcome.
Return to Work: An Indicator of Performance
A major quality goal in workers' comp is return to full work. Responsibility for achieving that goal rests with the treating physician. Another major quality goal in workers’ comp is return to maximum or full work capacity at the least cost. This article explores the many non-medical functions of treatment that spell quality in workers’ compensation, factors that must be considered in rating doctors’ performance.[WCx]
For instance, multiple and repeated studies have shown that early return to work is a major indicator of better outcomes in workers comp. (Google search: “Return to Work studies in workers’ compensation.”) The overwhelming take-away from these studies is that the sooner employees return to work after a work-related injury, the sooner they are re-acclimated to the job and the lower the overall cost of the claim. Alternatively, the longer the employee is kept off work, the higher the cost of the claim, with reduced chance of successfully returning to work. Studies show a 1:1 correlation between length of time off work and returning to work — ever. Treating providers are the major driver in returning claimants to work. Therefore, early return to work and reduced overall work loss are key indicators for evaluating medical provider performance.
Cost Measures of Performance
Also important to rating provider performance in workers’ compensation is the issue of cost. Two quantifiable generators of unnecessary costs are frequency and duration of medical treatment. Because PPO, MCO, and MPN networks discount each unit of service delivered, the tendency of some providers is to exploit both frequency and duration of treatment to overcome their discounted fees. Individual provider’s frequency and duration of medical treatment for specific injury types should be measured and compared with the performance of their peers treating similar injuries.
Another comparative quality indicator is direct medical costs. Billed costs are not a true performance indicator by themselves. However, assessing billed costs with paid amounts or percentage reduction of charges recommended by bill review is a more accurate measure.
Prescriptive Practices
Recent research indicates a problem of opioid misuse or abuse in workers comp. Evaluate prescribing practices of individual physicians by monitoring current data, thereby creating an opportunity to intervene. Prescribing practices are a valid indicator in measuring performance.
Outcome
Of critical importance is evaluating providers in terms of outcome like how did things turn out in the claims where they were involved? Is the employee back at work, permanently disabled or somewhere in between? What is the provider’s record? If a provider is associated with a high rate of litigated claims, that should also be considered in the descriptive mix.
Create Algorithms to Measure
Providers can be rated specifically for workers' comp by creating a set of algorithms measuring these factors using data. An algorithm is simply a defined process, often mathematical, used to solve a problem or reach a conclusion. Algorithms should be used to compare similar types of providers who have treated like injuries in the same jurisdiction during the same time frame. Consistency is achieved because the computerized algorithms apply the same standards to all medical providers who meet a set of conditions.
Analyze Data from Multiple Sources
The data used to evaluate provider performance should be derived from more than one source. Raw billing data or bill review data should be integrated with claim data in order to reach a valid conclusion. Billing and treatment data must be integrated with loss time and outcome information, usually found in different systems, in order to reach legitimate conclusions regarding providers.
Ratings for medical providers must be transparent, fair, and objective. Fairness and accuracy in developing and measuring provider performance is critical. The indicators can be found in the data. The data must be integrated and evaluated using computerized algorithms that measure and monitor provider performance based on a combination of workers’ compensation-specific values.[WCx]
Measuring Provider Performance Is a Good Thing
A post was submitted by Joe Paduda last year, “Like it or not, physician ratings are coming”. The title suggests rating doctors is a bad thing. It is actually a good thing, unless you are a poorly performing provider. Using legitimate workers comp-specific rating systems to provide objective evidence for selection and for weeding out the less effective or even fraudulent providers is positive progress. A poorly performing provider guarantees complexity and cost in the claim. Informed decisions about medical providers based on data will replace personal biases and unknown outcomes. Basing provider selection decisions on objective data is imperative.
Author Karen Wolfe, BSN, MA, MBA, is President/CEO, MedMetrics®, LLC. Karen is founder and president of MedMetrics® LLC, an Internet-based Workers’ Compensation medical analytics company. She applies her medical knowledge to gathering, understanding and applying Workers’ Compensation data to the operational process. MedMetrics imports, integrates, and analyzes its clients’ medical billing and claims level data. MedMetrics uses several tools such as Predictive Intelligence Profiling and Medical Provider Performance Assessment to gather and analyze data. Contact: Phone: 541-390-1680; Karenwolfe@medmetrics.org; www.medmetrics.org.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
How Can You Find Quality Providers?
According to a recent MedMetrics blog, finding quality providers in your data has never been easier. See the complete blog
here.
Author Karen Wolfe explains in the blog there are several steps, including:
1. Identify and avoid the poorly performing doctors
2. Having good data.
3. Keeping a historic perspective.
4. Provider performance evaluation is essential.
5. Defining good data.
6 Record proliferation.
7. Data entry procedures.
8. Provider performance suite.
To learn more, visit
MedMetrics and to learn how, contact KarenWolfe@MedMetrics.org
The Texas Department of Insurance Offers New Rulebook
Texas Department of Insurance, Division of Workers’ Compensation just supplemented its Rulebook for 2012-02. It is now available online for amendments and new rules to 28 TAC chapter 180 regarding the monitoring and enforcement authority of the division of workers’ compensation.
The supplement can be printed from the TDI website
here.
16th Annual Texas Safety Summit for Employers and Employees April 10-12 in Austin
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) will host the 16th Annual Workplace Safety Conference, the Texas Safety Summit, on April 10-12, 2012 in Austin at the Doubletree Hotel Austin, 6505 IH-35 North. The TDI-DWC is hosting the conference to help all employers reduce injuries and their associated costs through workplace safety and return-to-work programs, whether or not they subscribe to workers’ compensation insurance.
A pre-conference session entitled Workers' Compensation 101 and Return to Work will be offered from 1 p.m. to 4 p.m. on April 10.
Conference general sessions include Technology in Collision Reconstruction presented by Clifford McCarter of Rimkus Consulting Group; Occupational Safety and Health Administration (OSHA) Region VI Update presented by John Hermanson, Regional Administrator of OSHA, Region VI; Generational Issues in the Workplace presented by Dr. Richard Lewis of Round Top Consulting Associates; and Personal Fitness for Work presented by Petti Redding of the Redding Group.
In addition, over 20 breakout sessions are planned to address pertinent issues facing Texas workplaces, including:
Accident/Incident Investigation;
Asbestos Awareness;
Combustible Dust/Respirable Dust;
Components of Effective Safety Programs;
Drug and Alcohol Awareness for Employees;
Effective Safety Committees;
Fatal Driving Distractions;
Federal and State Reporting Requirements;
Fire Safety in the Wild and Urban Interface;
Hazard Communication and Material Safety Data Sheets for Small Employers;
Heat Illness Prevention and Response;
ICS402 Incident Command System (Disaster Planning);
Job Safety Analysis;
Lockout/Tagout;
Management’s Role in Slips, Trips and Falls;
Material Handling;
Office of Injured Employee Counsel;
Personal Protective Equipment: Employer Responsibilities;
Tips for Safety Trainers;
Top Ten New Traffic Laws;
Uses of Injury/Illness Data Requested by OSHA and the Bureau of Labor Statistics (BLS);
Traffic Work Zone Safety; and
Workplace Violence Prevention
Conference rates for hotel reservations are available at the Doubletree Hotel until March 19 or until the conference block of rooms is full. To make hotel reservations, call the hotel at 512-454-3737 and reference “Texas Safety Summit” or register online using the Doubletree Hotel website
here.
Texas Supreme Court Grants Rehearing in Ruttiger Case
Feb. 22, the Texas Supreme Court issued its long-anticipated option in Texas Mutual Insurance Co. v. Ruttiger. A divided Court held that some, but not all, “bad faith” claims based upon alleged violations of the Insurance Code are “at odds with” the works’ compensation system and, thus, may not be presented to, or considered by, the district courts. To read more on this case, click
here.
Study Provides Baseline to Measure Impact of Reforms on Illinois Workers' Compensation System
According to a WCRI release, “The reform legislation addressed key cost drivers in the workers’ compensation system, especially medical prices, by reducing fee schedule rates by 30 percent, introducing preferred provider networks for selecting treating physicians, implementing American Medical Association (AMA) guides for evaluating impairment, and requiring clinical reports by physicians.”
The Texas Department of Insurance Shows Proposed Revisions
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting comments on proposed revisions to the following employer and self-insured political subdivision forms:
1. DWC Form-005, Employer Notice of No Coverage or Termination of Coverage;
2. DWC Form-007, Employer’s Report of Non-covered Employee’s Occupational Injury or Disease;
3. DWC Form-020SI, Self-Insured Governmental Entity Coverage Information.
These proposed form revisions are not a formal proposal and comments received will not be responded to in accordance with the Texas Administrative Procedure Act. The proposed draft form is available from the TDI-DWC website
here.
Informal comments may be submitted to the TDI-DWC by e-mailing
informalrulecomments@tdi.state.tx.us.
The Texas Department of Insurance Seeks Comments
The Texas Department of Insurance Division of Workers’ Compensation formally proposed in February new Rules Relating to Notice and Reporting Requirements for Subscribing and Non-Subscribing Employers; and Rules Relating to Notice of a Texas Labor Code §504.053(b)(2) Election by a Self-Insured Political Subdivision.
TDI-DWC is accepting public comment on the proposals to add new 28 Texas Administrative Code (TAC) §§110.7, 110.103, 110.105, and 160.1, and to amend 28 TAC §§110.1, 110.101, 160.2, and 160.3.
The proposal relates to various notice and reporting requirements imposed upon subscribing and non-subscribing employers, specifically requirements for notifying the TDI-DWC of non-coverage status, termination of coverage, and occupational injuries, illnesses and fatalities; and requirements for notifying employees of the employer’s coverage status.
The primary purpose of the proposal is to update and clarify these notice and reporting requirements. The proposal also contains a new rule that would require a self-insured political subdivision that elects to provide medical benefits in accordance with the manner described by Texas Labor Code §504.053(b)(2) to notify the TDI-DWC of its election to provide medical benefits in that manner. [WCx]
The proposal will be published in the February 24, 2012, issue of the Texas Register and may be viewed on the Secretary of State website at
http://www.sos.state.tx.us/texreg/index.shtml once published. Public comments may be submitted by e-mailing rulecomments@tdi.state.tx.us.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Employers can save money by following the Best Practices we often recommend in our articles. While there are numerous ways for the employer to reduce the cost of workers compensation through Best Practices, the following is a general outline of the basic approach the employer can take to manage the cost of workers compensation.
We recommend a three prong approach to employer Best Practices in workers compensation cost control. These are the three areas. While there are many best practices, these three are critical – and basic. [WCx]
- Safety
- Quick Response to Injuries
- Managing the Claim
The number one way to reduce the cost of workers compensation is to eliminate claims. The cost of a comprehensive safety program is only a small fraction of the cost of needless employee injuries. An employer who incorporates safety into the corporate culture will significantly reduce both the severity of injuries and the frequency of injuries.
The reduction in severity and frequency of injuries impacts both the direct and indirect cost of workers compensation. Not only are the workers compensation premiums and assessments reduced, the indirect cost of lost productivity and retraining of replacement employees is diminished.
Every department within the company should have at least one representative on the Safety Committee. This creates a level of involvement for all departments and facilitates the assignment of roles and responsibilities on the safety committee. By having designated duties on the Safety Committee, the employer creates accountability and a safety discipline.
The safety committee members should be made responsible for completing a regular and thorough workplace assessment to identify potential hazards. The management at the employer is responsible for taking prompt action to remove or eliminate the potential hazard.
Quick Response to Injuries
A strong Safety Program will reduce the number of injuries but it will not bring about the total elimination of injuries. When accidents do occur, a quick and well organized approach to the accident is essential. The actions of employer in the minutes after an injury occurs can have a major impact on the overall outcome of the claim.
Each person involved in the accident response should have a set of pre-designated responsibilities. The employee, the employee’s supervisor, any witnesses and the workers compensation coordinator should know the established procedures to follow in the event of the injury.
If on-site medical care is not available, the supervisor should immediately accompany the injured employee to the pre-selected medical provider. The supervisor should provide the medical provider with a copy of the employee’s job description and responsibilities, including the physical requirements of the job, and a copy of the Work Ability Form.
The workers compensation coordinator should immediately report the claim to the claims office. The workers comp coordinator should gather the employee’s statement of injury, the witness report form(s), the supervisor’s statement of injury and the completed Work Ability Form from the medical provider’s office. All the documentation should be provided to the claims office. If the injury warrants, the workers comp coordinator should contact the adjuster handling the claim to discuss and plan the course of action.
Don't leave questions on the FROI blank — append additional information as needed. When the EMPLOYER leaves blank spaces on the FROI, the EMPLOYEE (and his/her attorney) has the opportunity to fill it in…and you can bet their additional information will not be helpful to the employer.
The workers comp coordinator should contact the employee within 24 hours of the injury to express the employer’s concern for the welfare of the employee. The coordinator should inquire about the nature and extent of the injury and the diagnosis and prognosis provided by the medical provider. If the employee is unable to return to work on either full duty or modified duty, the coordinator should follow up with the employee after each medical visit to ascertain the status.
If the employee is remaining off work, the employer should provide the medical provider with sample transitional duty job descriptions that can be offered to the employee. By making it easier for the medical provider to return the employee to light duty work, you will shorten the length of time the employee is off work and reduce the probability of any permanent partial disability. [WCx]
Safety, a quick response to injuries and claims management are a part of the Best Practices for employers. For a more in-depth discussion of these Employer Best Practices and to learn about other Best Practices for the reduction of workers compensation cost, contact us about our book, 2012 Workers Compensation Management Program, Reduce Costs 20-50%.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20%-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) reports it recently cited Monster Contracting LLC for alleged willful and serious violations of safety standards at a residential construction site located at 100 Bradley St. in Manchester, New Hampshire. The Candia-based framing contractor faces a total of $59,200 in proposed fines following an inspection by OSHA's Concord Area Office.
"Employees at this job site faced the risk of disabling or deadly injuries from falls, crushing injuries, or being struck by flying debris or objects while operating nail guns and other tools," said Rosemarie Ohar, OSHA's area director for New Hampshire. "Compounding the situation was the fact that these employees lacked training that would have taught them how to recognize and avoid such hazards." [WCx]
OSHA found employees exposed to falls from heights of 6 to 20 feet while performing exterior and interior framing work without fall protection or near an unguarded window, floor and stairwell openings, which resulted in a citation for one willful violation with a $28,000 fine. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health.
Nine serious violations with $31,200 in fines include a lack of eye protection for employees working with nail guns, power tools and staplers; damaged and misused ladders; a damaged sling used to lift walls; the employer's failure to certify that powered industrial truck operators had been trained; unsafe access to elevated areas of the building; lumber with protruding nails in a work area; not training employees to recognize fall, material handling, electrical and flying object hazards; and not training employees in the safe operation of power tools and the proper use of ladders.
A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. [WCx]
The company has 15 business days from receipt of its citations and proposed penalties to comply, meet with OSHA's area director or contest the findings before the independent Occupational Safety and Health Review Commission.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
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