6 Steps to Mitigate PTSD Workers’ Comp Claims after Trauma

Escape, hide, fight back. Those are the suggested reactions — in order — to an active shooter situation provided to employees of one of the nation’s largest supermarket chains. In a dramatic, realistic-looking video, a man with a gun walks into a grocery store and begins shooting.


The fact that the video is part of required training for all company employees underscores the very real threat of violence in many workplaces. While employers can and should take any and all precautions to prevent violent incidents from occurring, there are still situations that arise all too often.


One thing companies can do is prevent such a situation from escalating into long term claims involving post traumatic stress disorder. Identifying and intervening early after a workplace trauma will help ensure employees recover and get back to work as quickly as possible.



Who Gets PTSD


Just about everyone will have stressful reactions to a traumatic event, such as workplace  violence. But the vast majority will recover and have no symptoms within several months.


A segment of the population — around 7 to12 percent will have a more difficult time recovering. They may improve, only to see their symptoms recur with a new stressor. Some may develop a lifelong illness that affects every aspect of their lives.


Diagnosing PTSD is not an exact science, as its symptoms often mirror other conditions. Generally, experts say having the following for more than one month are clues:


  • Reliving the event. Internal or external cues that resemble any aspect of the incident may cause images, perceptions, dreams, or dissociative flashback episodes.
  • Avoiding certain stimuli. The employee may refuse to discuss the incident, or avoid places or people associated with it, including coworkers.
  • No interest in participating in group activities.
  • Feeling detached from others.
  • Emotional overload. The worker may be irritable or have outbursts of anger, or trouble concentrating, and may be easily startled.
  • Physical symptoms. Headaches, high blood pressure or gastrointestinal issues may be present as well.


The risk of developing PTSD depends on many factors, including the presence of psychosocial issues. Even many of those who recover slowly and are at increased risk can be helped and recover, often within 8 to 12 weeks. The key is to get them into appropriate treatment as soon as possible.



Crisis Intervention


Traumatic incidents can happen in any industry, but are especially prevalent in certain ones. Employers in fields such as healthcare and retail are wise to consider implementing a post trauma crisis intervention protocol to help employees immediately after a traumatic event.


The plan should include the following elements:


  1. Early contact. Within 24 hours of a workplace trauma, employees should be contacted by a trained trauma specialist. That contact should continue until there is a face-to-face meeting for acute psychological intervention. Responding early shows the employer cares about the employees, which can help prevent delayed recovery and require less use of medical and mental health services.
  2. Face-to-face assessment. A psychologist should perform an assessment and begin trauma recovery of care. In most cases, no more than three visits will be needed before the employee can return to work.
  3. PTSD determination. If symptoms persist for more than one month, the psychologist should conduct a criterion-based PTSD diagnostic assessment to help determine whether the workplace trauma was the actual cause of the employee’s symptoms.
  4. Trauma interventions. An employee diagnosed with PTSD may find his work and daily living is disrupted. Increased absenteeism and decreased productivity may be among the results. Once a PTSD determination is made, the worker should be referred for specific treatment.
  5. Long, drawn-out therapies are not necessarily needed to help injured workers with PTSD. Cognitive behavioral therapy, for example, has been shown to help. It includes principles of learning and conditioning to help injured workers change their negative beliefs about themselves while gradually exposing them to the thoughts and situations they fear. Exposure/desensitization therapy is also effective in treating PTSD. This may involve imaginal exposure, where the worker is exposed to the traumatic event through mental imagery; or in vivo therapy, in which the worker confronts the actual scene or similar events associated with the trauma.
  6. Short term use of certain medications may be helpful, depending on the severity of the symptoms and the worker’s preference. Some antidepressants have been approved by the Food and Drug Administration to treat PTSD. However, benzodiazepines such as Valium and Klonopin should be avoided, as there is no evidence they are beneficial and can even increase the likelihood of developing PTSD when they are prescribed in the acute aftermath of trauma exposure.




Workplace trauma can take a devastating toll on all affected employees and an organization as a whole. But it does not need to result in long term disabilities.


The vast majority of people who are exposed to traumatic events recover with limited help. Of those who need further follow up, many will be able to return to work and function. Employers who are proactive about identifying and intervening can better protect their workers and their bottom lines.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The Single Biggest Mistake With BIG DATA in Workers’ Comp


Hey, there, Michael Stack here, CEO of Amaxx and founder of Amaxx Workers’ Comp Training Center.


Today is an exciting day in the Stack household. It’s back to school day. We have four children, a daughter going into second grade, a son going into first, another daughter in pre-K and a youngest son in first year of preschool. Everyone is excited, we did the first day of school pictures and the whole nine yards and they got on the bus just this morning.



Proper Sequence Is Critically Important


What if I told you that our seven-year-old daughter, instead of putting her into second grade, we actually enrolled her in Kennebunk High School? The odds of her being successful in that environment are basically very slim, if not, impossible. It’s not that the information taught at the high school level isn’t critical to her educational journey which hopefully then leads on to a successful life and career. It just that it’s taught out of sequence and she needs that foundational knowledge taught at the elementary level to be able to properly use and utilize that information.



Biggest Mistake Companies Make with BIG DATA


Now, I want to talk to you about a topic in worker’s compensation which is very popular: big data and analytics. I see a lot of companies making that same mistake. It’s not that the information or the tool of leveraging big data and analytics isn’t critical to your journey to a best in class work comp management program. It’s just that it’s typically implemented out of sequence and most companies don’t have those foundational, fundamental, necessary elements in order to be able to properly use and utilize the information both inputted into that big data tool and extracted from that tool. If you don’t know how you are measuring success, if you have no clear goals in your organization and a way to understand if you’re being successful or not and you’re spending all your time and resources researching and implementing this tool, then you’re out of sequence and I encourage you to go back and look at some of those fundamental elements in order to be able to properly use and utilize that extremely valuable tool.


Again, I’m Michael Stack with Amaxx and your work in workers’ compensation cannot only dramatically reduce your workers’ compensation cost but it will dramatically impact someone’s life. Be great.


To Learn more, check out The Step by Step Process to Master Workers’ Comp in 90 Days



Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The Deep Cut That Got Deeper Due to Poor Injury Response Procedure

The best time to develop defense strategies is before a claim is even filed. Employers that implement proactive tactics toward injury response management will see reduced attorney involvement and lower overall claim costs.


Instead of leaving things to chance, employers need to take control of all facets of a post-injury situation. Employers who do so also exude competence, which helps set expectations for the injured worker and can reduce much of the animosity typically present in the workers’ compensation system.



The Problem


The less control an employer exerts following a workplace injury, the longer the time off work — leading to higher costs.


Consider the following example;


A worker gets a fairly deep cut in her arm rounding a corner at work as she’s carrying a heavy load of paper. Neither she nor her supervisor know what to do, so the supervisor calls someone in HR who asks if the injury is ‘life threatening.’ Since it is not, the HR person spends 20 minutes asking a series of questions before sending the employee to a physician’s office.


In the meantime, the injured worker and a coworker have covered her wound with paper towels from the restroom. The cut is deep and she loses enough blood to make her feel dizzy.  


Appalled at the presence of unsanitary paper towels on the employee’s cut, the physician prescribes antibiotics as well as stitches and suggests she take a few days off work because of her dizziness and to see if there is an infection.


She is not contacted for several days and becomes increasingly disgruntled. Ultimately, she files a workers’ compensation claim.


This scenario shows the disorganization and wasted time, energy and expense that occurs all too often following the injury. Having a formal, post-injury procedure in place can avoid much of that.



The Strategies

A post injury response plan that is fully communicated to managers, supervisors and employees is a must to avoid the scenario described above. It should incorporate a series of action steps to be taken after any workplace injury.


  1. Supervisor’s responsibilities. Immediately after the injury the employee should contact her supervisor, as she did in the case above. However, the supervisor should understand and follow a specific protocol. She should know that the employee’s injury is the most immediate need. If the company employs a triage nurse, he should be contacted immediately to determine the severity of the injury and next steps. If the case is an emergency, the employee should be taken to the closest emergency room. In the absence of a triage nurse, the employee should be given the names and locations of the company’s workers’ compensation physicians. The supervisor should escort the worker to the physician’s office; if not possible, she should designate someone to drive her there.


  1. Information. A packet should be readily available for the supervisor to give to the injured worker. It should include instructions and phone numbers on whom to call, how to file a claim and what to expect in the days ahead. It should also contain a ‘work ability form,’ for the physician to fill out.


  1. Investigation. The supervisor should immediately begin an incident investigation, that includes statements from any witnesses to the incident. If immediate medical attention is unnecessary, the supervisor should speak with the injured worker about the incident.


  1. WC designee. A workers’ compensation coordinator should be available to meet with or speak with the employee upon her return to the office. The coordinator should review the physician’s notes and restrictions — if any — and determine if transitional or modified duty is required.


  1. Communication. If the employee cannot return to work immediately, she should be contacted by her supervisor, a manger or the workers’ compensation coordinator on day 1. The communication should continue on a regular basis.


  1. Documentation. The designated workers’ compensation coordinator should fill out and send to the insurer or third-party administrator a first report of injury that includes statements from the worker and any witnesses, as well as photos of the incident site. A detailed job analysis should also be provided to the carrier/TPA.


  1. Monitoring progress. The workers’ compensation coordinator should meet with and/or contact the employee at least weekly to discuss the employee’s progress, and when she might return to work in some capacity.


Establishing such a procedure requires up-front leg work to be effective. A workers’ compensation coordinator must be designated and properly trained in workers’ compensation issues, including alternative leave plans; the injury response plan should be formally written up and presented to all employees; treating physicians should be identified and working with the company to understand its culture and the focus on returning the employee to work as soon as possible; and transitional work assignments should be outlined.





Workers who are injured on the job do not typically start out being angry toward their employers. But the failure to have a formal, structured, well-understood post-injury response plan can lead to confusion and anxiety and, ultimately, an expensive claim.


Employers can cut disability durations, hostility and costs with a well thought-out plan that addresses the employee’s needs as well as the company’s.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Practical Implications of the Revised CMS WCMSA Reference Guide

Earlier this month the Centers for Medicare and Medicaid Services (CMS) released a revised Workers’ Compensation MSA Reference Guide (WCMSA) (find Version 2.6 here) with several notable changes and additions impacting its review of MSAs in workers’ compensation cases. The Tower MSA compliance team has taken some time to review and consider not only the substantive impact these changes have on our processes, but the implications for our clients. Please find below a summary of the notable changes to the Reference Guide along with practical implications.



Recognition of a Hearing on the Merits of the Case (Section 4.1.4)


The relevant change to this section is as follows:


Because the CMS prices based upon what is claimed, released, or released in effect, the CMS must have documentation as to why disputed cases settle future medical costs for less than the recommended pricing. As a result, when a state WC judge or other binding party approves a WC settlement after a hearing on the merits, Medicare generally will accept the terms of the settlement, unless the settlement does not adequately address Medicare’s interests. This shall include all denied liability cases, whether in part or in full . . .



Practical Implications:  Over the years CMS has had several definitions of under what circumstances it will recognize a hearing on the merits, but the takeaway has consistently been that CMS gives itself complete discretion as to whether or not it will recognize a particular judicial decision, order or finding as limiting the MSA. Some commentary in response to the Reference Guide revisions has indicated the changes found in this section will result in Zero MSAs based upon a complete claim denial no longer being approved without a hearing on the merits confirming the basis for the denial. We are not certain this is the correct inference to draw from this change. This section addresses the effect of a hearing on the merits of a case to the projection of future medical care. If there is no hearing on the merits of the case, which is the situation in most MSA submission, Zero MSA or otherwise, then this section should have no applicability to CMS’s review of a Zero MSA.


Tower MSA’s plan is to stay the course on the long-used criteria for a Zero MSA based upon a claim denial unless and until we identify any changes through the MSA submission process which requires modification to these criteria.



Recognition of State-Specific Statutes (Section 9.4.5)


The relevant change to this section as follows:


Submitters requesting alteration to pricing based upon state-legislated time limits must be able to show by finding from a court of competent jurisdiction, or appropriate state entity as assigned by law, that the specific WCMSA proposal does not meet the state’s list of exemptions to the legislative mandate. For those states where treatment is varied by some type of state-authorized utilization review board, the submitter shall include the alternative treatment plan showing what treatment has replaced the treatment in question from the beneficiary’s treating physician for those items deemed unnecessary by the utilization review board. Failure to include these items initially will result in pricing at the full life expectancy of the beneficiary or the original value of treatment without regard to the state utilization review board recommendation.



Practical Implications – State-Legislated Time Limits: Similar towards its policy on recognizing decisions stemming from hearings on the merits, CMS has consistently given itself complete discretion as to when it will recognize any state statute as providing a limitation on the medical care allocated in the MSA. Experience has shown CMS to be unwilling, under most circumstances, to recognize a state statute as having the affect of limiting medical care in the MSA. A notable example is the Georgia statutory provision limiting an employer’s responsibility for medical care to 400 weeks post the date of injury in non-catastrophic claims (applicable to cases with DOIs of 7/1/2013 and later). We have yet to see an instance where CMS has agreed to limit the MSA amount based upon this statute.


The changes to this section of the Reference Guide provide hope that CMS may be more open to recognizing state statutes, like Georgia’s, as a basis for limiting medical treatment and medications in the MSA. Unfortunately, the requirement “to show by a finding from a court of competent jurisdiction . . . that the specific WCMSA proposal does not meet the state’s list of exemptions to the legislative mandate” presents a challenge in attempting to use a statutory provision to limit the MSA. For example, in Georgia a workers’ compensation case is by default considered non-catastrophic unless accepted by the employer or carrier as catastrophic or the claimant’s attorney submits to the Georgia Workers’ Compensation Board a request for the claimant to be designated as catastrophic. It is unclear at this point whether confirming the non-catastrophic nature of the claim in board approved settlement documents or a separate finding by the board that the claim is non-catastrophic will be sufficient for CMS to recognize the limitation. Based upon our experience with similar types of issues, we expect CMS to require a specific finding separate and apart from the settlement documents. Accordingly, this will require settling parties, whether in Georgia or in other states, to work with their WC board, commission or other judicial authority to provide the necessary finding confirming the claim does not meet any of the exemptions to the statute.



Practical Implications – Utilization Reviews:  Revisions to this section of the Reference Guide also address the use of URs to limit care in the MSA. According to the requirements delineated by CMS the following must be presented with the MSA submission:


UR denial pursuant “some type of state-authorized utilization review board.”
“Alternative treatment plan” from the treating physician showing what treatment has replaced the UR denied treatment or medications.


The addition of the language regarding URs raises more questions than it answers. What does CMS define as a UR Board? For example, the California Independent Medical Review (IMR) process, while statutorily created, does not include a UR review board (Although we believe it can be argued that the IMR process is equivalent to such a board). Further, CMS fails to define what would be considered an “alternative treatment plan.” It would seem that an intransigent treating physician could refuse to provide alternative treatment, thus resulting in inclusion of treatment or medications in the MSA denied through the UR process. It is unfortunate CMS added this “alternative treatment plan” requirement as it undermines the very reason a UR process is in place, namely to limit medical care based upon evidence-based treatment guidelines. As Tower MSA submits MSAs to CMS with UR denials we will provide further recommendations as to how CMS is defining a “UR board” and “alternative treatment plan.”



Addition of “Amended Review” to Re-Review Policy (Section 16.0)


As fully explained in the Tower MSA article of 7/12/2017, “Second Chance with MSA Approval!: New CMS Policy Allows for Review of a New MSA Post a Prior Approval,” CMS has introduced what is called an Amended Review process for cases meeting the following criteria:


    • CMS has issued a conditional approval/approved amount at least 12 but no more than 48 months prior,


    • The case has not yet settled as of the date of the request for re-review, and


    Projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount.

Practical Implications:  The Amended Review criteria presents an opportunity to have a second bite at the CMS MSA review apple when it comes to claims which despite having a previously approved MSA, failed to settle medical. It is important to note that the Amended Review process applies not only to MSA determinations resulting in counter-highers, but any MSA determination, approved as submitted or counter-lower, that meets the above-defined criteria. Please contact Tower MSA to discuss eligible claims.



Added Section on Required Resubmission (Section 16.1)


The addition to this section is as follows:

Where a proposed WCMSA amount has been closed due to inactivity for one year or more from the original date of submission, a full-file resubmission will be required.



Practical Implications: Previously a case closed for inactivity for one year or more would be reopened if the submitter provided the documentation in response to a Development Letter (The most common reason for case closure). CMS is now indicating solely providing the documentation in response to the Development Letter will be insufficient for them to reopen, instead a completely new MSA proposal and supporting documentation will be required. Tower MSA will advise when a case meets the criteria for filing a resubmission.



Additional MSA Administration Guidelines (Section 17.1)


The addition to this section is as follows:


Although beneficiaries may act as their own administrators, it is highly recommended that settlement recipients consider the use of a professional administrator for their funds.



Practical Implications: While not requiring professional administration, this is an acknowledgement by CMS of the difficulties a claimant may face on their own in administering an MSA. Tower MSA agrees with CMS on the benefits of professional administration and when requested by our client will provide MSA professional administration through our partner, Ametros.


Other less notable changes found in the Reference Guide apply to clarifying the order of jurisdictional precedence for MSA pricing, updating requirements for spinal cord stimulator pricing, updating off-label medication requirements, clarifying total settlement calculation guidelines and clarification of change of submitter requirements.



Final Comments


While we are pleased CMS is addressing the concerns expressed by Tower MSA and others in the MSP compliance field concerning a second chance at CMS review of an MSA and recognition of state statutory limitations on injury-related medical care, the real test will be in the coming weeks and months the affect these revisions have on the review of MSAs submitted to CMS for approval. Tower MSA continuously monitors these responses and will provide our clients appropriate guidance on the impact, or lack thereof, of these revisions and additions to the WCMSA Reference Guide.




Author Dan Anders, Chief Compliance Officer, Tower MSA Partners. Dan oversees the Medicare Secondary Payer (MSP) compliance program. In this position, he is responsible for ensuring the integrity and quality of the MSA program and other MSP compliance services and products. Based upon his more than a decade of experience in working with employers, insurers, TPAs, attorneys and claimants, Dan provides education and consultation to Tower MSA clients on all aspects of MSP compliance. Contact: (847) 946-2880 or daniel.anders@towermsa.com

Increase Generic Fill Rate to Eliminate Wasteful Pharmacy Spend…Brand Name Drugs Increased 208% Since 2008

generic fill rate workers compHere’s a sobering statistic: “the average price for the most commonly used brand-name drugs has increased 208 percent since 2008, while generic drug prices overall have declined.” That revelation from the Express Scripts Prescription Price Index should cause workers’ compensation payers to take a close look at their generic/brand mix.


Overall, generic drugs still offer the best cost savings for payers while ensuring injured workers get the medications they need. Surprisingly, not everyone is as focused on generic fills as you might think.


For reference, the average generic fill rate among Express Scripts’ workers’ comp payers in 2016 was 84.4 percent. But that average is not necessarily true for all payers. Brand name drugs are commonly prescribed for many reasons including habit, lack of awareness of available alternatives, or patient request.


Clearly there are instances when a brand-name drug is more appropriate for a particular injured worker. But by and large generics offer the same outcomes and at lower costs.


“From the base price of $100.00 set in January 2008, in December 2016, prices for the most commonly used generic medications decreased to $26.27 (74% decrease),” the Index explained, “and prices for the most commonly used brand medications increased to $307.86 (208% increase).”


The news begs the question, are you doing all you can to ramp up your generic fill rate? If not, it may be time to turn to your pharmacy benefit manager for help.



PBM Advantage


A good PBM has an inherent advantage over individual payers in getting the best quality for the lowest costs. They typically have large client bases, giving them better leverage to negotiate for reduced generic prescription drug prices. That creates competition and pressure among manufacturers of generic drugs to provider better pricing.


Work with your PBM to get a higher generic fill rate with the following:


  1. Educate providers. Prescribers may choose a brand name over the generic drug out of habit. Or they may be unaware of an available generic. You need to inform providers about the generics that are available, especially for the most commonly used medications.
  2. Inform employees. Injured workers may believe they need a brand-name drug — even if they have never tried the generic version. Employees need to understand more about the workers’ compensation process than they typically do. They should understand, for example, how unnecessary costs impact the entire organization, including for pay raises and/or additional help. Informed employees who become injured are more engaged in their own recoveries if they have a good understanding of the system.
  3. Praise & reward. Generic medications have the same clinical outcomes as their more expense brand name counterparts. Providers that turn first to generics over brand-name drugs should be praised and rewarded.
  4. Create programs. Work with your PBM to develop strategies that will improve the generic fill rate, while still ensuring injured workers get the most appropriate medications and treatments.





If your medical spend seems higher than it should, it’s time to find out why and what you can do about it. Pharmaceuticals are among the biggest cost drivers in the workers’ compensation system. By working with a PBM, you can cut wasteful spending while still ensuring your injured workers get the very best medical care.



Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

4 Keys to Successful Workers’ Comp Vendor Management

workers' comp vendor managementBusiness success relies on having the right people in the right jobs. Often that means outsourcing aspects of the business that are best handled by others. To maximize these relationships, you need to ensure your vendors’ goals are aligned with yours and they are giving you the best value for your money.


Too many organizations in the workers’ compensation system fail to appropriately manage their vendors and instead assume they are doing what is expected. These companies miss out on opportunities to positively impact their workers’ compensation programs and their bottom lines.


Vendor partners should be just that: partners in your business. Their relationship with you should be transparent and cost effective. Rather than outside entities, they should be considered part of your overall team.



Select the Most Appropriate Vendor


The first step in creating effective partnerships with vendors is to choose the ones that are best for your particular organization. Whether you seek a third-party administrator, medical providers, pharmacy benefit manager, medical bill review company, or something else, the process is generally the same. You need to first understand what you want from a particular vendor.


Analyzing your business requirements is a good first step, as that can lead you to the type of vendor(s) you need. Form a diverse team that will be working most closely with the vendor and brainstorm over the most important requirements that will benefit your organization. Come up with an outline of the ideal vendor, and include questions to ask prospects. Then identify prospective vendors that at least meet your minimum requirements.


In evaluating the vendors make sure you keep to the goals outlined by the team, so you don’t get swayed by those offering all sorts of bells and whistles that you really don’t need. Ask questions about the services the vendor provides and the success rates. You can also ask for a client list or at least a couple of clients to speak with.


You may also ask if the company conducts internal audits and, if so, if it will share the findings with you on a regular basis. While the vendor may not routinely share all aspects of an audit you can at least get a sense of challenges the company faces.



Set up the Contract


This part is crucial as it sets the tone for the partnership. Consider using a service level agreement (SLA) and/or risk/reward strategies. A SLA defines the level of service expected, and includes things such as time frames for various reports. You want to include performance measures so you can hold the vendor accountable to them.  The contract may also include incentives for the vendor to meet or exceed expectations, and penalties for failing to meet them.


Before you enter into a final agreement, decide how long or short of a term you want and whether you want an exclusive relationship with the vendor. It’s also important to look for hidden costs. Find out, for example, if a price quoted includes data capture or reporting.



Communicate Regularly

Now that you have the vendor on board:


  • Are you getting timely reports that are clear and actionable?
  • Is the vendor keeping you in the loop when challenges arise?


Minor problems like these can be avoided or easily cleared up with ongoing communication.





The vendor’s performance should be monitored, especially once the contract is implemented. Qualitative or outcome based performance measures agreed to by your internal team and included in the contract should be met. For example, are the providers in your network using evidence-based medicine? Do they meet the expected return-to-work rates?


Quality assurance audits conducted by independent reviewers can also be used to point out problems that may be hindering your workers’ compensation program.


Finally, make sure you are getting the aggregate data that you need, when you need it. Review reports the vendor gives you to make sure they provide valuable information that will help you further improve your overall workers’ compensation program.





Outside vendors can save you money and help ensure the best outcomes for injured workers. But they need to be part of your organization. By finding the best ones and working with them closely vendors can and should be a valuable asset to your organization.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

4 Key Ways to Ensure Return to Work Programs Save Money

The longer an individual is off of work, the less likely he is to return. That fact is the overarching reason companies adopt return-to-work programs for their injured workers.


While most in the workers’ compensation world agree with the premise, there are myriad reasons many companies either have no or ineffective Return to Work programs. Small companies may think the money, time and resources involved don’t make financial sense for the number of injuries they typically have, or may be convinced there are just no ‘light duty’ jobs to offer injured workers. Some employers are uncomfortable paying the full salary of a worker who is not at 100 percent capacity. Still others have Return to Work programs in place but can’t see the benefits and let them fall by the wayside.


These ‘legitimate’ sounding reasons are, unfortunately, doing employers a disservice. RTW programs don’t need to involve massive amounts of money or personnel to be effective. There are alternative positions available for injured workers, even in companies without specific light duty jobs. Paying the full salary of a worker who is still recovering can save vast amounts of money compared to the alternative.



Why Return to Work


The longer an injured worker is off the job, the more money it costs the employer/insurer. Long durations can even turn into creeping catastrophic claims — a seemingly simple injury that involves multiple medical procedures and medications, and long-term disability.


Various studies have shown that Return to Work programs save money on medical costs, lost time days — including medically unnecessary ones, and workers’ compensation costs. Good programs reduce the duration of claims and the large indemnity costs associated with them. They also cut the number and costs of lawsuits; and wage replacement costs; and productivity losses.


Return to Work programs also help the injured worker recovery faster. Research clearly shows that, except for the most catastrophically injured, people who are at least somewhat active and engaged recover physically faster than those who are sedentary.


Finally, returning an injured worker in any capacity helps not only lift his spirits, but the morale of his coworkers. It shows the employer cares about them and wants to help them return to work.



Effective Return to Work Program Components


The first order of business in setting up a Return to Work program is to look at the specifics of the company to create a program targeted to its specific needs. See if there are patterns within the company. For example, how many injuries does the company typically have at any given time? Do some facilities have more injuries than others? Do certain jobs have more injuries? Working with managers and supervisors can help.


Benchmark a company’s workers’ compensation stats against others in the industry also can help. Small companies can turn to their insurer or third-party administrator for help.


Supervisors, managers, the insurer or TPA, physicians, and any others should be involved in putting together a Return to Work plan. It should include the following:


  1. Day 1. Begin the Return to Work process as soon after the injury occurs as possible. Stress that you want to help the injured worker return to work as soon as possible, and make sure others in contact with him continue the message “you are a valued employee and we want you back to work”.


  1. Communicate the plan. Every employee in the organization should be familiar with the Return to Work plan; whom to call with an injury, what the procedure is, and who has responsibility for different aspects of the post-injury response. Employees should understand that there is a specific, consistent plan in place following any injury, and that the goal is returning the person to work. When an injury does occur, provide additional information to the injured worker — such as what to expect, when and from whom.


  1. Light duty jobs. Nearly every company has tasks that are consistently put on a back burner; mundane activities that don’t necessarily directly impact the bottom line but could make things easier and more efficient. Injured workers are perfect for those types of tasks, as long as they are within medical restrictions. Engage the injured worker in the discussion, as he might have some thoughts. Working with the insurer, TPA or others within the same field might also trigger some ideas.


If there really is nothing available, consider sending the worker to a nonprofit organization — in states where that is allowed. Doing so will reduce indemnity costs, and help the company’s image in the community.


Once a light duty position is identified, set a deadline for it to end (maximum 120 days) and require regular medical reviews to see when the worker could return to his regular job on either a full- or part-time basis.


  1. Right providers. Medical vendors are a key part of the Return to Work process, so they must be fully aware of and engaged in it. They need a detailed, accurate job description immediately following an injury. They should focus on what the injured worker is able to do, rather than what he cannot do. And he should be committed to returning the injured worker to work.


In urban areas, there are likely occupational medical providers available. After vetting them, they should be included in the network and spend time learning the company’s cultural. In more rural areas, it may be necessary to find and educate nearby physicians.





A Return to Work program is a cost saver, not a cost driver and should not be considered a luxury only in good times. A well thought-out Return to Work plan can save significant dollars for an organization. They just need to be developed, implemented and maintained.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Top 3 Pitfalls When Implementing Wellness In The Workplace

Numerous studies demonstrate the benefits of wellness programs and their positive impact of reducing workers’ compensation costs.  While they can reduce costs in a program of any size, it is important to be aware of some common pitfalls organizations face when implementing wellness programs.



A Common Hypothetical


The owner of the Acme Widget Company attends a workers’ compensation seminar and learns about the benefits of wellness programs in the workplace.  After returning, he installs a basketball hoop and buys a ball for employee’s to use while on their lunch break.  Postings about the basketball hoop were posted in common spaces and the owner strongly encouraged all employees play during their break times.


After the installation, the employees were excited.  A “one on one” league soon formed and the owner administered it.  Shortly thereafter, John Doe, the chief widget engineer, injured his knee why playing.  Is the injury compensable?


In Hemmler v. WCAB-Clarks Summit State Hospital, 569 A.2d 395 (Pa. Cmwlth. 1990), the following injury was found to be compensable.  Like anything, these cases are fact dependent.  Central to the court’s review were the following issues:


  • Did the injury take place while the employee was engaged in the furtherance of the employer’s business or affairs?


  • Was the injury caused by a condition of the employer’s premises that was a required part of the employee’s employment at the time of the injury?



Avoiding Work Comp Issues While Promoting Wellness


Promoting wellness within the workplace can create a double-edged sword for employers.  Liability will not be ignored in many instances even though the concept of healthy living and better health are a noble cause.  Proactive stakeholders can take the following steps to avoid liability from injuries suffered when employees engage in wellness-related programming.


In reviewing cases that involve injuries while engaging in workplace wellness programs, courts will generally examine whether the activity in question “furthers” the business or affairs of the employer.  Because wellness programs reduce workers’ compensation costs, courts have found the requisite connection between the work activities and an injury to uphold compensability and force the payment of various workers’ compensation benefits in certain instances.


  • Avoid dictating specific wellness activities during the workday: Courts have consistently found that direct employer mandates in the form of exercise can make injuries compensable.  Making generic or benign statements about wellness and not prescribing its preferred form of exercise or activity and reduce exposure in workers’ compensation matters.


  • Mandated performance of wellness activities. It is important to give employees the option to participate in wellness or other health program activities.  It is important to note that when managers and supervisors require or otherwise pressure employees to participate, resulting injuries are compensable under a workers’ compensation act.  Interested stakeholders seeking to minimize their exposure may consider using a third-party service provider to promote and provide information to employees about a wellness program.


  • Avoid hosting wellness program activities during the workday or while someone is scheduled to work. Wellness events and engaging in healthy activities is something that should take place every day.  An interested stakeholder can minimize their exposure by encouraging employees to engage in wellness activities during their personal time and away from the employers premise.





Encouraging wellness within the workplace has many positive benefits.  This should not be overshadowed by the risks of employees sustaining injuries while engaging in these activities, and employers should be encouraged to implement wellness in the workplace.


However, the diligent risk manager should be aware of common pitfalls and implement a wellness program in a manner that avoids unnecessary risks and promotes a better bottom line.



Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

3 Instances to STOP Unnecessary Temporary Total Disability Benefits

Members of the claims management team need to be mindful of their files when the injured worker is receiving wage loss benefits, including temporary total disability (TTD) benefits.  While these benefits are mostly capped, failure to pay only these benefits the employee is entitled to can significantly raise the cost of a claim and negativity impact your program’s bottom line.



Payment of TTD Benefits


The majority rule is TTD benefits are paid to a claimant at two-thirds of their average weekly wage.  In some jurisdictions, there is a three- to seven-day waiting period before the payment of TTD is to commence following disability.  These benefits are payable to the employee following an injury when based on their physical condition, in combination with age, training and experience and the type of work available in this community, they are unable to secure anything more than sporadic employment.  A cap on the number of weeks TTD benefits are payable is in force under most workers’ compensation acts.



Discontinuing the Payment of TTD Benefits


There are a number of instances where employers/insurers can terminate the payment of TTD benefits.  These defenses to the payment of wage loss benefits are defined by statute and subject to limitations and other due process considerations.  In some instances, benefits will terminate once a condition is met and or post-discontinue period expires.  Statute will also define how the payment of TTD benefits will recommence.


Being proactive claims handlers requires a diligence in looking for legal and ethical opportunities to discontinue the payment of TTD benefits.  Some common instances include:


  • Refusal of job offer: Injured workers sometimes lose the ability to choose what type of work they perform following a work injury.  Refusal of an offer of gainful employment within the employee’s physical restrictions or a rehabilitation plan can result in loss of ongoing TTD benefits.  This is based on the premise that the injured party must mitigate their losses.


  • Withdrawal from the labor market: Following a work injury, an employee is required to remain in the labor market provided they are not completely restricted from work.  Simply put, sustaining a work injury does not entitle someone the opportunity to take a vacation, spend time at his or her cabin, or move to a warmer climate.  (subject to applicable FMLA laws)


  • Attainment of maximum medical improvement (MMI): Reaching the end of one’s healing can serve as a basis for discontinuing TTD benefits in many jurisdictions.  MMI signifies the end of healing, assignment of permanent restrictions, if any, and a determination regarding permanent partial disability (PPD) benefits.  This can be determined via the employee’s treating doctor or following an independent medical examination (IME).





Termination of wage loss benefits is dependent upon each jurisdiction’s workers’ compensation act and case law interpretations.  Claim handlers need to understand what events can trigger a discontinuation of benefits.  They also must understand the nuances within the law to effectivity make such determinations.  Understanding these concepts can lead to significant savings in any program.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/


©2017 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Safe Patient Handling and Mobility Claims Coding: A Pragmatic and Functional Approach

Authors: Vicki J. Missar, Michael Fray, Candy Raphan, Mary Matz, Wendy Weaver


Whitepaper originally published by The Association of Safe Patient Handling Professionals (ASPHP). All of the authors of this white paper are members in good standing with ASPHP and serve as Board members.  


Reference: https://www.choosebroadspire.com/media/11899/safe-patient-handling-white-paper.pdf





Healthcare organizations are now engaged in Delivery System Transformation (DST), whereby performance-based incentive payment programs are used to support and reward hospitals for investing in projects that advance care and population health while lowering costs. In these efforts, it becomes critical to understand causes of patient handling and mobility workers’ compensation injury claims. Until now, programs that are self-administered or utilize a Third Party Administrator (TPA) have differing, if any, codes to determine employee injury trends. Unfortunately, these coding structures, particularly when it comes to causes, lack any real, actionable data to establish investment needs for safe patient handling interventions. Healthcare organizations are left to drill down to the accident-description level and extract key causes of the patient handling injury, a time-consuming and unrealistic option given the human resources demand within healthcare. This paper proposes a condensed, yet powerful, sub-level coding structure for safe patient handling claims that any claims reporting system can easily adopt. As a result, this coding structure will eliminate the need to manually sort through lines and lines of data for relevant trends. Adopting this proposed coding structure nationally will reward the safe patient handling community with a consistent and transparent approach to claims. As a result, it will enable facility-level comparison of key functions and tasks associated with patient handling claims, peer-to-peer benchmarking of these causes and return on investment calculations at the fingertips of the end user.





Healthcare companies in today’s business environment experience an unprecedented amount of change in terms of change drivers and pace of change: technology, shifting workforce demographics, global opportunity and competition, new sources of competitive advantage and rapidly evolving risk and regulatory requirements. Healthcare is an industry in the midst of fundamental transformation across the entire value chain and to all sectors, including physician groups, individual hospitals, senior care facilities, managed care organizations, insurance companies, wellness organizations, and integrated healthcare systems. As organizations address new business realities driven by healthcare reform and DST, they must reassess their data-mining capabilities around leading loss drivers that impact employee health and safety. With the right data and trending capabilities, safe patient handling claims can be easily dissected and solutions funded.


An apparent need exists to develop a standardized coding method focusing on the sub-category of activity type associated with patient handling injuries. So far, no national standard addresses the way these claims are coded in a Risk Management Information System (RMIS). This lack of uniformity leads to time-consuming efforts to extract key trending and cause analysis for meaningful solutions.


Standardization is applicable to overall workers’ compensation management, as well as risk managers, safety practitioners and occupational health professionals concerned with preventing safe patient handling and mobility (SPHM) injuries. The current mechanism to track injury types and occurrences proves neither healthcare specific nor customized by individual stakeholders. In addition, there’s a lack of detail-level standardization to provide easily identifiable and actionable data. Table 1 shows a snapshot of a healthcare organization RMIS loss run. The vague nature of the injury and cause descriptions provide little intelligence on the tasks (e.g. transfer type, toileting, bathing, etc.) performed at the time of injury. Therefore, a significant blind spot remains for safe patient handling professionals, and need for improvement on a national level is evident.



Table 1: Snapshot of a RMIS Loss Run for a Healthcare Organization



Current State: The Era of Big Data


Claims administrators require the ability to pare down injuries to focus on cost and frequency. Data available through loss run or other high-level data output provide only a general understanding of cause (See Table 1). The table does not provide sufficient detail to describe how the action being performed caused the injury. Technology is available via RMIS to affect change, but it cannot be used productively without changing and improving the information captured. A small addition to the current coding will make patient handling claims/injuries more transparent and actionable, create a best practice in the industry and produce long-lasting benefits.


Multiple methods are used in an attempt to address the need for this transparency which will bring patient handling claim trends forward. The following are examples:


  • Manually reviewing narrative reports to ascertain cause, associated circumstances and activities performed at the time of injury
  • Creating manual methods to map injuries with specific sites within a facility
  • Manually creating and using customized codes specific for a healthcare system or facility
  • Benchmarking national research reports that take years to publish
  • Using the National Institute for Occupational Safety and Health (NIOSH) Occupational Health Safety Network (OSHN) coding system (NIOSH, 2015)


Manual attempts at transparency are generally labor-intensive and may be highly burdensome. In an environment where human resources are stretched and patient and staff safety have become national priorities, the current state requires change.



Patient Handling Claims


Frequent injuries to patients and residents—regardless of the healthcare setting—have created a national call for action as demonstrated by several laws passed over the past few years. In addition, the American Nursing Association has issued an interprofessional national standard with the goal to put an end to these life-altering and career-ending injuries. The Occupational Safety and Health Administration (OSHA) points to manual patient handling as the cause of the high incidence, and severity, of injuries in the healthcare industry (OSHA, 2003). In 2013, the most frequent national, nonfatal occupational injury and illness, as well as injury and illness requiring days away from work, transfer, or light duty, were within healthcare and social assistance categories (Bureau of Labor Statistics (BLS), 2014). BLS data for 2013 demonstrate this impact  on caregivers. As seen in Figure 1, nursing assistants and orderlies accounted for some of the highest rates of nonfatal injuries and illnesses resulting in lost work days. These rates are approximately three times that of construction laborers and similar to that of firefighters. Compounding the personal and organizational impacts of such severe injuries, the financial cost of these injuries is profound (Institute of Medicine, 2011).



Figure 1: BLS Musculoskeletal Injury Rates for 2013 (per 10,000 work hours)



As illustrated above, injuries to caregivers, who are providing essential services for the infirm, are clearly significant. A typical certified nursing assistant, one who provides the majority of direct patient care, averages 4.5 injuries per year, according to a study by Khatutsky et.al (2012). However, while the study listed patient handling as a key loss driver, the study did not define the cause or activity (toileting, repositioning, etc.) involved in the injuries. Lack of easily accessed injury details on a sub-category level is a significant disadvantage for many SPHM professionals. Without that detail, there is no mechanism to facilitate implementation of effective Safe Patient Handling and Mobility Programs using RMIS data. Practitioners are left with manual, time- consuming data-crunching processes.



Reaffirming the Core Problem


There is a significant lack of easily accessible, detailed causative factors related to patient handling and mobility incidents available to healthcare sectors and stakeholders on a cumulative level. Patient handling and mobility incident causality data is generally a labor-intensive extraction effort using manual processes Without key elements, justification for the financial support of development, implementation and maintenance of SPHM programs may not be attained.


Collection and reporting of patient handling and mobility injuries must be easily implemented, concise and user-friendly to be sustainable. Above all, this proposed standard collection and reporting of more detailed data elements associated with patient handling and mobility injuries must also address the realities of the normal working environment and the various documentation requirements posed to the practitioner on a daily basis. In the era of big data, we must simplify the approach.



Future State:  Keep it Simple and Transparent


Figure 2 provides a basic workflow for any healthcare system to investigate and adjudicate claims. The current U.S. workers’ compensation structure lacks uniformity across casualty claim service organizations related to patient handling and mobility injury identifiers. This inconsistency prohibits the ability to affect change through benchmarking or modeling at the local, regional and national levels. These critical data elements promote effective resource allocation, pre- and post-loss program development and implementation. Some of the key data elements not currently documented range from the most obvious, such as making an occupied bed, to other notable elements such as managing aggressive behavior. These causes provide the information to propel effective change and mitigate costs of these pervasive and many times debilitating injuries.


Other categories used to define specific types of movement and activities will create consistency across claims platforms as well as the much needed transparency for better injury cause identification and implementation of relevant, impactful solutions tied to the visible trends. This provides a mechanism to quickly and credibly identify a host of benefits:


  • Trend injuries by patient handling task/activity (e.g. repositioning up in bed, limb holding, toileting, vehicle transfers)
  • Identify predictive causes of injury
  • Track frequency of specific injury types
  • Effectively simplify big data into actionable elements
  • Measure return on investment with SPHM programs
  • Identify impact of patient handling and mobility equipment and programs
  • Add additional dimension to the description of injuries
  • Provide a method to benchmark outcomes
  • Develop a sustainable best practice


Clearly the benefits demonstrate the need for moving forward with a simplified method. This approach will have a broad appeal as it closes a significant gap in the scope of the data being collected and allows SPHM professionals to compare data across peer groups in a consistent manner. Collecting more detailed information regarding the injury will also streamline RMIS coding constructs and allow providers to set up identical coding for all healthcare-related clients.



Figure 2:  Current and Proposed Claim and Reporting Processes


The detailed injury information proposed to be added to the intake process and RMIS systems will have a profound impact on the ability to extract actionable data elements. By instituting standard coding for the type of “Patient/Resident Handling and Mobility Activity” and “Patient/Resident Handling and Mobility Equipment Use” as shown in Table 2, risk managers or consultants to healthcare companies can retrieve actionable data from their claims administrators or internal systems.


Table 2 also shows the proposed national standard for additional elements, and it comprises a simple, yet easily implemented coding structure to add increased value to the claims intake and reporting process. By adding these critical categories, the benign loss run categories of “patient handling” or “strain—pushing/pulling” for example, bear more meaning and record vital information. (‘Patient’ is used in this paper to include all healthcare recipients; patients, residents, clients, etc.)



Table 2:  Proposed Patient Handling and Mobility Injury Codes



It is accepted that some patient handling injuries are difficult to classify and fall into the “no defined/listed cause (21)” category because they are cumulative in nature and may not have a specific cause. It is not uncommon to hear a caregiver say she has been lifting patients all day and now experiencing back pain. No specific task is identified as the cause nor can the caregiver suggest what caused the pain or injury other than, “lifting patients all day.” Such cumulative injuries are included in the “no defined/listed cause” sub-code. Additionally, RMIS includes cumulative trauma as a cause, so that code was not included in the proposed structure. Importantly, although cumulative trauma codes do not provide a clear understanding of what activity led to caregiver discomfort or pain, knowledge of trends in cumulative trauma provides actionable data in and of itself.Table 2 shows the codes defining patient handling, which will provide a clearer picture of the injury the caregiver experienced while performing a specific patient handling and mobility task. These definitions are supported by other incident reporting systems (e.g. NIOSH, Veterans Health Administration (VHA), etc.). Only a single code is required from each column. Ultimately, the data will provide information that may point to a single causative factor for that injury, such as the use or non-use of a SPHM assistive device.


Some workers’ compensation personnel may not be entirely familiar with the range of equipment used to support SPHM including ceiling and floor-based lifts, air-assisted lifting and lateral transfer devices, slippery sheets, friction reducing devices, roller boards, powered wheelchair/bed movers, powered toilet lift seats and more. Some beds, stretchers and gurneys are also included as SPHM equipment when they perform functions to help move and handle patients. However, walking aids such as walkers, canes, and crutches, as well as push wheelchairs and fixed or manually adjusted beds/trolleys/gurneys are NOT considered SPHM equipment. Slings (Table 2, Item 12) are used with patient lifting equipment to move and/or lift a patient or body part.



Stakeholder Value


Evidence-based information clearly demonstrates that certain categories of the data are linked to cost drivers. It is important to effectively utilize that information to more globally understand the overall results. Understanding the collection, reporting and data available to SPHM injury stakeholders and the impact that this information will have is imperative. The information in Table 3 will guide the improvement of the SPHM program functioning overall and reduce the negative effects of unnecessary patient handling and mobility injuries.



Table 3: List of Stakeholder Benefits and Corresponding Details


When Table 3 was developed, each of the named stakeholders’ perspectives was assessed through its own respective lens. For the reader to clearly understand how standardization of coding will impact each of the named stakeholders, a brief description and situational illustration is offered for each label in Impact of Coding Improvements.



Impact of Coding Improvements


Data Integrity and Consistency – Accurate, complete and concise capture and report of all requested data elements. Without standard data elements that are practical to obtain and easily recorded, the risk of incomplete and inaccurate information increases, reducing the possibility of any analysis or conclusions to be drawn organizationally or nationally.


Benchmarking – Comparing one’s SPHM program and performance metrics to industry bests or best practices. Comparative analysis provides a point of reference to internal and/or global results that may be either compared or assessed. Benchmarking provides a method through which each organization/facility may measure its SPHM program success against that of others; providing information to facilitate change.


Predictive Analytics – Extracting information from existing data sets to determine patterns and predict future outcomes and trends. Through the use of a set of standardized data elements, these trends may be used to draw sound conclusions and provide direction for future program decisions, such as determining SPHM program and equipment needs.


Claims Management – Advice or services related to claims for compensation, restitution for loss or damage due to injury or illness incurred in the practice and performance of patient handling and mobility activities. Standardized data elements provide claim managers valuable information to complete a thorough investigation and adjudication of each claim.


Capital Equipment Purchase Justification – Typically capital equipment is defined as items of considerable value that have durability and that are used to provide a service or increase revenue over the lifetime of the item. This may also be considered a tangible corporate asset. For the subject at hand, the justification of capital equipment purchases may be considered the more significant obstacle to development of a SPHM program. Data collected as a result of customized coding identifies cost drivers that in turn provide justification and validation for SPHM program capital expenditures.


SPHM Program Operating Cost Justification – Operating costs are expenses related to the operation of a business, or to the operation of a device, piece of equipment, or facility. They are the cost of resources used by an organization to maintain its existence. SPHM Program and equipment costs are considered operating costs. In healthcare, there is much competition for these funds. For this reason, there must be iron-clad justification/s for SPHM program and equipment costs. SPHM justification must include direct and indirect SPHM operational costs including equipment, staff training, staffing, and others. As well, benefits and cost savings for both patients and staff must be included. Staff cost savings relate to decreases in the rate of injuries, lost time, and modified duty injuries. Decreases in patient adverse events result in huge cost savings for an organization when there is an effective program.


Direct and Indirect Operational Costs – Direct costs of medical care (including rehab), indemnity (lost wages) and legal services are only several line item expenses to consider when assessing the fiscal impact of a musculoskeletal workers’ comp injury incurred due to SPHM activities. To be included with these obvious core costs are other expenses that must be accounted for when evaluating at the entire monetary effect of these injuries. Professionals also acknowledge injury indirect costs which include wages paid to injured workers for absences not covered by workers’ compensation insurance; administrative time to investigate the incident and perform other related supervisory duties; employee training and costs for replacing the injured workers; and lost productivity and accommodation of injured workers. While specific stakeholders are able to use data on certain line items to provide financial and other useful information, all stakeholders need to see the full picture of how SPHM injuries can affect the facility’s fiscal health and overall employee satisfaction.


Identification of Specific Cost Drivers – Specific activities or actions that have been identified to have costs associated to them. Customized coding will provide detailed activity descriptions to allow quantification of data and associated costs resulting from injuries.


Labor Retention and Recruitment Efforts – Data supports the fact that successfully competing for educated, trained and experienced healthcare workers in today’s market does not just depend upon wages, salaries, benefits, work shifts or available days off. Musculoskeletal injuries, cumulative or traumatic, have a significant effect on the professional and personal lives of the injured. Some injuries can disable and/or destroy a career. Competent caregivers also acknowledge that their safety and health closely relates to the welfare of their patients/residents. Having a SPHM program in place within a culture of safety demonstrates to recruits and affirms to current employees that the facility supports and protects them.


Patient Safety and Quality of Care – Currently, organizations must pay for negative patient outcomes related to hospital stays. Increasing evidence points to the importance of mobilization of all patients in the recovery process, which patient handling equipment facilitates. Falls, skin breakdown, UTIs, pneumonia, and other hospital-acquired injuries/illnesses are positively impacted when SPHM programs foster equipment use.


Utilization of Best Practices – There are tried and true processes for SPHM program development, implementation and maintenance. The ANA Safe Patient Handling and Mobility Interprofessional National Standards relay those national experts agree upon. The Veteran’s Health Association has the largest and most successful SPHM program in the United States, incorporating best practices found to be valuable in other organizations as well. When these best practices are supported, patient and staff injuries are impacted positively.


Quality Improvement Programs – These specific and defined process-based, data-driven approaches to improving the quality of a product or service are significant in all modes of healthcare provision. In the context of this paper, patient handling injuries drive many of the quality improvement programs’ focus. Customized coding will provide a consistent method from which data may be obtained and analyzed in the context of performance-based measurements.


Caregiver Safety – Occupational health and safety programs continue to identify risk factors and specific interventions to mitigate injuries due to patient handling. Rates of musculoskeletal injuries from overexertion in healthcare are among the highest when compared with other industries. A primary focus of this paper is to identify those data elements, which will provide sound and reproducible data to drive the continued development and improvement of SPHM programs.


Public Relations and Brand Protection – Communication systems provide immediate and up-to-date information to the consumer seeking products or services. These channels, whether newswires or social networking sites, provide the conduit for widespread public relations and positive branding. Public acknowledgment and reporting of a SPHM program developed, installed and maintained in the facility bespeaks the culture of safety that has been promoted and secured by administration. Knowledge that the facility cares not just for the patients/residents but also for the employees focuses on the humanity of the healthcare entity and instills consumer trust.



Engagement Blueprint


To gain consensus and buy-in for consistent coding, first think and act locally, then move to global applications. Figure 3 shows a simple process for adopting the proposed category in a gradual yet meaningful way. Step 1 involves adding proposed codes to the incident reports and other data capture processes to get consistent points adopted on the front end. As with any change, stakeholder education is critical. Steps 2 and 3 are at the administrator level, whereby stakeholders gain approval to institute the new coding in RMIS or other data capture systems. For example, adjustments to intake scripts would need to include the new coding, ensuring these questions are answered at the claim-reporting level. Because the new coding is simple in nature, there should be minimal impact to a data warehouse/RMIS system.



A Call to Action


Early adopters of more detailed coding practices have clearly demonstrated a positive impact on overall loss costs when compared to those that have yet to embrace this practice. These organizations are likely to garner peripheral and significant benefits such as staff retention, attraction of clinical talent in an environment with skilled nursing and medical professional shortages and productivity drains to name a few. However, administrators require tangible metrics to support the business case for development and maintenance of robust SPHM programs.



Ongoing state legislative activities are gaining momentum to encourage development, adoption and standardization of programs. This movement will likely continue. Federal adoption and support of SPHM standards and practices have yet to be enacted. However, without a standard from which to measure outcomes, comparison and trending, enumerable losses will continue. Moving forward, stakeholders will need to take a pragmatic and incremental approach to engage all participants in the process. As engagement increases and results are measured, further expansion of codes may be introduced as practically appropriate.





Fundamentally, caregiving is a humanitarian effort based on respect and concern for others. As science and the ability to treat and cure has progressed through the years, longer lives lived with chronic, debilitating and frail conditions and the needs for more challenging rehabilitation efforts have resulted.


The caregiving workforce and the patients/residents are all aging. And more than ever, the condition of the financial bottom line is tenuous and difficult to control.


It can easily be acknowledged that the implementation of a successful SPHM program, led by an expert in the field and supported by others who are educated and experienced in the scope and practices of the program, makes a significant difference in the health and welfare of the caregivers, the cared-for and the service-providing entity.


Be reminded of Table 3, illustrating the value of this proposition, and all the ways that patient handling and mobility injuries can negatively affect lives, jobs and the bottom line. The proposal for standardized coding herein is simple and easy to implement so that healthcare organizations can maintain the practice and contribute meaningfully to decreasing staff injuries, improving patient/resident care and prolonging solid careers.


With inclusion of the proposed categories, improved data and its analysis will become consistent and available to all; providing the information necessary to improve safety programs. Assistive patient handling and mobility equipment is available and will continue to improve when the exact needs for the implicated tasks are consistently coded and brought to light.





  • American Nurses Association (ANA). (2013). SPHM Interprofessional National Standards Across the Continuum. Publisher: Nursebooks.org. Silver Springs,
  • National Institute for Occupational Safety and Health coding system [Occupational Health Safety Network (OHSN) (2015) http://www.cdc.gov/niosh/topics/ohsn/injury.html
  • Bureau of Labor Statistics 2014 BLS Newsletter 2014. http://www.bls.gov/news.release/archives/osh2_12162014.pdf
  • S. Department of Labor, Occupational Safety and Health Administration. (2013). Hospital eTool: Healthcare Wide Hazards – Ergonomics. Available at: https://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html. Accessibility verified 1/29/2016.
  • Institute of Medicine (IOM) (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies
  • National Institute for Occupational Safety and Health (NIOSH). NIOSH Standard Occupational Data Architecture (SODA 2.0) Draft document dated June 24,
  • Khatutsky, G., Wiener, J. M., Anderson, W. L., & Porell, F.W. (2012). Work-related injuries among certified nursing assistants working in US nursing homes. RTI Press publication No. RR-0017-1204. Research Triangle Park, NC: RTI Press. Retrieved from rti.org/rtipress.



Disclosure Statement


The Association of Safe Patient Handling Professionals (ASPHP) does not endorse one particular company or organization. Reference within this paper to any specific commercial or non-commercial product, process, or service by trade name, trademark, manufacturer or otherwise does not constitute or imply an endorsement, recommendation, or favoring by the ASPHP.


The views and opinions of the authors of content provided in this paper do not necessarily state or reflect the opinion of the ASPHP and cannot be used for advertising or product endorsement purposes.





All of the authors of this white paper are members in good standing with ASPHP and serve as Board members.  Wendy Weaver is the past Executive Director of the organization.





Mike Fray PhD, BSc(Hons), BHSc, MCSP, FHEA Senior Lecturer

HEPSU, Design School, Loughborough University UK


Vicki  Missar,  MS, CPE, SSBB, CSPHP, CHSP

Associate Director, Global Risk Consulting Aon 


Candy Raphan, RN, BSN, ARNP-C, MAOM Regional Vice President

Client Services Medical Management Broadspire®



Patient Care Ergonomics Consultant President, Patient Care Ergonomic Solutions


Wendy Weaver, MEd

Gateway Coaching & Consulting, LLC

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