Earlier this month the Los Angeles City Council passed an ordinance requiring condoms to be used in all permitted adult films shot within their city limits. It brings up many interesting workers compensation issues. After all, this requirement is for the health and safety of employees. Is it any different from requiring construction workers to wear a helmet? Road workers to wear a bright, orange vest?
In this commentary on Salon.com porn performer, writer and director Lorelei Lee calls the ordinance well intentioned but ineffectual. She notes that the new law requires adult film production companies to pay a fee with permit applications. “Currently, condoms are used in the mainstream gay adult film industry (which includes only gay male films), while the heterosexual industry (which includes both lesbian and straight films) has used mandatory STI (sexually transmitted infections) testing as a health and safety precaution since the early 2000s,” she writes.
Lee writes that until May of 2011, the Adult Industry Medical Center, founded by a retired performer, ran a nationwide STI testing service and database that certified heterosexual performers as STI-free previous to their working on any production whereas the new ordinance is in response to a San Francisco-based nonprofit AIDS Healthcare Foundation campaign along with other groups that have picked and boycotted companies which sell or show condom-free pornography.
One of the protest leaders called the testing service a “fig leaf” over the adult industry and backed the lawsuit that led to the organization’s financial insolvency and shutdown last year, which left a vacuum in health and safety protections in the industry, Lee writes. “(He) seemed to hope that leaving performers without any kind of health protection would force legislators to mandate condom use,” she writes.
Lee writes that she became a condom-only performer in 2010 but had worked for eight years previously relying only on the testing service. “But during my time as a non-condom performer, I never once contracted an STI on set that condoms would have prevented, and truthfully, I’m not sure that condoms actually keep me safer than testing alone,” she writes.
She writes that performers have a mix of opinions as to whether they mind actually using condoms on set and some are even strongly opposed to using condoms at work, believing that they may actually increase likelihood of STI transmission.
Lee says what she is most opposed to is regulating condom use in the industry through government regulation. “Many of the people attracted to this industry are still those who don’t care a lot about public opinion or about obeying authorities. In the case of a condom mandate tied to permits, many producers will simply shoot in Los Angeles without a permit. Others will move production outside of the city – to places like Las Vegas, San Francisco or Miami, where some companies are already established,” she writes, noting that perhaps that s what the city is after.
In effect, Lee writes, this legislation has made it more difficult for the industry to use the protections already in place with AIM’s testing program. “We’re also opposed to the squandering of AHF resources – resources that could be effectively used to help prevent and treat HIV and AIDS – on a political campaign against an industry whose health and safety regulations are already working. In the decade since AIM began the program of mandatory testing, six performers have tested positive for HIV, and only three of those have shown to be from on-set transmissions,” she writes. “That’s three transmissions during the course of filming tens (or perhaps hundreds) of thousands of scenes. There are no real statistics as to how this compares to transmission rates in the general population.”
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.
Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Stephen Buehrer recently announced the addition of a workplace wellness program to help employers meet the challenges related to rising incidences of obesity and chronic disease.
Over the next four years, the program will make $4 million available to employers to create programs to control escalating costs of workers’ compensation claims associated with these health risk factors.(WCxKit)
“Health factors like obesity and chronic disease can contribute to workplace injuries and slow the recovery of an injured worker,” said Buehrer. “By promoting wellness programs in the workplace, we are helping improve the quality of life for working Ohioans and their families, as well as helping reduce costs for Ohio’s employers.”
Participating employers will be awarded up to $15,000 over four years to implement wellness programs in their workplaces. BWC expects more than 600 employers will benefit from these grants, which will be awarded on a “first come, first serve” basis based on availability of funds.
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, contactInfo@ReduceYourWorkersComp.com.
As U.S. companies continue to ask workers to shoulder a greater burden of the cost of health care, a recent survey from Aon Hewitt, The Futures Company and the National Business Group on Health, reveals that consumers want their employers to do more to help them improve their health and get the most from their employer-provided health and wellness plans.
Together with the National Business Group on Health and The Futures Company, Aon Hewitt surveyed more than 3,000 consumers (employees and their dependents) covered by employer health plans to determine their perspectives, behaviors and attitudes towards health and wellness.(WCxKit)
Under continued pressure to mitigate costs and adjust to new regulations, employers are continuing to carefully consider the future of their employer-provided health plans. However, as they adjust their plan design and wellness strategies, the survey finds that many employers are not aligning these strategies with the goals, needs and concerns of their employees.
While a majority of consumers (74 percent) are worried about being able to afford health care now and in the future, they understand that health improvement programs, along with well-designed employer-provided health benefit plans, can help them get healthier while also holding down costs. But, the survey reveals that workers really want four simple things -programs and communication that are easy to use, motivating and meaningful to them, but that also provide personalized information and ideas.
"Employers continue to face countless challenges when it comes to offering health plans that effectively meet the needs of workers and their families, while also managing rising costs," said Helen Darling, president and CEO of the National Business Group on Health. "We hear over and over that the key to ensuring real health improvement is employee engagement, so knowing what employees want and what will motivate them is essential to success. Consumers are telling us that the one-size-fits-all approach to health and wellness is not working for them. In order to help with their challenges and reduce costs, they want health programs that speak to their individual and families' health care needs."
Faced with rising health care costs and new regulations, more employers are introducing health care plans that require workers to take more responsibility for managing their health and the related costs. In fact, a recent Aon Hewitt report shows that 51 percent of employers now offer a Consumer Driven Health Plan (CDHP), up from just 9 percent in 2005.
The good news for employers is that consumers are willing to try CDHPs if the immediate cost savings are apparent. Among those with a choice, most employees (63 percent) select a CDHP because of the lower premium costs.
Additionally, 39 percent choose this plan option because their employer contributes to an associated account-Health Savings Account (HSA) or a Health Reimbursement Account (HRA). In fact, among those enrolled in a CDHP who have a choice, over 90 percent will definitely or probably re-enroll. While CDHPs are, in part, intended to encourage workers to take a more active role in their health, the survey findings indicate that they are having a mixed effect on behaviors.
Encouragingly, 42 percent are getting more preventive care and 40 percent are looking for lower cost health services options since choosing this plan. More troubling, a sizeable number of workers (35 percent) are sacrificing or postponing care (28 percent) to avoid out-of-pocket costs.
"While an eye towards cost is certainly a valid and reasonable reason for consumers to select a certain health care plan, choosing a plan that fits a worker's lifestyle and needs also ensures that people are getting the most appropriate coverage for their needs," said Cathy Tripp, managing principal Health & Benefits at Aon Hewitt and project leader for this study. "However, employers need to make sure workers aren't sacrificing health and the future costs of poor health for lower costs today. Giving employees the tools and advice to decide what is the most appropriate plan for them is critical."
When it comes to tools to help them make health decisions, consumers want information that is tailored to their specific situation. Half of participants (50 percent) want a personalized plan that recommends specific actions they can take to improve their health based on their health status, up 9 percentage points from 2010. Workers are also looking for convenient, one-stop access to information with 40 percent expressing a preference for a wellness website and more than a third (35 percent) want personalized health tips and reminders. Cost is still not far from the minds of consumers though. Fully 44 percent would like cost savings tips and a third (33 percent) want cost estimating tools.
"If companies truly want to move the needle in terms of overall health and cost, they have to stop looking at employees as one group, and start looking at the individual," stressed Joann Hall Swenson, principal and health engagement best practice leader at Aon Hewitt. "Employers can customize health information and related programs to address the specific health conditions and risks of their workers as well as offer specific tips and actionable steps they can take to improve their condition. In addition, offering tools that allow individuals to see and understand the cost of their health care services goes a long way in helping workers make the most of their health care dollars."
In addition to shifting a greater share of the cost to employees, companies are also looking at ways to get employees and their dependents healthier. According to consumers, the best way to motivate them to participate in employer-sponsored health plans is by using rewards. More than half of consumers would prefer either non-cash or cash incentives to encourage them to take part in wellness (60 percent), condition management programs (50 percent) or respond to a health risk questionnaire (58 percent).
For employers, getting workers engaged in their health is critical to health improvement and cost containment. However, the survey finds that there is a disconnect between how healthy people think they are and how healthy they actually are.
The Centers for Disease Control and Prevention reports that approximately one-third (33.8 percent) of U.S. adults are obese, though only 24 percent of survey participants say they are obese. Similarly, the survey found that more than three-quarters (76 percent) of consumers rated their health as "very good" or "good,” while just 15 percent considered their health "fair" or "poor." While employees may think they are healthier than they likely are, they do acknowledge that their health is not perfect. Approximately 60 percent of consumers report having at least one health condition with obesity, high blood pressure and back pain most often mentioned.
"This lack of awareness between real and perceived health is a huge problem since we know that concerns about risk factors can help overcome our natural tendency to put-off making the tough life changes needed to significantly reduce health risks," stressed Darling.
Despite the potential disconnect between real and perceived health status, consumers do understand what it takes to get and stay healthy. When ranking what matters most to their health, many (85 percent) say that good health is a result of making smart health choices each day, over two-thirds (68 percent) say that getting regular preventive care ranks in the top three, while 40 percent rank living and working in a healthy environment in the top three. While people know what it takes to be healthy, there are still often barriers to reaching health goals. Most people cite lack of time (42 percent), cost (40 percent) and unwillingness to sacrifice (35 percent) as the leading obstacles to getting and staying healthy.
Consumers do acknowledge that there are people and things in their lives that may help move the needle when it comes to improving their health. Nearly three-quarters (72 percent) are influenced by advice from a doctor, almost half (47 percent) from friends or family, and 41 percent from general health websites. Just 13 percent consider health information from their employer a trusted source.
To improve health and productivity, employers are increasingly offering programs to both workers and their dependents such as biometric screenings, health risk assessments, onsite clinics/pharmacies and Employee Assistance Programs. However, many employees and their dependents do not seem to be aware of many of these programs. In 2011, more than one-third (36 percent) of consumers did not participate in any health program or service offered by their employer. Among the programs that workers did participate in, blood tests or biometric screenings were the most popular (61 percent participation), followed by health risk assessments (57 percent participation).
Despite low participation, when workers do take part in these programs, satisfaction is extremely high. Almost all (97 percent) of consumers who took part in blood work/biometric screening were satisfied, 97 percent were happy with their on-site clinic or pharmacy, and 92 percent were satisfied with the health risk assessment.
In addition to lack of awareness, and despite the availability of health improvement programs, many consumers do not feel their employers are fully supportive in helping them get and stay healthy. A majority of workers (60 percent) think their company is only moderately-to-not supportive when it comes to their efforts to be healthy.(WCxKit)
"Employers may be missing the mark when it comes to health improvement programs being offered to workers," said Tripp. "Workers need to see that their efforts to become healthy are supported by the company. Developing a culture where leaders care and support healthful living communicates to workers that this matters to the company."
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, contactInfo@ReduceYourWorkersComp.com.
As members of a management team, around the winter season, reevaluate for the upcoming year. Set goals, benchmarks, implement new techniques, purchase new materials, etc. But there is one area that seems to be focused on more than others: And that is ‘how can we use what we have to be better?’.
Chances are in a medium to large shop, there is plenty of talent, in more than one form. The workers can be your most important capital. So why not focus on how to better use that talent? (WCxKit)
1. Provide the best tools so employees can perform efficiently
As an example, if you drive cars, this does not mean that all all drive a top of the line Cadillac. But this is meant more to show how to provide the best output for workers. Make workstations adjustable so workers can perform at the levels they need to. This will increase output and performance, not to mention that it will make workers less prone to injury, especially in repetitive-motion workstations. Extra lighting can provide clarity and precision. Hand trucks and dollies can make moving heavy materials easier and quicker, and so on and so on.
2. Don't run it like a prison
The workplace does not have to run hard-nosed and rigid. As an employer allows some flexibility such as flex work hours, rotating job tasks, allowing hourly breaks, then you can best utilize workers time at work for production. A rested workforce is your best workforce. Sometimes having job rotation can provide breaks for those that do heavy duty work day in and day out. Also this can reduce injury since those workers that just do heavy lifting or moving of materials can get a much needed break from time to time throughout the day. You could also discover that one of your workers may be better suited for another type of job task, versus the one they are currently in now. This could lead to increased production, and better efficiency.
3. Keep an open mind
Time and time again we recommend listening to employees and their suggestions as to how changes can be made to make production better. Discuss alternative job tasks and how things could be done quicker and easier. Remember these are the people that do these jobs all day, sometimes for years. They have ideas and suggestions and you have to make management become approachable. If someone knows that you will take the time to listen to them, you may get an idea that you can implement. Not everyone will hit the ball out of the park every time, but you could stumble upon something that can really make a difference, and it could change the way things are done on a daily basis.
4. Encourage healthy lifestyles and reward those that make a change
A healthy body is one that comes ready and able to work, and able to take on the challenges of the day. Healthier employees also have less sick time away from work, and have fewer injuries. A lot of companies now offer discounts to local gyms, reduced medical premiums for wellness exams, smoking cessation programs for free, etc. The HR department probably has a lot of ideas and plans that are already in place to promote a healthier lifestyle, and the incentive programs to go with it, so check in to some of them and try to implement some over the course of a year. Provide some incentives for the workers to participate, and see what happens. I bet that more will participate than you thought.
5. Launch a return to work program
It has been well documented that the longer a person is out of work, the harder it is to get them back to productive employment and there is a strong correlation between a high return to work ratio and a low mod. Older employees also take longer to heal than younger ones, so consider home-based employment. If you provide some light duty work, employees know that even though they have an injury, they can still work and make a decent wage. This will help them transition back into full time work once they are released from medical care, and will reduce claims dollars that are spent on lost wages while injured. It will also free up full duty employees to do something more productive, while those with medical restrictions can take care of the lighter tasks you need done day in and day out. Make a "wish list" of tasks you wish you had someone to help perform, then use the wish list to create transitional duty tasks. For instance, I wish I had someone to proofread my writing.
6. Set up a mentoring program
It is always hard to start a new job. Nobody wants to be the new person, so set up a mentoring program to help those new or less-experienced employees. Shadowing programs work well also. The new employee can gain some great knowledge from the veteran worker, including how to do things quicker, properly, and more efficiently. A good mentoring program will improve productivity of the newer, younger employees while making veteran workers feel like they can contribute more to the company other than just cranking out their job tasks day after day. The more you make workers feel like they are involved, the better, harder, and more dedicated they will work for you.
7. Do not be afraid to hire experienced workers
There are many benefits to hiring experienced workers. These workers already have sound work habits, years of experience in the field, and the skills the company needs to take you to the next level of competition. These workers also have less out of work distractions, such as needing more time off for child care or more time off for school commitments. Experienced workers will also add some diversity in workforce, contributing their ideas and experience to the team projects and ideas. If you utilize their assets, the workplace will benefit. (WCxKit)
Summary
A New Year means it is time to reflect on the year to date, and focus on what you can do better for the upcoming New Year. But you should also think about what the veteran workers can bring to the table for the company. Experienced workers are a great untapped resource, and their ideas and work ethics can be beneficial in more ways than one, especially in fields other than just being at their workstation. Tap the greatest free resource- the employees. Listen to their ideas, and make the management team approachable when someone has an idea about how something may be able to be done better. If you make this one of several things to focus on, accomplishing the rest of the goals could just be that much easier.
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, Manage Your Workers Compensation: 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.
Many small and medium size companies wish for a wellness program like the larger competitors, but due to budget concerns and lack of personnel in the Human Resources Department, have not started their own wellness program. It is not as difficult as one might think. Here are some guidelines on how to get a wellness program started.
Gaining management support for the implementation of a wellness program is the first step. As senior management is all about the financial success of the company, explaining how the wellness program will improve the company's financial picture is a good place to start. Read the study on wellness programs completed by the Wellness Council of America. Explain how for every $1 spent on wellness programs, there was a $3 reduction in the cost of the the health insurance program. If management is still not sold after learning the wellness program has a ROI of 3 for 1, an article published in Forbes states “According to the Centers for Disease Control, more than 75% of the employers' health care costs and productivity losses are related to employee lifestyle choices.” (WCxKit)
There is a similar correlation in workers compensation cost as healthier employees have fewer accident, and when they do have an accident, they return to work sooner. This was supported by a combined 56 studies on work site wellness programs. Per the American Journal of Health Promotion, there was a 32% reduction in workers compensation.
After gaining the support and participation of senior management in the creation of a wellness program, form a wellness committee. Whether electing to utilize an outside company that has a wellness program already structured that can be implemented quickly or deciding to build your own company wellness program, the involvement of additional personnel from various departments will expand the ideas and insure the success of the wellness program. Broad representation on the wellness committee will be drawn from human resources, finance, risk management, safety, union, senior management and production. You can also invite volunteers from any department within the company. The wider the variety of specialties the better.
The goals and objectives of the wellness program should be the first order of business for the wellness committee. By establishing benchmarks, you will be able to measure the success of the wellness program. The primary reason companies abandon wellness programs is the failure to have benchmarks showing the success of the wellness program. Some benchmarks that can be considered include:
1. absenteeism
2. health care cost
3. employee retention rate
4. employee participation (percentage) in the wellness program
5. reduction in number of workers compensation claims
6. reduction in overall workers compensation cost
The wellness program should not be based solely on the ideas of the wellness committee. Employee interest and involvement is essential to the success of the wellness program. Obtain the input of the employees themselves in what they want to see in the wellness program. An anonymous survey, whether on-line or on paper, can be used to obtain employee input. Some categories that can be considered for inclusion in the survey for the wellness program include:
1. diet and nutrition
2. weight loss solo and weight loss groups
3. exercise equipment
4. walking solo /walking groups
5. muscle toning
6. reduction in blood pressure
7. reduction in cholesterol level
8. reduction in body mass index (BMI)
9. cessation of smoking
10. cessation of illicit drugs
11. cessation of alcohol abuse
12. healthier food options in company cafeteria / snack machines
13. on-site flu shots
14. hand sanitizers and other sanitizing items in public area
15. ergonomics at work and at home
16. seat belt use
17. safe driving
18. pamphlets and posters reminding employees of health topics ( pamphlets on cancer screenings)
19. vision screenings provided on-site (mandatory for all employees who drive on duty)
20. yoga classes before/after work hours
In addition to these topics, leave three or four blank lines on your survey for the employees to suggest their own wellness topics and/or concerns they would like to know more about or to have assistance with.
Once you have established the employees' wellness program interest, it is important to quickly proceed to implement and promote the wellness program. This can be done in a variety of ways including:
1. provide non-smokers with a $5 per week credit on their health insurance program
2.
provide employees with a BMI under 30 with a $3 per week credit on their health insurance program
3. a $6 per week credit for the the employees with a BMI under 26
4. provide pamphlets on wellness topics
5. have posters on wellness issues
6. offer "lunch and learn" on wellness topics
7. organize group walks before work/after work/lunch time
8. have wellness calendars
9. schedule on-site flu clinic (ask a nearby medical clinic for a group rate discount or inquire if the health insurance carrier will pay for it)
After implementation of the wellness program, it is important to give the program enough time to have an impact. The above mentioned benchmarks should be established on the first day of the wellness program, and the results measured after one, two and, three years. Evaluate what has worked and what has not. A repeat survey asking the employees who participated their impression of the wellness program is a good way to get additional feedback. Also, a survey for the employees who have not participated in the wellness program asking why they do not participate can provide insights on ways to improve the wellness program.(WCxKit)
By establishing a wellness program, you will improve the financial picture of your company, reduce absenteeism, reduce work comp claims, reduce health insurance claims and improve employee morale. It will also reduce your workload if you deal with human resources issues or workers compensation.
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, Manage Your Workers Compensation: 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
Authors: Brian Anderson DC, CCN, MPH and David C. Radford, DC, MSc
Employers are unlikely to find another issue that leads to more absenteeism and detracts from productivity in the workplace more than occupational low back pain (LBP). This, the
first in a series of articles, introduces the ubiquity of this problem in the workplace, what solutions are effective in addressing it, and what treatment options can be most successfully employed when workers do injure their low backs.
In order to understand the scope of this problem, it is worthwhile to discuss some statistics related to occupational LBP.
· Occupational LBP is the largest single health problem related to work absenteeism, and the most common cause of incapacity among workers younger than forty-five years old.
· Worldwide, 37% of LBP was attributed to occupation.
· 1% of the US population is permanently disabled from this problem.
· Occupational LBP accounts for 68% of sick days and 76% of sick leave payment costs in some industries.
As is obvious from the above statistics, LBP consistently creates huge expenditures and time loss from work. Employees whose job involves lifting, bending, twisting or repetitive spinal movements are most at risk for these injuries. This type of LBP is classified as kinetic or dynamic overload injury. Due to the nature of LBP, these workers are also more likely to need extended time off work when suffering a low back injury. Transitionally, they may also need modified duty for a period of time on their return to work.
Ergonomic interventions, which will be addressed in part two of this series, are crucial for the prevention of occupational LBP. Acute LBP is almost never
related to one specific event, but rather is the culmination of a long history of improper mechanics and micro-trauma to the spine. As apposed to kinetic injury, static or postural LBP is also a huge problem for “desk jockeys,” or those who sit for prolonged periods of time. Lack of movement can sometimes be as detrimental as too much movement.
To summarize, the risk factors for occupational LBP are:
· cumulative traumas;
· dynamic activity-trunk flexion and rotation, heavy physical work, bending or squatting, lifting or carrying loads;
· long work shifts without pauses;
· static and inadequate postures.
Workers suffering low back injuries can be divided into three groups: work being the primary cause of LBP; work being one of many contributing factors related to LBP; and those with a preexisting back injury which may be aggravated by work. Those workers who fall into the latter category should be very carefully monitored. There will always be cases of occupational LBP that cannot be predicted or even prevented, but a worker with a previous history of LBP does not fall into this category. Matching the worker to the job is a crucial prevention strategy, which will be discussed in part two of this series.
What should be most concerning to employers, and is likely the most important reason for intervention, is preventing acute low back pain from becoming a
chronic problem. There is plenty of data to suggest that most acute low back pain is self-limiting. With or without treatment, many cases of acute low back pain resolve in a few weeks. There are, however, two issues that should be of concern regarding occupational LBP; recurrence and chronicity. The recurrence rate of low back pain is 30-60% within 1-2 years.
There are also some documented risk factors for developing chronic LBP after an acute injury which employers and health care providers should be aware of. These are:
· dissatisfaction with work
· physical inactivity/obesity
· low vitamin D levels
· smoking
· performing heavy lifting
· depression
· being involved in litigation
· educational level
In part three of this series, we will discuss treatment options designed to prevent chronic low back pain.
If employers are not actively working with their company nurses and doctors developing strategies and programs to address and prevent occupational LBP, hopefully they will after reading this series of articles. Next time we will address programs and interventions targeting primary and secondary prevention of occupational LBP. Stay tuned!
Resources:
1. Estimating the global burden of low back pain attributable to combined occupational exposures – http://www.who.int/quantifying_ehimpacts/global/5lowbackpain.pdf
2. Occupational low back pain: Rev Assoc Med Bras 2010; 56(5): 583-9
3. Preventing Occupational Low-Back Pain. West J Med 1988 Feb; 148:235
4. Can We Identify People at Risk of Non-recovery after Acute Occupational Low Back Pain? Results of a Review and Higher-Order Analysis. Physiother Can. 2010;62:9 –16
5. Designing a workplace return to work program for occupational low back pain: an intervention mapping approach. BMC Musculoskeletal Disorders 2009 10:65
6. Liebenson, C. Rehabilitation of the Spine- A Practitioners manual, 2nd edition. Lippincott Williams & Wilkins
Dr. Anderson works as a supervising clinician and instructor at National University of Health Sciences in Lombard IL. He has been in private practice, as well as part of a team in a University based Integrative Medicine setting. In addition, Dr. Anderson has experience in the medico-legal field, serving as an expert for various insurance companies and legal firms. He earned a Masters Degree in Public Health, as well as a Certified Clinical Nutritionist designation. He is currently working toward a specialty diplomate in Functional Rehabilitation. Contact Dr. Anderson for more information at
banderson@nuhs.edu
Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at
DCR8888@aol.com or (440)-248-8888.
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
British businesses have been reminded about new incident reporting arrangements that were introduced starting September 12, according to information from Health and Safety Executive HSE
Only fatal and major injuries and incidents will be able to be reported by phone to the HSE, with all other work-related injuries and incidents reportable under RIDDOR to be reported via one of a suite of seven online forms available on the HSE website. (WCxKit)
According to Trevor Carlile, director of HSE of Strategy, "This should not be a significant change for many, as more than half of reportable injuries are already notified to HSE through the website. The new forms are intuitive, quick, and easy to complete. The most important thing is that there will still be somebody at the end of the phone to assist those who are reporting a traumatic event that has resulted in a death or major injury.”
Later this month, the HSE Infoline telephone service currently providing basic information services to callers will end. Instead, from September 30, those seeking information and official guidance will be directed to the HSE website – a huge knowledge bank where they can access and download resources and use interactive web tools free of charge. Various improvements have been made to the HSE website to coincide with the closure of Infoline. (WCxKit)
There is clearer information on what HSE does and does not do, so people can check that HSE is the right organization to assist them, and expanded'question & answe' sections for the most frequent health and safety enquiries such as those on RIDDOR reporting and First Aid.
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.
Chronic or long term inflammation is very often involved in the development of our chronic disease processes. Thirty percent of chronic illness can be attributed to genetic inheritance, but about 70 percent is due to diet lifestyle. Modern diets are making people sicker, but fortunately some relatively minor, painless adjustments can reverse the trend toward chronic disease processes.
Obesity, type-two diabetes, chronic inflammation, and degenerative diseases, such as arthritis, dementia, alzheimer’s, and atherosclerosis leading to heart disease and stroke can all be slowed down and for many, the incidence of certain types of cancer can be reduced.
One of five young adults have measurable findings of early peripheral artery disease (PAD). You have to ask yourself, “Why?” These are young adults are our future employees.
USA Today reported in late September that more U.S. companies are helping employees combat chronic diseases in an effort to cut costs. This is a win-win situation. The employees become healthier with the employer’s assistance, and the employer cuts down health insurance costs and claims because they employ a healthier workforce.
The article reports employers across the United States are looking to trim health insurance costs by combating chronic diseases such as diabetes, obesity, and depression in their employees. The article goes on to say, “Some companies now offer gym access, programs to help people stop smoking, and even on-site medical visits as a way to lower health insurance premiums. ‘For an employer, costs can be as much as 40 percent higher in one year for someone who is overweight because of all the issues associated with obesity, including diabetes, back problems, asthma, depression, and heart disease,’ said Kenneth Thorpe, who co-directs Emory University's Center on Health Outcomes and Quality."
A large part of my conservative primary care practice is teaching patients how to prevent the development and even reverse chronic disease. Having a good family history gives me an idea of inherited risk factors, and having a good and honest social history gives me an idea of their lifestyle risk factors. This is the area where we can make great progress in lowering healthcare costs.
Writing for USA Today, author Kelly Kennedy, reports a new survey from the
Kaiser Family Foundation that showed health insurance premiums for families of four increased 9 percent in 2011. She writes that companies “have started to provide on-site medical visits, access to gyms,
chronic-care plans, smoking-cessation programs, and even discounts for those who buy a banana rather than a cookie.”
Based on a physical examination and a few objective biomarkers, I can motivate a patient to make changes. It is not unusual to see an obese patient lose a pound and a half to two pounds a week. I routinely see patients with type-two diabetes lower blood sugars and get off some or all of their prescription medications. The same holds true for patients with elevated blood lipids and many with inflammatory arthritis. Employers and insurance companies need to re-evaluate low fees paid to primary care physicians and look down the road to cost savings.
Kennedy, quoting Thorpe, explained in her USA Today article that health care costs can be as much as 40 percent higher in one year for someone who is overweight because of the issues associated with obesity, including diabetes, back problems, asthma, depression, and heart disease.
"Between 8 percent and 20 percent of health care costs is due to the persistent rise in obesity," Thorpe told Kennedy. "Wellness could make a difference." As an example, Thorpe cited a study he published in the journal
Health Affairs about an evidence-based program that reduced type-two diabetes cases by 71 percent in Medicare beneficiaries older than 60. It could save Medicare $2.3 billion over the next 10 years if pre-diabetic beneficiaries were enrolled, he said.
All of us need to learn the basic components of an anti-inflammatory lifestyle. To be healthier and prevent chronic disease I teach patients to focus on eating fresh fruits and vegetables, only lean meats, oily fish, eggs, nuts, seeds, legumes, beans, lentils, and green leafy vegetables. This type diet is
sometimes called a “Paleolithic” or Mediterranean-style diet. It should incorporate some saturated fat from dairy, use olive oil, and minimize vegetable oils because they oxidize and place a burden on the body.
Add some spice to your life. Over 2500 years ago,Hippocrates of Kos (ca 460 BC – ca 360 BC) the father of Western medicine, said “Letfood be thy medicine and medicine thy food.” The food that Hippocrates spoke of included the herbs and spices of his day. The last 20 years of medical research has shown us that some of the nutraceuticals derived from herbs and spices have potent anti-inflammatory properties. These are complex chemical substances that can down regulate the major processes that drive chronic inflammation. The herbs and spices studied include curcumin (yellow curry powder), ginger, cinnamon, hot red pepper, black pepper, clove, garlic, holy basil, coriander and licorice. Adding these types of spices to the diet will help modulate the inflammatory process that leads to many chronic diseases. Curcumin has been found to be particularly potent and protective, it can be used in cooking or simply taken as a capsule with food as a daily supplement.
No one should eat trans fats or high fructose corn syrup. A vegetarian or even vegan diet can also be used if you make sure you are getting adequate protein and Vitamin B12. All of us need extra vitamin D. Likewise, a multivitamin specific to age and gender is helpful, and cultured food like yogurt and kefir provide good bacteria for digestion. A probiotic is often helpful, and fish oil can be added to raise omega 3s.
Associated with the anti-inflammatory lifestyle are some common-sense components. Make sure you get adequate sleep and restorative rest. After age 50, many find 20 to
30 minute naps are helpful to extend the work day and stay productive. Exercise daily (cardiovascular and muscle building) to tolerance, here again, if starting a program, a visit to your primary care provider for guidance if suggested.
The anti-inflammatory lifestyle will slowly minimize body fat. Eat the right foods and use common sense for portion control, many of my patients lose 30 pounds their first year and achieve an ideal weight without trying. Maintain good dental hygiene to prevent infections in the heart and brain.
We should all practice good posture and attend to spinal and joint health. Bone health is a topic for another day. Stay well hydrated; drink plenty of fresh, clean water every day. Try to get sunlight every day, but never let the sun burn your skin. And finally, avoid all tobacco products, and, if you are going to drink, drink only in moderation.
The U.S. Department of Health and Human Services announced a further incentive late December according to Kennedy. “It asked businesses to participate in a project to show what happens when private insurers coordinate with primary-care physicians to address health issues. This means personalized care plans, electronic records and preventive care, as well as partnerships with large firms that can offer incentives to their employees,” she wrote. (WCxKit)
She reported that a tire-manufacturer began providing preventive care to all its employees three years ago, as well as chronic-care management for five diseases. Before the program started, only 7 percent of employees received basic care for diabetes but now nearly 100 percent do. That cut health care costs for those patients by about $700 a year, according to the company president. They have seen a 30 percent reduction in employees classified as high-risk for chronic conditions, as well as an increase in people who work out.
Author: Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at
DCR8888@aol.com or phone: (440)-248-8888.
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.
David C. Radford, DC, MS
Obesity is a chronic disease that involves three simultaneously occurring interactions. These include a genetic predisposition that is estimated to contribute to about 30% of the problem. The other 70% includes the individual’s behavior and environment. Let us break this complex interplay down into these individual components and think about how, as employers, we can help reduce the incidence of this epidemic affecting more than a third of our nation, and driving our cost for healthcare into the unsustainable range. We know that smoking and tobacco costs
our nation about $2 billion a year in lost time, decreased productivity, and cost of illness. Obesity is far more expensive, costing American business an estimated $13 billion dollars a year in lost time decreased productivity, and cost of illness, and the cost to our nation is approaching $300 billion. While obesity now affects more than a third of the entire US population, more than 50 percent of the injured workers with low back pain are obese.
Advancements in human genetics and human genome-wide association approach have isolated 20 genes that are associated with obesity and type 2 diabetes. Alone, these genes only have a modest effect, but if we couple genetics with a poor diet and a sedentary lifestyle, we have the prescription that has led to our current healthcare disaster. Obesity results when body fat accumulates over time as a result of a chronic energy imbalance (calories consumed exceed calories expended). Obesity is a major health hazard in our nation and it is associated with several relatively common diseases such as Metabolic syndrome, leading to insulin resistance and Type 2 diabetes, hypertension, heart disease, Vitamin D deficiency, osteoarthritis of the lower extremities, gallbladder disease, and gout as well as several types of cancer. In women these cancers include endometrial, cervical, ovarian, breast, and colorectal. In men, obesity increases the incidence of prostate and colorectal cancers. In both men and women obesity contributes to sleep apnea, morning headaches, daytime sleepiness, and decreased productivity. (WCxKit)
Integrative medicine and cooperation between different types of healthcare providers is required to provide a solution. Patients need cost effective conservative primary care, using evidenced based methods for weight loss coupled with preventive medicine. Physicians, nurses, and dieticians need to work one on one to encourage patients to move towards a healthier life style. Treating obesity is a process that requires making lifestyle changes.
As a physician treating obesity and working to prevent chronic illness today, I have witnessed rapid and spectacular advances in medical research in the fields of biochemistry, physiology, biophysics and genomic medicine. We know the cause and cost of obesity and its consequences are not just taxing our resources, the increased incidence of obesity and its related problems are rapidly bankrupting our nation’s healthcare programs under Medicare and Medicaid. Obesity is driving the costs for private insurance through the roof. Physicians fees are not to blame. It is the high cost of managing the co-morbidities associated with obesity, which fuels the development of chronic diseases by the systemic inflammation that is caused by morbidity.
How do we get Employers and Employees to Address Obesity?
The question is how do we get employers and employees to buy into addressing obesity? There are preventable contributors of a chronic illness like obesity, and making changes to address obesity will lower our healthcare costs. What will motivate the person to lose weight? I like to use the BMI (body mass index) to start the discussion. Obesity is defined as a BMI greater than 30. I use serum biomarkers (objective laboratory tests) to monitor progress. These lab tests are covered by health insurance. Sitting with a patient and reviewing these results allow goals to be set and progress can be tracked. Seeing improvement in an objective measurement and positive feedback reinforce the goal.
Developing interest can be particularly difficult for those living in poverty. As they face a far greater and more challenging environment. Access to a variety of fresh foods can be challenging, and payment vouchers for food often lead to bad nutritional choices. Returning to grassroots education at the community level through public health clinics will help. It is important that all county, state, and our federal government address this epidemic of obesity, as well as the Type 2 diabetes and Vitamin D deficiency. As these are related problems that increased the morbidity of obesity, and we all pay for this epidemic through higher taxation.
For the employed, the incentive that seems to hold great promise is a financial benefit for buying into preventive medicine. A financial incentive to lower the employee’s contribution to their insurance premium cost is a good starting point. Patient’s using a health savings account and having a higher deductible learn that some of the burden of care is their personal responsibility to themselves and their families.
An onsite exercise area or a negotiated group discount to local area health clubs will encourage greater activity. Group instruction to teach healthy eating pays off quickly, and employees may need some guidance to learn how to live a lifestyle that normalizes weight. The weight loss process starts by reducing the refined carbohydrates in the diet. These calories from simple starches, sugar, and high fructose corn syrup pack on the pounds. Eating plenty of fruits, vegetables, nuts, seeds, fresh and dried herbs and spices create a strong anti-inflammatory response in the body. The extra pounds of fat in obesity drive inflammation, good bacteria in the gut counteract this process, so that eating fermented foods that contain healthy live bacteria like yogurt and kefir are very beneficial. I have found patients with lactose intolerance, gluten intolerance, constipation, IBS or irritable bowel syndrome, yeast infections, allergies and even asthma benefit from a probiotic if they lack the good bacteria in the gut. (WCxKit)
Finally, we all need to make sure that we are getting enough vitamin D. Teaching our employees how to eat sensibly can be the first step in reducing our employees healthcare costs.
Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at
DCR8888@aol.com or phone: (440)-248-8888.
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.
Evidence seems to be coming to the forefront that gluten intolerance could be behind common symptoms diagnosed as fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, thyroid disorders, diabetes, esophageal reflux, intestinal disorders and even infertility.
This March, the Wall Street Journal cited a study in the Journal
BMC Medicine that may show a link. Lead study author Alessio Fasano, a medical director of the University of Maryland's Center for Celiac Research said in the March article, "For the first time, we have scientific evidence that indeed, gluten sensitivity not only exists, but is very different from celiac disease." (WCxKit)
Melinda Beck, reporting for the WSJ’s Health Journal wrote the news will be welcome to people who have suspected a broad range of ailments may be linked to their gluten intake, but have failed to find doctors who agree.
" ‘Patients have been told if it wasn't celiac disease, it wasn't anything. It was all in their heads,’ said Cynthia Kupper, executive director of the nonprofit Gluten Intolerance Group of North America,” Beck reported. Although much remains unknown, it is clear that gluten — a staple of human diets for 10,000 years — triggers an immune response like an enemy invader in some modern humans.
Beck wrote, “Some experts think as many as 1 in 20 Americans may have some form of (gluten intolerance), but there is no test or defined set of symptoms. The most common are IBS-like stomach problems, headaches, fatigue, numbness, and depression, but more than 100 symptoms have been loosely linked to gluten intake, which is why it has been so difficult to study.”
One human resources worker for a large medical company in the workers compensation business recalled an employee who suffered from fibromyalgia for nearly three years. She was diagnosed by a medical doctor, according to our source, who asked not to be named. The doctor was a specialist in treating fibromyalgia and gave the employee “every test you can imagine to rule out brain injury/neuro disorders. She spent thousands of dollars and underwent (physical therapy) for many months.”
Our source estimated health costs exceed $150,000 in tests, doctors’ visits, physical therapy and medications.
After all those dollars and hours were spent, it turned out not to be fibromyalgia, our source said.
After attending a chiropractor’s advanced nutrition course, she learned some believe fibromyalgia can be cured if the patient is willing to change his or her eating habits. “This involves avoiding all sugars and grains and consuming good fats and protein. Among the treatment included were chiropractic adjustments – she underwent about 12 and will need about 12 more on and off throughout her life,” the source said.
“In under 45 days she had reduced her need for medication (saving over $300 each month) and is pain free for the first time in 3 years,” she said.
Another source told us she had severe esophageal reflux (heartburn) for more than 20 years and was on prescription medication to combat it.
“Finally when I could not carry on a conference call without a colleague to assist me because I coughed so much, I consulted several specialists including ear/nose/throat and pulmonary specialists who diagnosed reflux and asthma and put me on an inhaler and Aciphex. I gave up coffee, spicy food, slept on my right side, inclined the bed, and went to yoga to reduce my stress because I was told my stress was so high it was making excess stomach acid. I gave up my cardio exercise to control the ‘asthma.’ Finally, they ruled out asthma with a complex and expensive pulmonology test,” she told us.
She continued, “On my own, for a routine physical, I went to a naturopath, and she suggested I might be allergic to gluten. I thought that was the stupidest thing I had ever heard, but she said 50 percent of people with ‘breakthrough reflux’ have a gluten allergy. … To make a long story short, I gave up gluten on a trial basis (no more oatmeal with bran), and within four weeks my cough and reflux went away. I suffered for 20 years! Today I am fine, off all medication, and do not eat gluten.”(WCxKit)
In conclusion, look at your diet if you are shelling out money to treat these symptoms:
Abdominal distention, pain or cramping; alternating bouts of diarrhea and constipation; anemia, arthritis, attention deficit disorder, bone density loss, depression, anxiety, irritability, dermatitis herpetiformis (skin rash), diabetes, fatigue malodorous flatulence or stools, hair loss headaches and migraines, hypoglycemia, infertility, joint pain, lactose intolerance, mouth sores or ulcers, nausea, numbness or tingling in the hands and feet, osteoporosis, teeth and gum problems, vitamin and mineral deficiencies, vomiting, and unexplained weight loss.
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. See www.LowerWC.com for more information. 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.
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