Texas Requiring Preauthorization: Reduces Costs, Return to Work Not Affected

By requiring preauthorization for occupational therapy services, spinal surgery, and work hardening and conditioning services, a study showed three Texas reforms from the early 2000s lowered medical costs without hurting injured workers’ return to work.
 
 
The Workers Compensation Research Institute (WCRI) study, Impact of Preauthorization on Medical Care in Texas, found when an insurer requires preauthorization there was a seven percent reduction in the number of injured workers receiving physical medicine and occupational therapy. Further, there was a 39 percent reduction in the number of visits per worker. Preauthorization also reduced the number of patients receiving more than 15 visits for physical medicine services.
 
 
According to the study’s abstract, “Texas policymakers enacted several reforms that were intended to give payors additional tools to manage medical care, patient outcomes, and costs. One class of reforms requires preauthorization by the payor for certain types of medical treatments and services.”
 
 
Among the workers compensation rules in Texas, an injured employee is required to receive approval from the insurance carrier before receiving occupational therapy services, spinal surgery, and work hardening and conditioning services.
 
 
To complete the study, WCRI used medical billing data for two sets of claims — one prior to the effective date of the preauthorization reform and one after. The abstract says, “For each type of medical care, WCRI measured changes in utilization after the preauthorization reforms. … WCRI also studied changes in disability duration and return-to-work as measured by the days in which an injured worker received temporary disability payments.”
 
 
The abstract says the study addresses these three questions:
1.      What impact does preauthorization have on reducing medical visits?
2.      Does preauthorization hamper return to work?
3.      Did preauthorization create a delay in spinal surgeries for injured workers?
 
 
3 Study Findings:
1.      Return to work did not change significantly over the time period for injured workers who received physical medicine services.
2.      There was a 21 percent reduction in the number of injured workers receiving work hardening and work conditioning services, but not significant changes in the number of visits and services per visit.
3.      Time to surgery was shorter among injured workers who received spinal surgery after preauthorization was effective.
 
 
You can read more about the study here.

Author Rebecca Shafer
, JD, President of Amaxx Risks 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.

New Zealand Improves Return to Work Ratio for Injured Workers

New Zealand’s Accident Compensation Corporation continued to improve its performance rehabilitating injured New Zealanders this past financial year according to a recent report.
 
 
The report says four key rehabilitation indicators improved during the year. They are: people no longer dependent on ACC after 70 days: – 71 percent, up from 67 percent  two years ago; people no longer dependent on ACC after 273 days: 93 percent, up from 91 percent two years ago; number of people on ACC long term: about 12,000, down from 14,500 two years ago; proportion of people going on to require time off work after an injury: 3.25 percent, down from 4.1 percent two years ago. (WCxKit)
 
 
Getting people back to their normal lives, as far as possible and as soon as possible is ACC’s core role. So these results are very pleasing,” said ACC Chairman John Judge. “Additionally, this improved performance has led to a further reduction in ACC’s net deficit, making the scheme more sustainable into the future.”
 
 
Preliminary financial results for the 2010-11 year show a forecast net surplus of about $2.5 billion. That means the corporation’s net deficit will fall from last year’s $10.3 billion to about $7.8 billion.
 
 
The $2.5 billion surplus is calculated by figuring improved performance of the insurance business, improved investment performance, economic, and miscellaneous  factors. Overall, ACC's scheme solvency has improved to 72% from just 46% two years ago. These results are due to a range of factors, most notably improved rehabilitation of injured clients and improved investment returns. It has also reportedly been important that ACC has stuck more closely to its legislation than was perhaps the case in the past.
 
 
ACC received over 1.6 million new claims this year. By helping these people get back to work or gain independence faster we’ve not only improved their lives but also lowered our own claim costs and stopped the growth in our future liabilities that was so severe for so many years,” Judge said. (WCxKit)
 
 
This is a great result, due in no small part of the efforts of ACC staff, but there is still a long way to go. The remaining deficit of $7 billion is still a major issue and now is not the time to rest on our laurels. These positive trends could easily reverse,” Judge added.

 Author Robert Elliott, executive vice president, Amaxx Risks 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.

Know These 10 Disincentives and Three Easy Fixes To Return to Work

You have implemented a corporate return-to-work program but your projected workers compensation savings haven’t yet materialized. Supervisors are telling you they can’t get employees back to work, and even if they could they don't WANT them to return to work. We've all heard it.

 
It may be time to examine the impact of collateral resources, often resulting in employees out on workers compensation receiving more income and benefits than they would have if they were working.
 
Here are some common disincentives for the injured not returning to work:
 
1. Salary and Wage Continuation: Some companies pay 100% of salary in lieu of having an employee collect workers compensation for injuries of short duration. (WCxKit)
 
2. Occupational Injury Pay Supplements: Many firms pay supplemental benefits to make up the difference between workers compensation benefits and regular earnings.
 
3. Open-Ended Job Return: Instead of holding jobs open indefinitely, employers should hold jobs open for a specific time period, such as six or nine months.
 
4. Vacation and Sick Time: Companies frequently allow vacation and sick time to accrue for employees on workers compensation. Some even allow employees to “borrow” more sick time if they need to stay out of work longer.
 
5. Short-Term Disability: In some companies, disabled employees receive STD benefits in lieu of salary after six weeks. But the standard definition for disability may differ from workers comp, allowing an employee to collect both.
 
6. Perk Continuation: Employers often maintain ancillary benefits and privileges such as car allowances, club and professional dues, company store privileges and periodical subscriptions for employees on disability.
 
7. Loan Protection Policies: Individual insurance policies are available to pay mortgages and consumer loans such as car loans and credit card debts in the case of a disability.
 
8. Unemployment Compensation: In a few states, an employee receiving workers comp also can qualify for state unemployment benefits.
 
9. Pension and Retirement Plans: If these plans do not allow for offset of workers comp benefits, an employee can receive workers compensation benefits and a full pension.
 
10. Product Liability Actions: An employee can file and action against the manufacturer of a product that injured him to collect damages. The employer should seek reimbursement for workers comp payment from any such settlement.
 
If you ask these three following questions, you can eliminate all ten of the above disincentives.
 
1. What Benefits are Injured Workers Getting By Not Working?
Many companies fail to look closely enough at their internal wage and benefits structure before embarking on programs to reduce workers compensation costs. There are numerous collateral income benefits and sources providing built-in disincentives to remaining injury-free or returning to work as soon as possible.
 
For example, a major newspaper was considering an expensive incentive program to motivate employees to return to work, but a careful examination of the company’s situation revealed the reason employees were not returning to work was because they earned the equivalent of 115% of their pre-injury earnings when the stayed out of work.
 
In another case, an injured construction company employee received long-term disability (LTD) payments after 26 weeks of disability, in addition to workers compensation benefits. The total of these benefits exceeded his pre-injury earnings.
 
And, his childcare and commuting expenses also were greatly reduced while he was home.
 
2. Examine Extra Insurance your Employee May Have.
If an employee has purchased credit disability insurance, he or she may have eliminated house and car payments while being unable to work.
 
As such, he refused his employer’s offer of a transitional duty job at full salary because his LTD and credit disability policies would have terminated the benefits.
 
3. Get your Departments to Work Together to Design WC Policies.
In a large company, the directors of human resources, industrial relations, workers comp and employee benefits and compensation must all be involved in designing, administering and maintaining policies.
 
Incentives to remain at and return to work must be built into the management systems. Disincentives must be removed from all direct and indirect sources.
 
Substantial savings can be achieved when a company coordinates its salary, benefits and compensation programs so employees dont earn more by staying out of work.(WCxKit)
 
If not properly coordinated, a company’s employee benefit and compensation programs may inadvertently serve to extend workers compensation absences.
 
Author Rebecca Shafer, JD, President of Amaxx Risks 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 or 860-553-6604.
 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

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.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

NEW ZEALAND Rehab at Work or Returning Workers Sooner

Many workers  in Auckland and Hawkes Bay will soon be able to remain at work, or return quicker after an injury following the introduction of ACC’s Better@Work program through a new partnership with west Auckland’s HealthWEST PHO (Primary Health Organization) and Hawkes Bay PHO.  The result will  be enhanced patient care from general practitioners (GPs), faster and more effective rehabilitation of injured workers and the retention of workplace skills and productive labor for employers.

Over the past year,  Better@Work has been successfully tried at Lake Taupo PHO, with the result that ACC is now actively rolling out the trial program to a selected group of larger PHOs, including HealthWEST and Hawkes Bay PHO.  Next year, the program will be further rolled out to more PHOs.

The benefits  of Better@Work arise from the program’s collaborative working arrangements, bringing together all parties interested in enabling the client to rehabilitate at work.  This happens through the “brokering” activities of the Better@Work co-coordinators employed by the PHO. They bring workers, GPs and employers together to plan a safe stay at, or return to, employment. They manage the process, and make it easy to identify clients’ abilities rather than their disabilities, and provide support to enable them to safely and productively rehabilitate at work.

Depending on need,  their return to work plans could include initiatives such as identifying and enabling alternative duties at work, providing workplace supports and treatment, and finding ways for the worker to remain in touch with the workplace when they can’t rehabilitate at work.

This is an  evidence-based program. A growing body of local and international research clearly shows workplace rehabilitation provides clinical, social and financial benefits for injured workers, and ACC is partnering with PHOs to ensure it can deliver these benefits to clients enrolled in PHOs.

Research shows:

1.  Suicide  in young men six and more months out of work is increased forty fold. (Wessely, 2004)

2.  The suicide  rate is six times higher in long term out of work. (Bartley et al, 2005)

3.  The health risk  and associated impact on decreased life expectancy is more than many “killer” diseases. (Waddell & Aylward, 2005)

4.  Staying out  of work creates a greater risk than some of the most dangerous jobs – such as construction and operating in North Sea industrial sites. (Aylward, 2007)

5.  Injuries heal  quicker in the workplace.

Over time,  the Better@Work program will foster a cultural change in the way general practitioners think about returning injured workers to work and how employers think about keeping injured workers productively involved in their workplaces. This will reportedly result in fewer workers being certified as fully unfit for work because GPs will have the confidence that the Better@Work co-coordinator, the worker and the employer will work together to ensure workplace rehabilitation is safely managed.  (workersxzcompxzkit)

ACC’s companion service,  called Stay at Work, provides a similar service in communities throughout New Zealand. The key difference being that in Better@Work the PHO GPs who offer the program refer claims directly to their Better@Work co-coordinators, whereas in Stay at Work ACC refers clients to community-based rehabilitation providers.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

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.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com

Six Return to Work Strategies You May Not Have Thought Of

Several strategies to consider when creating return to work opportunities: 1-Prepare a physical binder full of alternative job descriptions within the company (or sister companies) 2-Create a return-to-work resource center 3-Consider outside resources to accommodate transitional duty workers 4-Promote internal online job listing resources 5-Encourage volunteerism and partner with local employment agencies or volunteer groups to enhance workers' options. 6-Conside home-based employment Think "out of the box" when considering your approach to getting employees back to the workforce. There are many productive tasks to keep workers productive and involved in the workforce. Gordon R. Butler, national authority/consultant on employability & wage capacity in workers comp, liability, PIP and LTD Claims. can be reached at 321-377-1164 (cell) or email gbutler@gbutlerconsult.com www.gbutlerconsult.com WC Calculator www.ReduceYourWorkersComp.com/calculator.php TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101 www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. For reprint permission contact Info@ReduceYourWorkersComp.com

Poll shows 43% of companies do not have Return to Work Programs

Workers' Comp Kit's informal online poll shows that 57% of companies have RTW (return to work) programs and 43% do not. This is a huge opportunity for employers to save money. If a company has a large deductible, they can save money almost instantly by returning employees to work faster. One of the biggest causes of high workers comp costs is a disproportionate length of disability. If an employee is injured January 1, and healed January 15, they should be back to work January 15 – not June 15 or July 15. You must bring the time out of work back down so that it is proportionate to the length of time of the actual medical disability. Since almost all worker's compensation systems around the work pay for lost wages, this will apply to many countries occupational injury systems. Top 12 Steps to Bring Employees Back to Work Sooner

  • 1. Have a Transitional Duty Policy that requires participation when an employee is injured.
  • 2. Communicate your program to the workforce in a positive way so it becomes part of your corporate culture.
  • 3. Show management the cost savings of an effective transitional duty program with our Transitional Duty Calculator (below).
  • 4. Establish a goal to bring 90% or more of injured employees who would lose time from work back to work within 1-4 days after in the injury.
  • Click here for more TIPS www.ReduceYourWorkersComp.com/employees-back-to-work-sooner.php

For more cost savings tips go to WC Cost Reduction Tips. Do not use this information without independent verification. All state laws are different. Check with your legal counsel before implementing any changes.

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