How long will my injured worker be out of work?

How long will my injured worker be out of work? How long will my injured worker be out of work? Hello, my name is Michael stack and I’m the CEO of AMAX and that’s a good question to ask and a common question to ask when one of your employees is hurt because you need to have that expectation for how long they’re going to be out and what their recovery time is. If you’re not a medical genius, it’s hard to know if someone hurts their shoulder and has a partial rotator cuff tear, what that actually means in terms of recovery time. I want to talk to with you today about how to know that information by using a really, really handy little tool to help you uncover some of these medical secrets to say, well I don’t really know how long it’s going to be out, but they’ve already figured it out.

 

 

Evidence-Based Medicine Injury Duration Guidelines

 

Other people have already figured it out and they tell it to you in a very simple and easy to use format in the form of evidence-based medicine, injury duration guidelines. And these are provided by two different companies or most commonly by two different companies. One’s called ODG guidelines provided by the work loss data Institute and then MD Guidelines provided by the Reed Group. So two great resources to tap into this and I want to cover very quickly, so take a look at the board here. So this is the evidence-based medicine injury duration guidelines for a partial rotator cuff tear. And you’ll see here there’s various categories and levels that you can look at. So whether the person’s in a sedentary job, medium, heavy, light, very heavy type of job, and then they give these guidelines as far as expected, physiological.

 

 

 

Look at Simple Chart To Find Your Answer

 

So how long should it take that person’s body to physically heal for them to be able to be back to work in these different categories of jobs. So pretty general categories, but you could know where your forklift driver fits versus where your office worker fits. If you know what I’m saying, so let’s take a look here. So you’ve got your minimum, your optimum, and then your maximum physiological time that will be required for that person to return to work and you’ve got zero and it goes up to 21,42, 85 etc. And you can just figure out on that little chart there of what that looks like for you. So if you asked yourself that question, how long will my injured worker be out of work? Go ahead and take a look at this chart and have that expectation. Here’s what I also want you to realize, and this is if you’re not familiar with some of this, it will kind of probably surprise you, is that when you look at this, you see these guidelines even for the very heaviest positions of the heaviest light do or heaviest job required here, the maximum out of work time physiologically is 85 days for the most physically demanding jobs that are available.

 

 

50%+ Employees are Not Back to Work Within Maximum Expected Recovery Time

 

If you look at what the actual data says in both ODG and MD guidelines provide this actual data, you will see that actually only 5% of people are back to work within 18 days, so 5% of people are back to work within 18 days and the median so meaning 50% more and 50% less are back to work in 95 days, so more than 50% of people aren’t back to work within the maximum amount of time required for physical healing. Now that should put you on edge to say, what are we doing wrong? Why are we missing this? Look at some of this data, leveraging some of this data and you’ll see that if you have this type of injury, almost all of your people should be back here in some sort of light-duty job within at most four days and that should be your goal.

 

Getting them in that transitional duty position to start healing. Then continuing to progress them back towards their medium heavy and light duty positions, evidence-based medicine injury degree. Injury duration guidelines are a very handy and useful tool for you to implement into your work comp management program. If you’re using them, use them more. Tap into them, leverage them more if you’re not using them. I recommend starting today.

 

Again, my name is Michael stack and CEO of AMAXX, and remember your work today in workers’ compensation will have a dramatic impact on your company’s bottom line, but it will have a dramatic impact on someone’s life. So be great.

 

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2019 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.

Drive Buy-In With A Workers’ Comp Cost Allocation System

This is a 16 Minute preview of the complete course “How to Create and Implement a Workers’ Comp Cost Allocation System” Register for the complete on-demand course here: https://workerscomptraining.com/registration-cost-allocation/

 

Yeah. Hello everyone and welcome to workers’ comp mastery training. My name is Michael stack and I really couldn’t be happier than for you to be joining us for this training session today. What I think you’re going to find is you’re going to find some information and some contacts on a very important topic, which is how to motivate behavior, how to motivate behavior, which is the essence of what is the title of our training, which is how to create and implement a worker’s comp cost allocation system. Because if you think about it, it’s not a mystery of how to do it. It’s not a mystery of how to reduce workers’ compensation costs. We know what those fundamentals are. We know return to work. We know Andrew response, we know how to work with your adjusters. You can go to a bunch of our trainings to learn all those fundamentals in detail.

 

 

It’s Not A Question of HOW…It’s a Question of MOTIVATION

 

So it is not a question of how to do it. It’s been done successfully for years and decades by hundreds and thousands of companies. So then the question becomes if it’s not a question of how, how to add two plus two it’s a question of how to motivate engagement, how to get buy in from your senior managers, from your supervisors, from your employees and from your upper management at the organization. Because if you have that, if you have that vine, if you have that engagement then you will be successful period. If you have that buy in, if you have that engagement you will be successful period because we know how to do what the prep, the tactics are so well proven and documented for what [00:02:00] works. So we’re going to be talking about today is have you not get sort of caught up in sort of this minutia of the actual elements of cost allocation, which we will be talking about going over and examples we’re looking at numbers but going through all that in detail, what we’re gonna be talking about is the greater picture then of motivation.

 

So here’s what that looks like. Then as far as the three major points of how we’re going to kind of flow through today’s session. So the first major point is we’re going to be talking about these drivers of behavior. What are those drivers of behavior in sort of getting into that greater context as I was referencing of what actually motivates us to engage. Second piece then is these actual cost allocation systems. We’re going to go through the examples. We’re go through different methods. We’re going to be looking at numbers, what have you sort of going through how companies do this, how they set it up, actually, what does it look like from a setup and numbers standpoint and like I said, we were going through some examples of that and then the third piece then is then those steps to actually implement this cost allocation. What are those steps?

 

 

The Greater Picture of Motivation

 

Then once you know kind of these nuts and bolts, once you know the greater picture of motivation, how do you then implement this into your organization? A couple of quick administrative points before we get going. The outline for today’s session is in the GoTo webinar interface, so it’s a word document. You can download that, take some notes right along there. There’s also a lot of good examples in there, so if you’re not able to kind of follow along. If I write something on the board and I erase it and you meant to see it, that’s a great place to reference it. That’s the outline for this today’s session. That’s what I follow when we’re going through the session. It’s a great thing to reference. You can get it there. I know sometimes some people with firewalls and things have trouble downloading that. Another place to look at that is in the final email that I just sent you that said we are starting now.

 

There’s a link in there where you can download that as well. And then the other piece that I want to encourage you to do too is this is a live session. The greatest thing and one of the greatest things about this style is that we can work together. So I encourage your comments. I encourage your questions. I do have my big screen right behind the camera here, so when you type something in, I’ll be able to address that as best we can through the out today’s so get, let’s get right down then into this first major point, which I think is really the most interesting. You know it’s the most sort of theoretical, but it’s also the most interesting and also as we’re getting into this topic, the most important because if we look at it as I referenced earlier, we’re going to be talking about this in several different instances.

 

 

If You Are Only Looking At Numbers, You are Missing the Point

 

If you’re looking only at the numbers, then you’re missing the point of this entire training and you’re missing the effectiveness of what a cost allocation system can actually do. Okay, so I want to lay out the context of this sort of idea of motivating behavior. And I want to start with this research study that was done by MIT and what it was called. It was called large stakes and big mistakes. So large stakes and big mistakes was the name of the research study. And here’s what they did is they took a group of students and this study has been replicated many different times. They did in India, they did it at MIT, they did it out in California. They’ve done it many different times. So here’s what they did is they said, okay, we want you to do this set of tasks of what they were looking at and studying was this reward system.

 

So we always think, and sort of the typical thing that we always think because we think that results and rewards are perfectly correlated. So we always think if you give a bigger reward, then you can expect that to drive behavior. That should be a one to one symbiotic relationship. If we give you a bigger reward that’s going to drive your behavior, that should drive greater results. So that’s what they were testing. So they split the kids up into different groups and they asked them to do these tasks. So memorize digits, do word puzzles, shooting a ball through a hoop, very sort of rudimentary tasks, pounding in a nail, things like that. Things that don’t really require a huge amount of thought. It’s just kind of go, go, go, go, go, go, go, go, go, go, go, pound as many nails in as you possibly can.

 

 

The Bigger the Reward, The Greater the Result?

 

And the more nails you pound it in, the bigger the results, the bigger the rewards. Fantastic. And as they look at those results that held true. So that was that sort of one-to-one relationship that we kind of expect and that sort of made sense, make bigger reward, bigger results, fantastic. Then they asked them to do a little bit more difficult, a little more tasks that required a little bit more cognitive skill. So a little bit more thinking involved in regards to these tasks. And here’s what they found is they found actually the exact opposite of what we would expect. So what they found was the bigger the reward, I’ll, maybe I’ll do this in blue so we can differentiate. What they found is the bigger the reward. Then I just grabbed my black, all right, here we go. Bigger. The reward actually the worse the results.

 

So the bigger the reward, the worse the results. And that finding was, as I already mentioned, anytime the skill that they were testing required even a little bit, even just a little bit of cognitive skill, more than just palmed in the hammer and pounding the nail pounded them in as many as you can. Anytime they required a little bit more thinking involved. The reward system that we expect was the exact opposite of what actually happened. So I want you to kind of think on that sort of conclusion for a second because if you can grasp that conclusion of why that’s the case, you can grasp this entire essence of what I talked about in that opening statement there of cost allocation and how to do it most effectively. I’m going to say that again, think about this result, this sort of opposite result of what we would expect.

 

 

The Goal is to Motivate Behavior

 

If you can grasp that concept of why that’s true, which we’re gonna talk about here in a second, you can grasp the entire effectiveness of everything involved in success in setting up a successful cost allocation system. Cause remember as we said, all we’re trying to do here is motivate behavior. We’re trying to have those results be better. And we’re looking at this reward system. This is all we’re doing in a cost allocation system really at its core. So if you have that in your mind, I want to talk about this sort of next sort of description of it or why that’s the case and the little bit more data [00:08:30] that was gathered and studies that I’ve done research that I’ve done that has been done to prove why that’s the case and that a study and that sort of context comes from the book called drive.

 

So it’s a book called drive written by the author Daniel pink. So if you’re interested in sort of this motivation and motivating behavior concept, great book, I highly recommend checking out a lot of really interesting information that he talks about in the, in that drive. Okay, next piece here, and I want to talk about sort of the, the why that’s the case. So why was that opposite results and rewards came out when it causes a little bit of cognitive skill. And if you think about worker’s compensation and work comp management, it requires a little bit of cognitive skill. There’s some complexity, certainly involved. There’s some human emotion involved, there’s a lot of stakeholders involved. So we’re definitely falling into that requires cognitive skill category. So want to bring your attention now here and what this is is this is something that we all probably learned.

 

 

Hierarchy of Motivation at Work

 

I don’t know if you’d go over this in grade school or high school, but this is Maslow’s hierarchy of needs. And so on the bottom you have the physiological needs and then as you move up the pyramid here you’ve got security, you’ve got a belonging, love and belonging, you’ve got the next, you have self esteem, and then you have self actualization. And we’ve probably seen all this before. And then we can kind of understand this general concept of this is your, your basic needs, you need to get those squared away, food, water, shelter, et cetera. That’s at the bottom of that period pyramid. And as you move up this of what actually drives our motivation, what drives our behavior, what drives us as individuals to want to be better and want to do better and wants to pursue more. That’s as you move up this chain, there’s a great article written by Roosevelt moth Moss Kanter in the Harvard business review and here’s what Rosa Beth has to say about motivation and that reward results, rewards dichotomy that we were kind of just talking about.

 

Roosevelt says the key to motivation doesn’t depend on elaborate incentive schemes. What makes a good work environment is getting better at stuff or mastering a task. So the key to motivation doesn’t depend on elaborate incentive schemes. What makes a good work environment is getting better at stuff or mastering a task. As we now start to kind of internalize what that might mean in regards to this rewards and incentive schemes. I want to add one more layer to this to have you start to think about, so Roosevelt came up with what she calls the four M’s, so the four M’s and those four M’s are money. Next up then is membership. So money, membership mastering. And at the top there is meaning.

 

So her four M’s are money, membership, mastery and meaning. And if you lay these over Maslow’s hierarchy of needs, you can see quite a connection in what’s actually driving our behavior. And what I want you to pull out of this is what I talked about in my opening statement, because if you’re missing this point, you’re missing the real value of what a cost allocation system can do for an organization. The point of what she’s talking about and, and, and that sort of root rewards results scheme is they use something very basic such as money. And if you see here, when we, what we all sort of think about  when we think about a rewards or a bonus system is we think we always go here. We always go to money and we stop there. We always go to money. And that’s where we stopped. And so if you look at this, as far as we all need money, everyone needs money.

 

 

Money Is Not the Best Motivator

 

Of course you got to pay the bills, you got to pay your mortgage, you gotta pay every whatever you gotta pay. You gotta pay for school, you got to do this and that. Everybody needs money. That’s at the bottom of this pyramid and everybody has food, shelter, clothing, all that stuff costs money. So you need money in order to do all that. But if you look at actually what is really driving our behaviors, what is really motivating us to pursue more, what it’s really mourning of us to be fully, fully engaged, which is what we’re trying to do here with this cost allocation system, is get people engaged in what the heck it is that we’re doing here and work on management. You got to think further up this chain and as Roosevelt said, it’s not about incentive schemes. What’s comes down here. It’s not about coming up with these elaborate schemes that people can make more money as long as they have enough to buy the stuff that they need.

 

They’re in pretty good shape and that’s only gonna get them so far. As you move up here, particularly as we’re talking about division leaders and we’re talking about these operations managers, you’re talking about a store, a location owner, or you’re talking about someone that’s in a bit of a higher position within an organization. When you’re talking about these cost allocation systems, that’s the level that we’re really talking about here. You’ve got our supervisor training when you’re talking about the supervisors and really getting them involved, and that’s a little bit of a different conversation when you’re talking about our metrics and you’re trying to get the senior managers involved, the upper management at the organization. That’s a little bit of a different conversation to get them fully engaged. When you’re talking about these division leaders, these operational leaders, as you’re thinking about this cost allocation system specifically, you need to start thinking about these higher levels of engagement.

 

These individuals are have some responsibility at the organization and they’re going to be more engaged. The more they can want to get better at it, the more meaning that they can put within the work that they’re doing. Then they’re going to be fully engaged. If you just talk about them, about money that might move the needle just a little bit. But if you want it to go off the charts, you need to start thinking about some of these other items as far as what actually drives behavior. So [00:15:00] if you think about that, results in rewards study from MIT of the large mistakes and big stakes and large mistakes. The reason that that was different is because the rewards and results was different because they were strictly focusing down here. And oftentimes those people that are fully engaged in what they are doing, and you would do it anyway.

 

 

You’re Doing It Because You Want to Get Better

 

You know, think about if you’ve ever picked up a guitar and you’re like, Hey, I just love playing guitar. And every night you’re practicing the songs and you’re singing, you’re having a great time, you’re never going to be on the stage with the rolling stones, but you just really enjoy it. You’re doing it because you want to get better at something or you’re doing it because you’re doing it with your kids and you find a great amount of meaning in that. That’s how you get fully engaged. And so when you think about sort of those levels of engagement, that’s when you can really start to cook with gas in regards to bringing in that element or bringing in some of that element to this cost allocation system that we’re going to be talking about. Getting into kind of some of the nuts and bolts of it.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2019 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.

Shifting or Falling? A Look at Fall Rescue Plans and Safety Culture Shifts

Working at heightsBoth construction and general industry see too many fatal falls. Let’s look at the safety culture shifts that are needed at job sites to eliminate fall deaths.

 

 

Startling Statistics

 

In December last year, the Bureau of Labor Statistics issued some sobering statistics: Fatal falls accounted for 17% of total worker deaths in 2017 (887 deaths), which is the greatest number of fall-related deaths recorded in the 26 years of their census. Moreover, fatal falls are by far the leading cause of death in the construction industry (not including traffic collisions, which are counted in a different category), with nearly 40% of construction worker deaths.

 

 

Limitations of Fall Protection PPE

 

Fall-related deaths are preventable. And having a fall protection rescue plan isn’t just a smart idea- it’s the law.[1] Workers can survive falls from heights by using PPE fall arrest systems (OSHA specifies PPE must be used six feet above a lower level for construction, whether that be above a roof or a hole, and four feet in general industry), but fall protection PPE is not enough. Fall deaths can occur even after PPE does its job.

 

In some cases, workers can successfully self-rescue using their own PPE. In other instances, assisted self-rescue, that is, PPE plus a mechanical rope/hauling system, is possible. Both of these scenarios assume that the worker who fell is conscious and physically capable of aiding themselves. A third scenario envisions a fall where the worker is unconscious or has sustained injuries that would prevent them from aiding themselves; this means a fully assisted rescue is necessary.

 

In the scenario where the fall victim is unconscious, we can immediately see how the risk of death may be imminent. What may not be so obvious is the additional risk of suspension trauma (also called “harness hang syndrome”), which is fast-acting and can be lethal- even for a fall victim who is initially conscious and uninjured. The combination of a person’s suspended weight in a vertical position and limited ability to move (and thus maintain blood circulation) can result in serious injury or death. The Emergency Medicine Journal has noted that in harness design experiments, loss of consciousness occurred in seven to 30 minutes.[2]

 

The American National Standards Institute (ANSI) recommends fall rescue in six minutes or less. Six minutes is not enough time for most local 911 emergency medical services to respond and rescue. Additionally, 911 requires special resources for fall rescue (both in terms of equipment and trained personnel). Employers should not automatically assume that their local EMS has these resources available at the drop of a hat. Fall rescues, then, must be performed by trained onsite personnel who can react more quickly.

 

 

Fall Rescue Plans and Culture Shifts

 

But since job sites are often frequently changing environments, how can employers keep up with the demands of having an effective, up-to-date fall protection rescue plan? And what does this mean for workforces?

 

To begin with, employers must recognize and facilitate the safety culture shifts that are needed for fall protection rescue at their job site. Creating and maintaining an effective fall protection rescue plan causes a safety culture shift for both the employer and the workers. The frequency of these safety culture shifts will be as often as hazards, or potential hazards, change at a job site.

 

The first safety culture shift comes with the move from relying on 911 for a fall rescue plan to embracing an onsite, in-house rescue plan. This shift is foundational, and both employers and workers must embrace it together. If they are not on the same page in terms of safety outlook, little progress will be made.

 

Employers should remember that OSHA cites companies both on the basis of unabated workplace hazards and on the basis of unresolved potential workplace hazards. It’s good for employers to adopt OSHA’s recommendation and exercise their fall rescue plan, that is, have a “trial run” of an actual fall emergency;[3] this exercise is best conducted by outside qualified rescue experts.

 

Another safety culture shift comes with inviting qualified rescue experts to audit and evaluate a location’s existing fall protection rescue plan; these experts can help employers see where gaps and holes (literally and figuratively!) exist. From there, qualified rescue experts can create a site-specific fall rescue plan that incorporates that location’s SOPs and existing emergency action plan.

 

 

Amazing Things Happen When Workers’ Become Rescuers

 

More still, qualified rescue experts train workers to become authorized rescuers. This is also an important safety culture shift. When workers themselves become rescuers at their site, amazing things happen for morale and strength of workforce unity. Incentives and perks invite workers to become part of a rescue team, where they can take greater ownership of their work environment. This personal investment is a positive, active form of engagement for fall rescue plans (whereas waiting for 911 is passive).

 

Safety culture shifts are a reality for all job sites because hazard assessments, required by OSHA, must be comprehensive and continuous.[4] Whenever a new hazard is identified, policies, procedures, and programs must be updated. These updates necessitate shifts in the safety culture of a workplace. Fall protection rescue plans shouldn’t be viewed as an inconvenient “one more thing” to add to the list of updates, but rather should be viewed as part of an integrated whole that will protect workers and save lives.

 

 

 

Author Raymond Loch, Safety Training Services Leader, Medcor, is a certified safety professional with over 32 years of experience as an instructor, operator, and consultant in safety, emergency preparedness, and emergency response for general industry, construction and fire service.   He has developed and implemented training programs for OSHA compliance, technical rescue, and industrial fire suppression. Ray has worked with Fortune 100 firms and with small companies and government entities.  . http://medcor.com.  Contact: raymond.loch@medcor.com

 

Author Jason Funk, Worksite Safety Coordinator, Medcor helps employers reduce the costs of workers’ compensation and general health care by providing injury triage services and operating worksite health and wellness clinics. Medcor’s services are available 24/7 nationwide for worksites of any size in any industry. Headquartered in McHenry, Illinois, the company operates 174 clinics and provides triage services to over 90,000 worksites across all 50 states and US territories. Medcor’s triage methods are covered by U.S. & foreign patents, including U.S. No. 7,668,733; 7,716,070; & 7,720,692; other patents pending. Medcor is privately held. Learn more at www.medcor.com.

 

 

[1] See OSHA standard 1926.502(d)(20)

[2] Caroline Lee and Keith M. Porter, “Suspen­ sion Trauma,” Emergency Medicine Journal 24, no. 4 (2007): 237-238.

[3] OSHA Appendix E to Subpart M, “Non-Mandatory Guidelines for Complying with 1926.502(k),” Sample Fall Protection Plan.

[4] ‘See OSHA standard 1910.132(d)

Just Culture – Making Mistakes In A Learning Culture

medcor learning cultureWe all make mistakes. Human error is a part of life. In many everyday situations, each of us makes errors, and most of the time, these errors bear no significant consequences for our lives or the lives of others. You mistake your brown shoes for the black ones and end up looking mismatched for the rest of the day. Likely, you’ll recover from your inadvertent fashion faux pas. But if you’re a healthcare provider, and you mistake one medication for another, the consequences could be much more serious.

 

Historically, the healthcare field has been marked by a punitive mindset, such that all mistakes, even those that bore no ill consequences, were reprimanded. This punitive attitude, which initially developed from the desire of healthcare organization to safeguard themselves against all potential damages, eventually grew into an atmosphere that deterred even minor mistakes from being reported out of fear of punishment.  This kind of atmosphere stifles constructive learning and tends to make providers feel unsupported by the healthcare systems in which then work.

 

 

Mistakes Can Grow Knowledge In Learning Culture

 

A healthcare learning culture is the opposite. A healthcare learning culture takes everyday occurrences, even mistakes, and uses them so that both organizations and providers can grow in knowledge, performance, and competence.  A learning culture engenders a just culture, and a just culture fortifies a learning culture.  Just culture seeks to create and reinforce a learning culture by providing a framework for managing mistakes and actions.  Just culture acknowledges that all people, including system designers, make mistakes.

 

So, for the healthcare provider who mistook one medication for another, a just culture promotes an environment where the provider who made the error should not fear to come forward.  A just culture investigates to see if the error was part of a system failure such that any provider in a similar situation would have made the same mistake.

 

A just culture, then, differentiates among unintentional human errors, system errors, mistakes made because of poor decision making, mistakes made because of disregard for procedures, and deliberate actions intended to be harmful. This differentiation helps determine the level of accountability and allows for a response on the part of the organization that is fitting and fair for the mistake maker.

 

 

Shift Focus to Management of Behavioral Choices

 

Just culture is founded in the belief that all stakeholders -from healthcare providers to business leaders- are responsible for the quality and safety of services. It demands that providers adhere thoughtfully and safely to clinical standards; furthermore, it expects that even minor errors are reported so that broader learning needs and system failures can be identified. In a just culture, errors become opportunities for the organization and all its providers, not just those who make mistakes, to learn and improve, which greatly reduces the chance that an error will be repeated.

 

Just culture shifts the focus of quality improvement from punishment and faultfinding to the management of behavioral choices in the context of the systems in which providers work.  Medcor has found that embracing a learning culture and a just culture increases providers job satisfaction and adds significant value to our quality improvement processes.  Just culture treats our advocates with fairness and respect and makes our leadership consider how we can improve our systems to promote the best outcomes for our employees, patients, and clients.

 

 

 

Author Dr. Sharon Moise, Chief Medical Officer, Medcor. Dr. Moise joined Medcor in 2015. Sharon is board-certified in emergency medicine and has extensive experience in occupational health, urgent care, clinical education, and clinical quality. Sharon provides broad clinical oversight for Medcor’s Worksite Clinics, Injury Triage Service, and supports all Medcor’s lines of business. In addition to involvement in many of Medcor’s projects and initiatives, Sharon is passionate about clinical quality and chairs Medcor’s Clinical Quality committee.

 

5 Ways to Ensure a Workers’ Comp Claim Investigation Is Off to a Good Start

Effective Workers’ Comp Claim Investigation TechniquesIf you’ve ever been intrigued by police investigations in TV shows or detective novels, you might want to use that enthusiasm to investigate workplace injuries. Approaching a workers’ comp claim investigation claim in ‘detective’ mode will lead to better results; meaning, reduced costs and superior outcomes for injured workers.

 

 

The Workers’ Comp Claim Investigation

 

The ultimate goal of managing a workers’ compensation claim is to help the injured worker recover and get back to work as soon as possible, without the payer spending unnecessary costs. But often there are many gray areas to a claim. Determining exactly what happened and, therefore, what should be covered by workers’ compensation can be difficult.

 

Investigating a claim should uncover as many details as possible. Employers/payers can get all the information they need by implementing a precise system that kicks in immediately after an injury occurs. At the very least it should include:

 

 

  1. The Basics

 

The workers’ comp claim investigation process should begin with statements from the employee, employer, and any witnesses. There should be separate forms for each which should have open-ended questions, rather than boxes to check.

 

Additionally, there should be a separate attachment for details on each form. A form from a witness that says, ‘Joe slipped and hurt his back,’ really doesn’t reveal anything and won’t help determine whether and to what extent the claim is compensable.

 

The essential pieces of information that should be included about the injured worker and the incident include:

 

  • Date of birth
  • Name of the employee
  • Social security number
  • Average weekly wage
  • Date of injury
  • Date of hire

 

Too often such information is either not included or is inaccurate.

 

Another ‘basic’ procedure that makes a tremendous difference in a claim is the way the injured worker is treated. Anyone involved with managing the claim at any point should treat the person as if it is a friend or spouse and approach the employee in the same way as they would want that person treated.

 

 

  1. Preserve the Scene

 

Preserving the scene is where reading and watching cases in which detectives try to understand what has happened comes into play. Just as a detective on a case is trying to get to the truth, so too is the employer/payer.

 

Once an accident occurs, the area should be roped off to whatever extent is possible. If it is an area in which many people are working and is crucial to business operations, this might take some creativity. But the idea is to ‘protect’ any evidence that could indicate what and how the injury occurred.

 

Looking at the scene might reveal a cause. For example, water on the floor could indicate the worker slipped and fell. Or, there might be evidence that a piece of equipment was faulty, which could result in subrogation from a third party.

 

A thorough examination of the accident scene may help reveal the mechanism and extent of an injury. That could be advantageous if, say several months later the injured worker claims additional injury from the initial accident.

 

 

  1. Talk to Others

 

Witnesses play an important role in a workers’ comp claim investigation. While the injured worker experienced the accident, he may not know exactly how it happened. Someone who saw it might be able to fill in some of the blanks; for example, that a heavy box on an upper shelf fell, triggering the worker’s fall.

 

Also, identifying all witnesses as soon as an injury occurs prevents ‘new’ witnesses the injured worker may try to bring in later on.

 

 

  1. Record

 

While witness accounts of a situation are important, they may not always be reliable. Sometimes what people think they saw or remember may vary greatly from one witness to another. That’s why it’s also important to record the scene in as many ways as possible.

 

Just as a detective investigating a crime scene might seek out video footage of the area, getting recorded descriptions of the scene can help determine how the injury occurred and can be extremely valuable later on, if the case is litigated.

 

Video cameras may be present in or near the work area. There may also be video cameras around the building, or even on nearby buildings. The footage may reveal more information about the incident.

 

If no videos were present in or near the accident scene when it happened, taking a video of the accident area via a smartphone can also help provide information about what may have contributed to the injury. The person filming should also include narration to describe various objects, direction, location, etc.

 

Photos can also provide details. These can be taken from a distance as well as close up, to get different perspectives and angles.

 

 

  1. Document, Document, Document.

 

Every step taken during the workers’ comp claim investigation should be written down; from interviews with witnesses and others, to bits of information observed at the scene, and any other potentially relevant information.

 

Documentation pertaining to maintenance and training schedules and previous corrective actions involving the injured worker should also be included in the investigation materials. Information about prior medical treatment to the injured body part can also be relevant and should be included in the documentation

 

 

Conclusion

 

Conducting a thorough workers’ comp claim investigation provides the best opportunity to ensure the payer covers all of what should be funded and nothing more. It also signals the entire workforce that this is a normal process; meaning a worker will think twice before trying to fake an injury.

 

 

 

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

 

©2019 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.

Overcoming Telemed Challenges for Occupational Health

telemedicine workers compTelemedicine has great value when used appropriately, and its promises are attractive: immediate access and convenience (anywhere, anytime!), early intervention, lower cost than other models, and quality services.

 

However, telemedicine has potential pitfalls. At Medcor, we’ve devoted considerable time and talent to assessing these pitfalls and navigating our way to a telemed solution for occupational health that works.

 

 

Reality of Telemedicine Today

 

An honest look at the telemedicine landscape today shows us that telemedicine adoption in occupational health is slower than the hype may lead us to believe. For example, contrary to some expectations, many tech-savvy Millennials prefer an in-person provider visit rather than a virtual one for their healthcare.

 

Also, just like other medical delivery models, telemedicine can be subject to misuse as well as inconsistent results and service levels. There isn’t yet enough published data to quantify results and quality. Overprescribing, unnecessary treatments, delayed return to work, conflict around OSHA recordables, causation, denied claims, creeping catastrophic claims, opioid addiction, and litigation are problems that do not go away just because the provider is accessed by video instead of in person!

 

 

Challenges for Occupational Health and Telemedicine

 

Recognizing the challenges is key to overcoming them.

 

Technology. Using telemedicine to treat work-related injuries can present layers of technological complications at the workplace. Internet access is needed, which means that appropriate bandwidth must be available, firewalls have been anticipated and won’t be a hindrance, and patients can access the facility’s wifi. Hardware for the virtual visit is also a consideration: Can patients use their own personal smartphones, or do they need access to an employer desk­ top? Tech support is another challenge: Who will help patients troubleshoot any difficulties?

 

In terms of technology, there are also challenges of system infrastructure: Do virtual visits need to be scheduled? Does the system rely on callbacks? How are medical records, reports, billing, data security, and patient privacy handled?

 

Scope. First aid cases don’t need a provider, either in person or through tele­ medicine. Life threats and emergencies require in-person care without delay. Furthermore, telemedicine cannot meet clinical needs when hands-on assessments and treatments are required, such as imaging, labs, palpations, sutures, splints, irrigation of eyes, etc.

 

Yet many cases are appropriate for telemedicine – identifying which of these cases are eligible for care through telemedicine is another challenge.

 

Coverage. To offer promised convenience and access, a telemedicine system must have many providers avail­ able to respond to calls. In small-scale systems, a few in-house or select providers handle the coverage – but they may be spread thin and have other duties and patients. Wait times increase and service is limited after hours (e.g., nights and weekends). When alternate coverage is used, results are inconsistent. In large-scale programs, multiple providers are needed across multiple states. Multi-licensed providers are the go-to solution, but when one of those providers is in a session with a patient (or not on duty), patients in multiple states are affected.

 

Coverage challenges also include having providers who understand the ins and outs of occupational health and work-related injuries as well as having providers who are skilled at conducting virtual patient encounters.

 

User Experience. Users are affected by the challenge of technology, scope, and coverage. They also often have unrealistic expectations. User proficiencies differ, too, as do their education level, technical experience, age, personality, and willingness to try. Moreover, people who are using telemedicine are patients – they are either sick or injured. These are moments when people are not at their best. The stress they may feel from their health concern can influence their experience of telemedicine. The most common technical support issue in telemedicine is caused by people who, in the stress of the moment, have forgotten the password on their smart­ phones and therefore can’t access the telemedicine system.

 

User experience can also be influenced by how users feel throughout the process. Patients can feel alone or even overwhelmed at different stages. The level of assistance users need varies just as their proficiencies and expectations vary.

 

 

Solutions Moving Forward

 

For telemedicine to deliver beneficial outcomes for employers and patients, we’ve found an accurate assessment needs to be made first regarding the needs of the organization and its potential telemedicine users. This enables selecting the right system and setting expectations realistically and honestly, knowing that telemedicine is not a magic solution for all work-related injuries. Telemedicine will yield the best outcomes only when its use is clinically appropriate for the health concern in question. The use of telemedicine, therefore, needs to include a system to determine appropriateness on a case­ by-case basis.

 

We’re working to ensure our telemedicine adopts the best practices that have been established in our other lines of business, namely evidence-based medicine, and attentive customer service so that telemedicine is an all-around successful endeavor. By emphasizing clinical outcomes and user experience telemedicine challenges can be surmounted.

 

 

 

Curtis Smith MedcorAuthor Curtis H. Smith, Executive Vice President, joined Medcor in 1995. He helped develop Medcor’s injury triage system and holds several US and foreign patents on injury assessments methods.  Smith has taught and practiced in EMS as paramedic and dispatcher.  He currently supports Medcor’s business development and marketing teams. http://medcor.com. Contact: csmith@medcor.com

6 Things Employers Can Do to Reduce Lag Time

workers comp lag timeLag time is the enemy of a successful workers’ comp claim outcome. When there is an injury at the workplace, you need to know what to do.  A lot will depend on the actual type of injury.  If the injury is severe and requires immediate surgery and in-patient hospital care, you are probably going to do all possible to get the claim to the carrier/TPA as fast as possible on the day of the injury.

 

On the other hand, if a guy comes in the office and says he hurt his arm but “it is no big deal,” chances are you are going to forget about it, not make a note about it. And when he comes back in 6 months and says surgery is needed tomorrow and will be off of work for 6 months, I do not think you are going to exactly recall the brief conversation with him 6 months prior.

 

 

Lag Time Is The Enemy 

 

Lag time is also the enemy to every claims adjuster.  It can affect every aspect of the claim, most importantly the compensability.  For every day that goes by after someone is hurt without reporting it to the employer, or even worse he reported an injury to the employer who did not report it to the carrier/TPA, lag time is involved.  Lag time is the time between date of injury and the date of reporting to the employer and from the employer to the carrier. Here are some tips to improve lag time. ASK FOR A LAG TIME REPORT FROM YOUR CARRIER. They should be giving them to you periodically, but if not, ask for it.

  1. Have a system in place

 

Regardless of the size of the work population, you need to have a system in place.  The employer is going to be faced with several different types of workers comp claims: report only, medical only, lost time, advanced lost time, and severe.  A claim that is a “report only” or “incident only” should not carry the same urgency as a severe injury claim.

 

 

Every person in risk management will have a certain way of keeping records and reporting claims to the carrier/TPA.  Organization is key.  The system has to work, or else a claim will fall through the cracks. Get a separate file cabinet, dedicate a certain area of the office to claim paperwork, and keep separate email folders for claims. Whatever you do to create a working system stick with it.  Think about prioritizing each type of claim and how each issue has to be addressed.  Take it one step at a time and walk through what the responsibilities are and where you need to focus.

 

 

 

  1. Get claims called in to the carrier/TPA

 

A rule should be made that any claim with medical treatment needs to have the State Injury report completed and sent to the carrier/TPA within 1-2 business days.  Not only does this prevent lag time from happening, but it will give the adjuster a head start on the claim from early in the injury.  This can apply to medical-only claims and non-severe lost time claims.  Plenty of claims start off innocently enough as a simple medical only claim.  But then, 3 months later after conservative treatment fails, the injured worker is heading for surgery, which is not a guarantee that the employee will be 100% in the near future. The earlier the adjuster is involved in the claim, the better chances you have of it not spiraling out of control.  Plus after it is reported and called in to the carrier, that is one less thing to worry about.

  1. Call claims in with correct and complete information

 

Adjusters dislike it when they receive an injury report and most of the information is missing.  Or the injury description reads “back strain.” Maybe the place where the employee was treated is not known, or if the injured worker even went for treatment at all. Maybe you view date of birth, social security number, job title, and complete address, as trivial information.  That is okay, but the adjuster needs that information, and it needs to be accurate.  It cannot take long to pull a person’s personal information up on the computer, or email the Human Resources person to seek help with that portion of the claim.  Any way that it can get done, do it and then get the claim sent.  Incorrect or incomplete information produces lag time from when the adjuster receives the injury report to when the TPA makes a first payment on a claim.  Or even when the adjuster can make contact with the worker.  If you forgot the claimant’s phone number, and did not have a complete address, how can the adjuster contact the injured worker?

  1. Include the hourly wage and the gross total from a year prior to the injury date to reduce lag time 

 

If this claim will involve wage loss, the adjuster will need the wage records.  Be sure to list the hourly rate for the injured worker, as well as the gross pay from one year backwards from the injury date. This will save the adjuster time, cutting down on the lag time between injury date and date of first payment.  Most states will penalize the carrier for a delay in payment after an injury occurs if there is lost time. Due to this statute, the adjuster will be requesting wage records. So why not be ahead of the game and include the records with the claim forms that are sent?  The adjuster will appreciate it. And of course it is one less thing you have to do.

  1. Keep eyes and ears open on your work floor

 

As a risk manager or HR person, chances are you are removed from the work floor where a lot of injuries occur.  But, the adjuster will be calling you to talk about the injury details.  So you have to know about the machines, know the people running them, and also know who the employee’s managers are and how to talk shop with them.  Your employees should know that the first contact person after an injury is their supervisor, and then that supervisor should be coming right to you to fill out the injury paperwork after they talked with the employee and sent them off for medical care.  Make sure those supervisors know the importance of coming to you to report a claim. If the worker does not tell the employer about the injury, then you are not going to have a report to send.

 

 

  1. Be involved with the process

 

We have said it time and time again, the employer must be involved.  Not only at the initial stages as indicated above, but throughout the whole process.  To have an effective workers comp program, there must be proper reporting, proper light duty management, and proper monitoring on all aspects of the claim.  You need to communicate with the carrier/TPA for claims reviews.  Get up to speed with what is going on, and what the current lag times are.  Set goals to reduce lag time from late reporting and keep track of the numbers.  Fix your system where it needs to be fixed.  There is no perfect blueprint that will work.  A program as variable as this also needs to be flexible.  Make changes as needed and track to see if they improve numbers or worsen them, and then make further changes.  Create the program, and then be involved in it.

 

 

Summary

 

Carrier/TPAs despise lag time from late claim reporting. They keep track of it for a reason, because the greater the lag time and the later the adjuster is involved, the more the exposure risk increases.  Take some of the key points listed above and see if they can be implemented into your risk management system.  Keep track of the numbers.  If you discover that you have a lag time problem, then you have the room and the resources to save a lot of claim expense money that is spent purely on late reporting.  Like it is said, “The numbers don’t lie.”  You will be amazed at how much money can be saved simply by getting that correct claim sent in to the carrier for immediate handling.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

 

©2019 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.

Fix and Flip Your Work Comp Management Program

Fix and Flip Your Work Comp Management ProgramIn the popular TV show Property Ladder, real estate junkies seek to find homes in need of repair, fix them and then flip it for a profit.  Like the show, members of the claims management team should be on the constant look-out for parts of their program that need to be improved to increase client satisfaction and ensure it is being run ethically and honestly for the ultimate stakeholder – the employee!  This takes a lot of hard work, but the ultimate result can improve the satisfaction of clients and improve the experience for persons who have sustained a work injury.

 

 

Finding a Home to Renovate – Effective Injury Response

 

Like a broken home, the employee who suffers a work injury is in need of help and tender loving care. A fast and effective response to every work injury, no matter how minor, can pay dividends in the future.

 

All workplaces need to have a plan in place to deal with work injuries.  This includes the accessibility of first aid kits and other medical equipment.  Factors to consider include having a plan for all types of injuries and emergencies, making employees aware of the plan and proper implementation.  Do not forget that even if your company is not required to have one, the inclusion of a safety chair and emergency response team can assist in a program renovation.  This team can be used for the following tasks:

 

  • Maintenance and use of various fire extinguishers;

 

  • Knowledge and ability to perform cardiopulmonary resuscitation (CPR);

 

  • Understanding on how to contain and dispose of bloodborne pathogens;

 

  • Proper chemical handling, storage and containment procedures; and

 

  • Dealing with and responding to incidents involving hazardous materials and workplace fumes.

 

Other items to consider should include teaching employees basic first aid and other features such as lifesaving equipment that can include a portable defibrillator.

 

 

Fixing Up the Property – Workplace Ergonomics and Safety

 

A great way to ensure a safe workplace should include a review of workplace ergonomics.  This can include features such as assessing risks in the workplace on an ongoing basis, correcting the problems and encourage physical health.  Suggestions can include:

 

  • Onsight or easily accessible health clinics that include vaccinations, immunizations, and wellness information;

 

  • Encouragement to use a gym or health club – be sure to include discounts on medical insurance for frequent users. Onsite stretching activities, yoga, and mindfulness can also promote a safe work environment; and

 

  • Training on preventing and dealing with workplace violence and “active shooter” situations.

 

 

Flippin’ the House for Profit – Ongoing Employee Satisfaction

 

Like a completely remodeled home, a workers’ compensation program that is in pristine shape will add value and create its own demand.  This will improve company morale and improve return to work rates following an injury.  Interested stakeholders should look for opportunities to add value through a workers’ compensation program’s “curb appeal.”  This can be accomplished by promoting medical and behavioral health consultations to assist employees manage their lives in and outside the workplace – and enhance one’s work/life balance.

 

Addressing the needs of employees mental health needs is important in today’s fast-paced society.  This is especially the case when employees work during a clinic’s hours of operation.  By making these services available to employees on-site or at a convenient location, people are more willing to receive the care they may need.

 

Addressing the mental health needs of all employees are important both before and after a work injury.  Studies suggest that people who receive mental health counseling following a work injury have a lower chance of re-injury or malingering.  This translates into lower workers’ compensation insurance premiums.

 

 

Conclusions

 

Members of the claims management team should seek to climb the property ladder to add value and reduce costs to a workers’ compensation program.  This includes simple steps that can be taken to renovate a program, make it better and increase its value.  When a program is strong, it also adds value to the clients it serves.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

 

©2018 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.

Orchestrate A Culture of Quickly Reporting Workplace Injuries

reporting workplace injuryAn important role of the claims management team is to coordinate with employers and defense interests to make sure quickly reporting workplace injuries is a top priority of your organization.  It is easier for claims to be evaluated and decisions regarding primary liability to be made in an effective and efficient manner when injuries are quickly reported.  There are many steps claims management teams can make to develop important work injury compliance steps, which includes the use of evolving technology.

 

 

Emphasis the Importance of Reporting Workplace Injuries

 

There are several steps that employers can make to ensure workers’ compensation claims are reported in a timely manner.  This starts with developing a culture of understanding on the part of the employees.  This goes beyond making sure the proper posters are displayed in the workplace:

 

 

  • Provide documentation on how work injuries should be reported and the information needed to make a report of injury; and

 

  • Ensure that the employer has a contact person to make sure the First Report of Injury is filed timely with the workers’ compensation insurer. In some instances, employers and their staff are unsure how the process generally works.  Making sure these persons understand the process is important.

 

All workers’ compensation insurance carriers and third-party administrators can provide information to their insured on these processes.

 

 

Ensure of Culture of Compliance from the Top

 

The best workers’ compensation programs at the employer level have a culture of compliance and consistency.  This means that senior-level leaders within an employer need to emphasize safety and ensure that reports are being dealt with ethically and honestly.  All employees need to be treated with respect and dignity.  Other steps can include:

 

  • Preparation, issuance, and posting of quarterly safety reports. State industrial commissions typically require the posting of job site injury information.  This should be viewed as the baseline requirements – do not be afraid to go beyond those requirements; and

 

  • Highlight improvements to safety within the workplace. This ensures that all employees understand the important role they play in the process.

 

 

Eliminate ‘Accident-Free’ Incentives

 

Employers often attempt to drive a culture of safety through creative programs that provide cash incentives for ‘accident-free’ days. These types of programs are a mistake because studies demonstrate they have an adverse effect where employees feel they cannot report a workplace injury.  In reconsidering these original programs, employers should focus more on a metric that encourages the timely report of work injuries.

 

 

Provide Effect Reporting Tools

 

Technology has created many opportunities for employers to ensure all workers’ compensation claims are reported by employees in a timely manner.  It also allows employees to provide greater detail, including documentary evidence that allows for quicker and more accurate decisions concerning primary liability.

 

One example of matching technology with efficient and effective work injury reporting is app-based technology.  The development of this technology is cheap, and it is easy to implement.  With a vast majority of employees having smartphones, it is something nearly anyone can upload and use.  Features that can be used on these apps include:

 

 

  • Easy communication with the injured worker and the claims management staff. Communications include information regarding primary liability determinations, request for documents and prior authorization requests; and

 

  • Payment status and direct deposit of indemnity benefits. This allows for injured workers to receive payments immediately, and avoids the uncertainties of mailing a check.

 

 

Conclusions

 

The workers’ compensation process starts with the reporting of workplace injuries. This is a process that causes confusion, delay, and frustration in the process.  Proactive members of the claims management team can work with their insured to improve the reporting process through reforms to internal processes.  It can also include the development and implementation of app-based technology to make the process efficient and user-friendly for all employees.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

 

©2018 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.

Health Navigation – Finding a Path to Better Health and Lower Costs

Health NavigationIf you or a loved one has ever been hurt or sick, you know well that healthcare and insurance systems are complicated; the challenges can seem endless and overwhelming.

 

Health navigation helps individuals and companies through these challenges. It includes clinical services, of course, but it’s much more than that. Knowing what services are needed, where to get them, and in what timeframe are critical elements to getting on the right path to recovery.

 

 

Fundamental Premise of Health Navigation

 

People can’t always tell at the onset how serious an injury or illness is. So, sometimes they go to an ER when they could have gone to a doctor’s office, or they go to a doctor’s office when they could have cared for themselves. Other times people underestimate or don’t recognize symptoms, and look back wishing they had realized how serious something really was – this regret can make them more likely to overreact the next time they are confronted with a health concern.

 

The fundamental premise of health navigation is getting people the care they need when and where they need it, which removes burdensome guesswork. A best-in-class health navigation provider should:

 

  • Have clinicians which navigate people to the right level of care at the right time, in the right place.
  • Have systems to help people determine the severity of each case and the best course of action for treatment.
  • Provide the needed care or guide patients in self-care whenever possible.
  • Make a referral when further care is required

 

People know overtreatments and over prescribing exist, but they don’t know how to tell when it is happening to them. What’s the best practice?

 

 

Evidence-Based Medicine

 

Evidence-based medicine is the best practice; it represents the science of proven medical effectiveness. Protocols, algorithms, and guidelines need to be built on evidence-based medicine. As a result, unnecessary treatments and prescriptions are avoided while required treatments are obtained right away.

 

People want to believe that all providers follow best practices, but still unnecessary care persists, including surgeries, prescriptions, therapy, and other interventions that contribute to high costs for everyone.

 

The healthcare and insurance systems have evolved to include many conflicts of interest, financial biases, and administrative costs. Effective navigation requires guiding patients to the right destination rather than following the momentum and pressures of a complex claims-driven system. Working with a provider who operates transparently and without conflicts of interest offers the key difference of advocating for patients rather than treating them.

 

 

Access to Care

 

It can take weeks to get an appointment. Lack of access to care drives frustration and drives people to go to more expensive options such as urgent care centers and ERs.

 

Clinics can and should be convenient and accessible, mobile units should go to patients, virtual health services should be available on-demand 24/7, and a telephonic triage service should be pre­loaded with clinics that accept walk-ins and new patients. In addition, staff should know the in-network providers in their patient’s communities, establish relationships, and have the tools necessary to gain appointments.

 

Serious illness and injury involves a lot of emotion, which affects people’s decision making. It feels awkward to tell a provider you want a second opinion or other options. It is not easy to know if a provider is in-network or out-of-network, and it is near impossible to find out in advance what services cost.

 

 

Decision Support

 

Navigation requires decision support – not just information, but recommendations. People need reassuring, they want to know the risks, and they appreciate assistance.

 

Health navigation gets people through the system to achieve better clinical outcomes and lower costs. That’s good for individuals, and it’s also good for their employers, who bear much of the cost of caring for their employees and their families, and who want their employees to be healthy and productive.

 

 

Author Curtis H. Smith, Executive Vice President, joined Medcor in 1995. He helped develop Medcor’s injury triage system and holds several US and foreign patents on injury assessments methods.  Smith has taught and practiced in EMS as paramedic and dispatcher.  He currently supports Medcor’s business development and marketing teams. http://medcor.com. Contact: csmith@medcor.com

 

 

 

 

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