Are Diagnostic Testing And Physical Therapy Overused In Workers Comp?

April 10, 2013 by Leave a Comment
If you are handling a pesky claim that just will not go away, or the objective signs are just not lining up, chances are a key diagnostic test is what you need to tie it all together. A well done MRI or EMG could be just what the doctor ordered (literally). However you must keep in mind that not all diagnostic testing is warranted. Below we point out some surprising statistics, and ways to prevent you from authorizing testing that may not be of any help:
 
  1. The right EMG test needs to be done at the right time
 
This is especially true for insurance claims, whether it is work comp or an auto accident injury. And it is especially true when dealing with Medicare, although it’s not necessarily applicable to our thoughts here. Doctors and their businesses sometimes are under the impression that once an insurance claim arrives at the waiting room looking for treatment they have free reign to treat at will. This is a big no-no, since if you get the wrong test done in the wrong location, what good does it do? Sure, numbness in the hands can mean impingement at the wrists or elbows, but what about the neck? Cervical radiculopathy can be the culprit underneath what seems like simple and basic carpal tunnel syndrome. 
 
So if a doctor performs an EMG at the wrist, which is negative, then they will be doing another test at the elbow, and possibly one at the shoulder, and one at the neck. When it is all said and done, they have performed 4 EMGs, when 1 would have sufficed if done properly at the neck level. 
 
Adjusters need to think outside the box a little, and look at the other symptoms as well as the medical history. Adjusters can also utilize their Utilization Review department, a nurse case manager, or a Record review from another physician to see what type of test should be done. All of these steps need to be taken in order to avoid medical cost leakage due to a hunch from the treating physician.
 
 
  1. Does an MRI really need to be performed?
 
The best way to see why a back injury will not subside is to obtain an MRI test. MRIs are probably the most common test performed, since a back injury is one of the most common injuries in the occupational world. However, if a back injury is not getting better after 3 weeks, obtaining an MRI may be jumping the gun.  Other symptoms need to be present, such as leg weakness, numbness, radicular pain, etc. If the claimant complains of just pain, should that warrant obtaining an MRI? Pain is a subjective complaint, not necessarily something that warrants expensive testing, other than possibly a series of routine X-rays.
 
It is my opinion that doctors sometimes want to pacify the patient by doing some sort of test. Plus, there are patients out there that want something objective and/or invasive to be done in order to feel “better.” So, to make lives easier on themselves, doctors will just order the MRI. When it fails to show anything remarkable, they move on to the next step in the course of treatment that they would have moved to anyway.
 
This is not to say that every spine MRI is unnecessary. If months have passed and the claimant is still in considerable pain with functionality issues, then yes it is time for additional testing to see what is going on. But not within the first few weeks after an injury occurs. Bearing in mind again that the other obvious symptoms are not there, those being the leg pain, foot drop, muscle atrophy, etc.
 
 
  1. Does the injured worker need months of physical therapy?
 
By default, there are many clinics that will see an injured worker, then dump them into their physical therapy program to help rehab their injury. The adjuster must stay on their toes when this situation happens. Oftentimes the patient will get prescribed a course of physical therapy after an injury, and this is the correct course of treatment for soft tissue injuries. But, to take a back strain injury and dump a person into a 6 week therapy program, then have the doctor reevaluate them 6 weeks later is not acceptable. The physician should be involved in the program, seeing the patient at least on a weekly basis so they can modify the frequency and duration of the program if needed. 
 
Dumping a patient in a long term therapy program happens more often than you would think, especially when the program is run inside of the treating doctor’s office. This means the doctor is getting two sources of income coming in: one from treating the patient, and one from the therapy program. 
 
Even if an injured party needs surgery, post-op patients need to be carefully monitored during recovery. Again, the doctor needs to be involved in the program, and watching the hopeful steady progress back to full duty. It is easy for these docs to forget about the patient, and just let the 6-8 week therapy run its course. What if the patient is not attending all of their therapy sessions? What if the patient tells their adjuster that therapy is causing an increase in pain? What if the patient is not being compliant with their home exercise and stretching program? All of these questions need to be addressed, and they need to be addressed right away, not 8 weeks later after the program has completed.  
 
 
  1. Some statistics to keep in mind (stats pulled from GAO Analysis of Medicare Part B Claims data; Boden et al. JBJS, 1990; Friedly J, Chan L, Deyo R; Spine, 2007)
 
  • Billing from 2000-2006 increased from $6.89 billion to $14.11 billion for lumbar imaging.
  • MRI research with patients that had “no back pain” showed that of those under age 60: 36% showed herniated discs, 21% had spinal stenosis, 79% had a bulging disc, and 93% had a degenerated disc.
  • The Medicare population increased 12% from 1994-2001, but billing for services increased 637%. 
 
 
Summary
 
Diagnostic testing and physical therapy can be two keys to helping discover what injury a patient has, and how they can get better. For the most part, these tests and therapy programs are done properly and when needed, but not all of the time. Adjusters have to use their network of professionals to help gauge what is needed and when. Nurses, Utilization Review departments, IME physicians, and Peer Record Reviews all can be implemented should testing or therapy not seem like the right course of action. The adjuster has to take the time to get involved in the claim, question why these things are being recommended, and keep the patient on the track to recovery. Just because a doctor recommends a certain action doesn’t make it in the best interest of the patient, or the carrier/TPA as a whole.  
 
 
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com.
 
©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

Filed Under: Medical Issues Tagged With: ,

6 Types of Diagnostic Testing for Back Injuries

August 17, 2011 by Leave a Comment
The most common and often the most expensive workers compensation claim is the back injury claim. Back injury claims often are associated with lifting heavier objects, twisting, bending, or falling. When the injured employee goes to the doctor, the doctor will normally treat the injury conservatively with rest and medication to see if the back injury is a sprain or strain of the musculoskeletal system.
 
 
If the injury does not respond to rest, the doctor will consider various types of diagnostic testing. There are several types of diagnostic testing the doctor can consider and request to determine the nature and extent of the back injury. The six most common diagnostic test are x-rays, MRIs, cat scans, EMGs,  myelograms, and discograms.(WCxKit)
 
 
 1.       X-rays
The most well known diagnostic test is the x-ray. It is often the first diagnostic test when the employee has fallen or suffered some other type of impact. The purpose of the x-ray is well known – to see if the injured employee has fractured any bones. The x-ray also allows the doctor to examine the vertebrae for other causes of back pain including osteoarthritis and for deformities like scoliosis.
 
 
The days of x-rays produced on film are no more. Today, x-ray images created by radiation are reproduced in a computer. There is very little risk to the employee in having an x-ray, unless the employee is pregnant, as radiation could harm a baby in utero. The results of x-rays are often available immediately, but there is usually a wait for the doctor to review results.
 
 
2.      MRIs
Magnetic Resonance Imaging (MRI) is a way for the doctor to examine soft tissues in an employee's body. The MRI machine uses radio waves, a large magnet and a computer to create images of soft tissue. In some cases, it is necessary for a dye to be inserted via a intravenous line (IV) into a vein to make it easier to detect inflammation or abnormality. Each MRI picture shows a view of the area being examined. Each picture is about a quarter inch deeper (or shallower) than the prior picture, allowing the doctor to get a detailed view of the area being examined. With a MRI of the spine, it shows areas where other structures may be impinging on nerve root areas. An MRI has no side effects, but occasionally there is a reaction to the dye.
 
 
The MRI machine is a circular tube with a table in the middle that the injured employee lays on — though response to claustrophobic patients has encouraged the creation of standing MRI machines. Typically, the MRI technician moves the table back and forth in and out of the tube while each MRI scan is taken. If dye is needed, it is injected about halfway through scanning. The employee will be told to hold their breath while each picture is taken. The MRI pictures are recorded on film which the MRI technician develops. It takes a doctor trained in reading the images to examine and interpret the images. Many physicians consider and MRI to be the best use as a pre-surgical tool.
 
 
3.      CT Scans
A Computed Tomography scan, referred to as a CT scan, or a Computerized Axial Tomography Scan, or CAT scan, is another way of taking pictures of the body using a specialized x-ray machine. The machine circles the employee's body and scans the area from every angle. The machine measures how x-ray beams change as they pass through the body. A computer generates a series of black and white pictures each showing a slightly different cross section.
 
 
If the x-rays and the MRI have not identified the cause of the employee's back pain, the doctor may request a CAT scan. The CAT scan is not often used for back injuries. When the treating doctor asks for a CAT scan instead of an MRI, the doctor is looking for some other reason the employee is experiencing back pain including problems with the kidneys and pancreas.
 
 
A CAT scan is done much the way a MRI is done. The employee lies on a table that passes in and out of the tube-shaped machine. The CAT scan is done with dye to outline the soft tissues and blood vessels. There is a small amount of risk from the dye. Some people have an allergic reaction to it. Also, since the CAT is a specialized x-ray machine, it should not be used on pregnant employees.
 
 
4.      EMG
An electromyography (EMG) is used to test the employee's nerve and muscle electrical activity. EMGs are usually done with a nerve conduction study (NCS). If the treating doctor suspects the back injury and resulting pain is to muscles or a pinched nerve, an EMG may be requested. In the EMG test, the employee has fine needles inserted into the muscles. Each needle is attached to a wire that sends signals to the EMG machine. The electrical patterns inside the muscles can be analyzed to determine which muscle is damaged. The EMG portion checks on muscle responses and the NCS checks nerve velocities. Together both are interpreted to help diagnose many problems from nerve
impingement to neuropthies and more.
 
EMG needles are too small to cause bleeding but most employees find the test uncomfortable. The electrical shocks that occur in the test are too mild to cause any permanent damage.
 
 
5.      Myelogram
A myelegram is an x-ray combined with a dye that is injected directly into the spinal canal. The myelogram is used to identify the point(s) in the employee's back where vertebrae are pinching the spinal cord. It is often used prior to surgery to confirm the MRI results. The myelogram is also used to diagnosis leg pain problems occurring in conjunction with back injury.
 
 
As with other dyes used in testing, some people have an allergic reaction. Also some people experience headaches from the dye, and pregnant women should not have the test done.(WCxKit)
 
6.  Discogram
Under monitored conditions, sterile water is injected into several adjacent disc spaces to attempt to reproduce symptoms (i.e., parasthesias, pain).  This test is subjective but common preoperatively to help doctors make sure they are operating at the source if the pain — which is not always the "worst disc."
 
 
Now when you hear the employee is having one of these tests done, you will have an idea what is happening to diagnose the employee's back problem.

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.
Filed Under: Assessment & Diagnostics, Medical Issues, Professional Development Issues Tagged With: , , ,

6 Times To Question Whether Medical Care is Reasonable and Necessary

August 4, 2011 by Leave a Comment

pic7Workers compensation statutes vary significantly from state to state, but one thing all states have in common in workers compensation laws is the requirement that employee be provided all reasonable and necessary medical care. The goal of all work comp jurisdictions is to return the injured worker to full productivity, if possible and to the level of maximum medical improvement if the employee can not be returned to work with full productivity. While all states require reasonable and necessary medical care, the divergence in the laws starts again when it comes to determining what is reasonable and necessary.

 

 

The employer/workers compensation insurer has the obligation to pay for all medical care for a work-related accident. Medical care includes not only doctor visits; it includes surgical care, hospital care, nursing services, medicines, and durable medical equipment. However, this obligation is not unlimited. It is limited to what is reasonable and necessary. Also, in states where the employer can control medical provider selection, it can also limit what is authorized.  (WCxKit)

 

 

6 Areas Where the Question of Reasonable and Necessary is Debated:

  1. Special devices.
  2. Home improvements.
  3. Massage, yoga and aqua therapy.
  4. Attendant care by non-medical assistants.
  5. Continuing medical maintenance.
  6. Diagnostic testing.

 

 

  1. Special devices

A question that often comes up when an employee has suffered a severe injury is the need for specialized equipment. While the adjuster is not going to question the need for a cane by someone who recently had back surgery, the criteria gets murky when the doctor states the employee needs a motorized wheelchair with four speeds, capable of doing wheelies. There is a tremendous cost difference between the non-motorized wheelchair for $99 and the motorized deluxe wheelchair for $1,999. Is it reasonable and necessary for the work comp insurer to pay for a deluxe piece of specialized equipment if the employee will only be using it for a month or so? The answer is, “No!” On the other hand, if the employee is going to permanently be in a wheelchair, the power version may definitely be reasonable and necessary.

 

 

  1. Home improvements

A medical provider who specializes in providing favorable impairment rating reports for plaintiff attorneys also wants to keep the injured employee happy. If the employee complains to the doctor she is not sleeping well, and the doctor writes a prescription for a new, extra firm pillow-top mattress, should the insurer have to pay for it? The answer is, “No!” Usually the doctor will not insist on such if the adjuster denies it. (In one situation, a doctor tried to justify a new mattress but the adjuster arranged for a furniture rental company to provide a mattress until the employee was at maximum medical improvement.) Other favorites include plaintiff-friendly doctors prescribing a new hot tub for an employee with a back injury, or a new Bowflex Ultimate Home Gym for an employee to do physical therapy at home. When physical conditioning home improvements are recommended, an adjuster should offer physical therapy, whether hot water soaks or stretching equipment, at a reputable physical therapy facility.

 

 

  1. Massage, yoga and aqua therapy

One well known “plaintiff friendly” Atlanta doctor sends all his back and neck injury clients to water aerobics, yoga, and massage therapy. Of course the doctor owns the water aerobics, yoga, and massage therapy facility. This is another situation where an adjuster must be vigilant to deny such medical services as not reasonable and necessary. If the doctor insists they are, then the adjuster should insist they be provided at a facility where the doctor does not have a financial interest.

 

 

  1. Attendant care by non-medical assistants

The seriously injured or debilitated employee may need some at-home assistance. Reasonable and necessary medical care in some states is not limited to medical professionals. If the employee needs at-home nursing services, the insurance company’s nurse case manager needs to consult with the primary medical provider to establish exactly what the employee needs in the way of home assistance. The work comp adjuster may have to approve the compensation for non-medical personnel to assist the injured employee with bandage changes or toilet needs. However, the adjuster should resist any efforts to expand the at-home assistance to cooking or doing laundry as not medically necessary.

 

 

  1. Continuing medical maintenance

Most states allow for continuing medical maintenance (a few states end medical maintenance when the employee is paid a permanent partial disability award and most states will allow future medical exposure to be transferred to the employee in exchange for compensation to the employee). When the medical is left open for continuing medical maintenance after the indemnity claim has been settled, the only reasonable and necessary medical care is medical services directly related to the initial injury. State laws vary but a significant number of states have statutes that close the exposure for future medical care if the employee has not sought any medical care for the injury in a specific time period — a year in many states. After that point, the adjuster should maintain that long-delayed medical care is not reasonable or necessary.

 

 

  1. Diagnostic testing

Diagnostic testing is an area in which some adjusters have difficulty determining whether the medical care is reasonable and necessary. Often it is necessary for the doctor to run various tests to determine the precise nature of the injury. If testing is a duplication of testing that has already been completed — for example, a repeat MRI — the diagnostic testing can be denied as not medically necessary. If testing is for a different body part — for example the cervical MRI on an employee who injured his lower back — the diagnostic testing should be denied as not being reasonable and necessary.(WCxKit)

 

 

Most industrial commissions and state work comp boards will approve anything the medical provider determines is medically necessary. However, in the areas discussed here, commissions and boards will often side with the employer when the medical necessity of an item or service is questionable and available alternatives are proposed.


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.

 

 
Our WC Book:  http://www.wcmanual.com

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

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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.

 

Filed Under: Assessment & Diagnostics, Claim Management, Legal Doctrines, Management Commitment, Medical Cost Containment, Medical Issues Tagged With: , , , , ,

How to Make Changes to Improve Workers Compensation Across Your Organization

May 18, 2010 by Leave a Comment

Making changes to improve workers’ compensation performance across your organization is hard. Maintaining your improvement might prove to be even more challenging! That’s why it’s important to make sure your processes are repeatable.

 

Conduct your assessments in a manner that is easily repeated and results over time can be compared. This means limiting open-ended questions and, preferably, using technology to make the trending of results easy.

 

Providing training for workers’ comp coordinators in the field is important, but how much will they remember six months later if you don’t give them easy access materials to use in the heat of the moment? Ideally, your organization will maintain an on-line instruction manual providing straightforward directions for each stage of handling an employee injury.

 

For that matter, you want to make sure it is easy to access the forms and tools needed throughout the life cycle of an employee injury. (workersxzcompxzkit)

 

This might include:

  1. Call scripts.
  2. Work availability forms.
  3. Employee brochures.
  4. Injury duration guidelines.
  5. And more.

 

Invest in repeatable processes and tools:

  1. Reassess and monitor compliance.
  2. Ongoing training.
  3. Easily accessible forms, manuals, and instructions.
  4. Formal trainings.
  5. Manuals and standardized processes.
  6. Standardized tools and forms such as an on-line WC manual, supervisor guides, wallet cards and duration guidelines.
  7. Examine the need to standardize communications to employees, doctors, claims managers, etc.

 

Author Rebecca Shafer, Attorney/Consultant, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. She can be contacted at:  RShafer@ ReduceYourWorkersComp.com or 860-553-6604.

Podcast: KNOW the New OSHA Recordkeeping Rules — OR Risk Fines and Criminal Penalties.
Click Here:   http://www.workerscompkit.com/gallagher/podcast/Non_Compliance_with_Recordkeeping_Standards/

 

WC Calculator:    http://www.reduceyourworkerscomp.com/calculator.php


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.

 

©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

 

Filed Under: Assessment & Diagnostics, Implementation and Rolling Out Your Program, WC 101 Tagged With: ,

Industry Survey Shows Employers Fall Short in Workers Comp Cost Control

January 31, 2010 by Leave a Comment

Results of First Industry wide Survey at Best Practices for Post-Loss Cost Control

The first-ever  industry wide survey on best practices for post-loss workers' compensation cost control reveals that most employers are falling short, according to Advisen, which conducted the survey for the Risk & Insurance Management Society.

The 2009 RIMS Benchmark Survey    included for the first time a workers' comp best practices survey. Respondents included 1,127 organizations in the United States and Canada.  

The survey  included ten questions selected from the National Workers' Compensation Management Score assessment survey in the Workers' Comp Kit located at www.ReduceYourWorkersComp.com  from Amaxx Risk Solutions.

Each respondent  received a numerical score, with 26 representing the high possible score. The average score was 11.1.  Only 11%, or 127 respondents, scored in the top category (20 to 26 points) considered to be best-in-class, while 215 organizations scored 0 or below. The companies in the best practice classification represented a broad range of industries including retail, wholesale, healthcare, education, energy, finance, construction and shipyard/aerospace/defense, as well as public entities such as city and local governments. These top-scoring companies are headquartered in the U.S. and Canada; many have both domestic and international operations.

"The top scorers  consistently use nearly every type of resource and tool listed in the survey," said Dave Bradford, editor-in-chief  at Advisen.  "They perform onsite file reviews, have a post-injury response procedure that is consistently applied across all locations, and have return-to-work programs that are implemented at all locations."

Consumer discretionary  companies had the best average score, 13.5.  Financials scored lowest at 8.0.  Nonprofits (10.7) and materials companies (11.2) were in the mid-range among the 12 industry groups.  Several survey questions included: Has a representative of your company reviewed some of your workers' compensation claim files within the last 6 months?  Most companies (65.7%) did the review onsite, 10.6% did not perform file reviews, and the remainder did phone or online reviews.  File reviews are crucial in keeping control over cases, according to Rebecca Shafer, industry expert. How consistently does your company follow written "post-injury response" plans describing procedures within the first 24 hours after an injury?   

Some 60.4% of respondents said they followed a post injury procedure consistently; the remainder said only some locations had these procedures, and others indicated they have no written plans.  No workers' comp program can function well without following a written plan, Shafer said. How consistently does your company follow a return-to-work policy where an injured employee returns to work in a temporary position until they have recovered? 

Almost 60% (58.5%) said they followed a policy in all locations and 26.9% said they followed a policy in some locations. Thus, over 80% of companies have return-to-work policies, at least at some locations. Although this leaves room for improvement in this best practice area, it serves as a benchmark for companies without a return-to-work program, that the majority of companies have such a program. Do your operating units visit the medical facilities where your employees receive medical care for occupational injuries? 

Only 19.2% of respondents said they did so consistently, even though this is an excellent opportunity to establish rapport with the doctor, explain what the company does, and show the doctor the transitional duty jobs performed at your workplace. Additional survey  questions let companies know what others in the industry are doing to control workers' comp costs. The questions above are merely samples illustrating the valuable information inside the complete survey.

(workersxzcompxzkit) The 2009 RIMS Benchmark Survey  can be purchased from Advisen at http://corner.advisen.com  It is an opportunity to learn what other companies do to reduce their workers' compensation programs. For free workers' compensation tools go to: http://corner.advisen.com/wc_free_tools.html. For free workers' compensation cost containment podcasts, go to:  http://corner.advisen.com/wc_podcast.html

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click here  http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

©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

Filed Under: Assessment & Diagnostics, Benchmarking & FTE & Operational Comparison, Professional Development Issues, Risk Management Tagged With: , , ,

Top Tips for Assessing Your Workers Comp Program

January 27, 2010 by Leave a Comment
What Do I Do? What Do I Do?
Those of us who cook know the time-tested technique for testing spaghetti doneness: toss a few strands up against a wall and if it sticks, it’s done – if not, well, it falls off the wall. So, what does spaghetti have to do with assessing your workers’ compensation program? 

Many companies  use the dartboard approach to control workers’ comp costs. They look into the global “pot” of work comp practices, pick out one or two, toss a solution against the wall, and hope it sticks. In other words, without really knowing what to do, they decide to “fix” some part of their WC program – an unplanned, unsuccessful and most likely costly approach.

Unfortunately,  more than 75% of companies try to work backwards toward improvement by reviewing the capabilities of their service providers and vendors rather than assessing the key problem areas in their own companies to determine the types of services ultimately needed.

Worker’s comp costs  cannot be controlled on a “hit or miss” basis. A solid workers’ compensation program begins with a careful assessment of what is in place now, rather than assessing your service provider’s capabilities. Only by analyzing your company’s current trends and weaknesses are you then able to select appropriate solutions and vendors to integrate into a comprehensive cost control program without overlap or gaps.

A reasoned,  impartial assessment and needs analysis is an indispensable part of an overall quality improvement process. It means determining how effective existing program elements are, not merely whether the elements exist. Solutions and recommendations for changes, upgrades or revisions in current practices are then based on a complete understanding of the “key cost drivers,” factors at the root cause of your company’s high costs.

If your workers’  comp costs are sky high, perhaps you are like one company, believing its managed care program was complete, but with $30 million in annual workers’ compensation costs. In turns out their employee brochure containing all the necessary information was written at the 11th grade level (like the Wall Street Journal), well above many of its employees reading abilities. Not effective!

Where Do I Start? Where Do I Start?

As companies  reposition themselves to be more cost effective and competitive in today’s marketplace, a thorough assessment of a company’s workers’ compensation program identifies problem areas responsible for escalating costs. Only after identifying the causes of these costs, can a company evaluate its program and develop a strategic plan to control and reduce workers’ compensation costs.

First, decide  if your company wants to devote internal personnel to a workers’ comp assessment process. Assessing a multi-state,  multi-site company is time-consuming and many companies outsource such a project.  In certain cases, a joint effort between internal personnel and outside consultants works well.

Consider the following points  when deciding who will perform the assessment:
     1. How will the assessment be used?
     2. What are the budgetary constraints?
3. Are internal personnel available to assist? The argument for internal personnel is their greater knowledge of the corporate cultural attitudes affect workers’ compensation. On the other hand, external or independent consultants are impartial and may have experience assessing a broader range of companies.

During the pre-audit  phase, reach an agreement on the purpose and scope of the audit, expected results and the content of the finished product. 
Be thinking about these questions:
Is the purpose to:
     1. Determine causes of escalating costs?
     2. Improve internal procedures?
     3. Select a new claims handler?
     4. Are multiple purposes? If so, prioritize, highest to lowest?
What will the finished product look like?
1. One report from a corporate perspective?
2. A separate report detailing each operating unit’s practices?
3. An oral presentation to upper management?
4. Contain “Findings” as well as corresponding “Recommendations?”

It is important  to know the intended use before going into the audit because the purpose and priority dictates the content of the assessment inquiries. And, intended use of the assessment dictates the format of the finished product.  

An Assessment Report  is a means to an operational end, not a well-written, handsomely bound report sitting on a shelf. It is a living, working document.
 
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.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/

Fraudulent_Workers_Compensation_Claims/index.php


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©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
Filed Under: Assessment & Diagnostics, Implementation and Rolling Out Your Program Tagged With:

Six Elements of Assessing Your Workers Comp Program

January 13, 2010 by Leave a Comment

Frequently instruction manuals give long lists of steps on “how to” implement a program, project or even hook up a DVD, utterly confusing and overwhelming. If you just looked at a list of all the elements required to implement a first class workers’ compensation program, you would also be overwhelmed. 

However, it is necessary to be aware of the elements companies need to review when auditing/assessing their internal workers’ compensation management systems, so just glance over these and then we’ll move on: data analysis; safety; communication; training; return-to-work; medical care coordination; medical cost containment; investigation; file reviews; hiring; account instructions; claim handling standards.

Six Program Effectiveness and Integration Elements

1. Don’t “inventory” the components of your workers’ compensation program for effectiveness and integration. Analyze!  For example, if your company sends loss cost data to operating units each month, be sure to summarize the data to draw attention to meaningful comparisons. 

2. Identify those  factors differentiating your company’s characteristics and problems from other companies by inquiring into your core systems covering documentation, attitudes, procedures, current practices, policies, and management systems.

3. Thoroughly review  the level of understanding and awareness within company management and employee perceptions and attitudes, critical to an effective assessment.

4. Review internal control  procedures by considering how consistently they are applied. Look for procedures implemented in a timely manner. For example, higher-than-normal indemnity costs may occur if there are delays in referring claims to the insurance company and delays in employees’ returning to work.

5. Consider the intangible  issues of organizational structure, such as internal company reporting relationships and duties of personnel responsible for workers’ compensation. There are certain factors impacting the types of workers’ compensation cases and expenses your company may experience, such as basic company information, your industry, number and location of employees, makeup of the workforce and type of work.
Obviously,  a call-center where everyone sits in cubes and are on the phones all day experiences a different kind of workers’ comp claim than a construction company employing “girder walkers” who may fail to fasten their safety belts and fall 10 stories. Likewise, “off-site” employees experience different problems than those of permanently sited employees. Off-site employees such as delivery people, outside sales forces, seasonal construction crews often have little or no supervision, use different transportation modes or be required to carry more tools or materials – thus are at greater risk of a work related injury. (workersxzcompxzkit)

6. Global Operations. Companies with operations abroad must analyze their workers’ comp program based on the rules of operations in their global community, plus United States laws applying to personnel working overseas.

 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. 

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©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
Filed Under: Assessment & Diagnostics, Implementation and Rolling Out Your Program, Uncategorized Tagged With: , ,

Eight Great Ways to Gather Information For A Workers Comp Assessment Report

January 12, 2010 by Leave a Comment

Whether your company decides to go “in-house” or “out source” the process toward building an effective workers’ compensation and/or evaluating what you currently have in place, we recommend seven methods for gathering information needed to make a careful, productive assessment. The method(s) chosen may depend in large part on budgetary restrictions and the amount of time personnel can invest. 

1. Self-evaluation Questionnaires
Prepare “open-ended” questions, (not “yes”/”no”) for the employer, claims handlers, treatment providers, and attorneys. Open-ended questions encourage respondents to describe how effective they really believe certain practices or procedures are.
The drawbacks to written questionnaires are they require more time to complete; written answers may be less candid as rapport is not developed with the questioner; questions need to be complete enough to gather the right information, but simple enough so respondents actually answer them.

2. Telephone Interviews
Very useful for  conducting follow-ups or companies with numerous locations, telephone interviews use the same questionnaire(s) developed for self-evaluation. More information can be gathered because the interviewer establishes a direct, person-to-person relationship with the interviewee. Also, based on responses, more in-depth inquires can be made.

3. On-site Interviews
Person-to-Person  interviews are probably the most effective way to elicit accurate information from managerial level personnel as valuable insights are more frequently offered during the personal interview. Questions need to be detailed enough to enable each manager to express ideas on the key cost drivers and possible cost reduction solutions. Conduct interviews with these departments —  safety, finance and operations, risk management, medical treatment providers, in-house medical, claim handlers, workers’ compensation attorneys, and union officials.

Encourage group interviews as a way to discover “gaps” in important procedures due to the duplication of responsibilities between human resources, risk management, safety and medical. Gaps often not recognized by the participants. Follow-up this group meeting with brief individual interviews as necessary to clarify and elicit sensitive information not necessarily divulged during a group meeting.When employers use the Workers Comp Kit.com assessment tools, it's a very effective group interview.

4. Employee Focus Groups
Direct employee input from a small group offers key observations about their understanding of how the workers’ compensation system works, how injured workers are treated, and what steps can be taken to improve the system. Develop focus group guidelines designed to keep the discussion focused on relevant issues.

Group discussion may uncover whether employees use the workers’ compensation system to resolve human resource problems. Are employees really injured, for example, or are they angry and/or frustrated, and using work comp claims as a vehicle to express indirect frustration with their jobs?  Develop focus group guidelines designed to keep the discussion focused on relevant issues.

5. Physical Review of Documentation
A physical review  determines what written procedures are in place and how well they are followed. Include a review of workers’ compensation policies, procedures, forms, employee brochures, pamphlets and newsletters. Written materials need to be written at a sixth grade level for the average person as opposed to 11th or 12th grade, a la the New York Times. Consider if languages other than English are appropriate for your workers.

6. Reviewing Loss Data
To help complete  the analysis of key cost drivers, review loss data to determine the causes of losses and allocated expense ratios and percentage of medical costs versus indemnity costs percentages. (workersxzcompxzkit)

7. Physical Review of Claim Files
The claims file reviewer must decide whether file handling is proactive or reactive, and is properly focused on rapid claim closure. Both opened and closed files are reviewed to find the quality of file handling in the past. A physician or experienced claim representative reviewing files notes whether medical care is well coordinated, of good quality, if medical bills are reviewed for duplication and fee schedule compliance, if strategies for claim closure are in place and being followed, and if time out of work is proportionate to the degree of disability. Overlap of other disability policy payments must be ferreted out as well.

8. Chairside Observation of Your Adjuster
The claims process can seem mysterious, so sitting "chairside" is the best way to find out how the process works from the TPA side. You can't possibly evaluate the workers comp process effectively without doing a chairside observation session with key staff at the TPA such as intake coordinator, claims supervisor, lost time adjuster, med-only adjuster, and "enhanced" medical adjusters. You won't regret spending a few hours of your day to gather information and knowlege this way. Trust me, after 25 years helping employers reduce their workers comp costs, I KNOW how to get the most information in the least amount of time!

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.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©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
Filed Under: Assessment & Diagnostics, Implementation and Rolling Out Your Program Tagged With: ,

Can Injured Employees Cheat on Hand Injury Isometric Strength Tests

July 16, 2009 by Leave a Comment

Reducing Workers Comp Cost Using Rehabilitation Assessments for Leg and Arm As discussed previously,  part of assigning an injured worker to transitional duty is the factor of "medical readiness" to assume a modified duty job.  Thus, it is important to know an injured worker's physical capabilities and strengths. Let's look at the second area of significant physical assessment.

  1. Hand Strength
  2. Isometric Leg Lift and Arm Lift
  3. Visual Estimation of Effort 

Two Studies Does Isometric Strength Predict Actual Dynamic Lifting Capacity? Isometric testing  (static testing) is an assessment of how much force can be generated against an immovable object.  Studied for over 40 years isometric strength testing is used to make hiring decisions, return-to-work recommendations and to assess validity of effort.  In 40 years  of isometric strength studies, only recently has a large normative database been used to find out if such raw measures of strength do, indeed, tell us how much an individual can actually lift.  It was conclusively demonstratedin a study of 130,000 job applicants no meaningful predictions of dynamic lifting abilities based on isometric strength can be made because the range of the predictions is 80-120 pounds wide. The study was submitted for peer review and accepted for publication. More details as the date for publication approaches.  Can the Static (Isometric) Leg Lift and Arm Lift Be Used to Classify Validity of Effort? In the 30 years  of using isometric strength to classify validity of effort, not a single peer-reviewed study was ever published demonstrating the Static Leg Lift and Arm Lift could be used as an index of effort. The same type  of biofeedback mechanism facilitating successful "cheating" during a hand strength assessment is also at work during isometric activities. In another study  on isometric strength, it was found 20 of 34 volunteers who had never before done isometric testing could successfully feign weakness by consistently reproducing submaximal forces during these isometric lifts.  As a result, a 95% confidence interval says between 40% and 75% of those tested could successfully "cheat" during isometric tests.  (workersxzcompxzkit) The study was accepted for publication. More details as the date for publication approaches. Author:   Darrell Schapmire, MS of X-RTS Software Products & Testing Devices develops distraction-based tests for use in functional capacity evaluations.  He can be reached at dschapmire@yahoo.com or   http://www.exrts.com/

Follow Us On Twitter: www.twitter.com/WorkersCompKit WC Calculator: www.reduceyourworkerscomp.com/calculator.php Do not use this information without independent verification. All state laws vary.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Filed Under: Assessment & Diagnostics, Medical Issues, Return to Work and Transitional Duty Tagged With:

Who Does a Workers Compensation Assessment and What Are the Benefits

February 2, 2009 by Leave a Comment

One of the initial issues a risk manager with high workers' comp costs is WHO should do the assessment and what are the benefits of each option. There are many resources available to assess your workers' comp program and tell you why your costs have skyrocketed. Several consididerations are: the cost of each, the availability and timeline of each, the impartiality of each, and the experience level of each. This is one area where you must have experience, and it's best to have experience in several industries. A resource with narrow experience will generally examine a narrow range of issues and options for correction, so a resource with a broader range of experience is generally best. You can discuss having these resources provide an assessment: 1-broker's staff – if your broker has post-loss consulting resources, they may have the type of experience that will be helpful because they may have serviced many types of companies 2- independent consultants – pre-loss, post-loss and experience modification professionals 3- automated systems – online web-based assessment provide uniform assessments across many business units (this is how Workers' Comp Kit operates) 4- medical doctors – MDs can review injury treatment protocol, over treatment/under treatment, effective use of nurse case managers, and IME process efficiency, among other issues Try the WC Cost Calculator to show the REAL COST of work comp. Look at WC 101 for the basics about workers comp. Workers' Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch. 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. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Filed Under: Assessment & Diagnostics Tagged With:
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