Conservative Care- The Do’s and Don’ts Employer Services | Occupational Medicine

Overview Discuss how: Providing Initial assessments of work- related injury to the employee limits liability to the employer Raise your clinical communication level Effectively assess and access medical expertise Allow providers to be key contributors to your organization’s culture of health and safety

Educate Employers on how to choose qualified Occupational Health Providers Why? Employees’ trust increases and outcomes improve when employers develop relationships with qualified medical professionals. A medical provider who lacks expertise in occupational health may compromise a worker’s critical connection to the workplace during a screening or treatment encounter.

Health Provider Expertise A medical provider versed in Occupational Medicine knows how to effectively balance patient advocacy with the overall business concerns of the employer. Is familiar with your workplace. Understands your regulatory constraints. Appreciates your objectives. Objective and focus is to return employees back to work within a reasonable time frame based on the nature of injury. *Providing favorable outcomes

Philosophies of Occupational Care Do NOT treat body parts NOT involved in the injury Treat and review effects of workplace accident (only authorized for this) Only a workers’ comp carrier can accept whether it’s a work related injury Appreciate the important role of work in recovery Offer communication as part of the service Use a multidisciplinary approach Understand the powerful effect of psychosocial factors Focus on functional improvement, not just pain management Build rapport during each encounter and educate employees about their role in their own recovery Apply the SPICE model

SPICE Model

Treatment Goals Foster trust Improvement in activities of daily living Relevant psychosocial improvement (monitor behavioral factors related to the injury – stress, depression, hostility, etc.) Pain Management Return to leisure, sport, work or other productive activity

Panel of Experts Gateway Physician Referrals Specialty Physician (Orthopedics, Neurology, Physical Therapy, Imaging) Must be versed in Workers’ Comp and have a track record of successful outcomes COMMUNICATION IS KEY! ND

What can employers do to encourage positive results? Make it easy for employees to choose optimal provider regardless of your jurisdiction 1 If qualified providers are not immediately available, seek outside expertise 2 Consider telehealth technology if access is an issue 3 Having access to a care coordination team to help manage and monitor referrals to specialists is key to providing successful outcomes. 4

Key Questions in establishing a preferred provider How often does the medical provider put injured employees off work or assign work restrictions, request diagnostic studies or recommend surgery? What is a provider’s average time to case closure by injury type? How often do apparent first aid cases escalate to recordable injuries? Is the medical provider a certified DOT Medical Examiner, MRO or have other certifications? What is the provider’s treatment policy?

Occupational Health Providers- Can do the Following: Contribute insight to safety, risk management, human resources, insurance, benefits management and related strategic functions. Hazard assessment & medical surveillance Safety audits, root-cause investigations Disaster and pandemic planning On-site clinic and clinical staff oversight Initial treatment and return-to-work guidance

Skills Needed in the Occ Med Environment: Case Management Consultations Drug-free workplace policy development and MRO Outpatient rehab recommendations and management Expert Witness (knowledgeable witness) Have access to Health Risk Assessments and Healthy Lifestyle Programs Have access to Employee Assistance Programs Have a care coordination team that oversees and manages communications between the provider, employee, employer and adjuster for all WC cases until the close of claim.

Functions of Care Coordination in Occupational Health Care Management

How can occupational medical providers promote safety in the workplace? Determine whether an injury has “arisen out of and during a course of employment” or from another cause Determine Engage care coordination team members in case reviews without micro-managing adjusters Engage Ensure compliance with OSHA regulations, workers’ comp, leave and work accommodation laws Ensure Leverage relationships with other physicians, insurers and TPAs (Third Party Administrators) Leverage

Understanding Laws and Regulations HIPAA privacy and security provisions (confidential medical record management) Family & Medical Leave Act Americans with Disabilities Act Genetic Information Non-Discrimination Act State and Federal OSHA regulations State Workers’ Comp laws Drug Free workplace policies/procedures PROVIDER MUST UNDERSTAND ALL LAWS AND REGULATIONS

In Collaboration with Medical Providers Employers should… Develop policies/procedures to ensure appropriate use of leave Verify medical certification and job accommodation requests Monitor red flags for possible fraud (patterns of absence, evidence of moonlighting, etc.) Manage care/leave associated with complex chronic conditions and fitness for duty issues. Establish enforceable workplace drug and alcohol policies Investigate all claims; some may be unrelated to work and covered under heatlh plan. In Collaboration with Medical Providers Employers should…

Make it a WIN WIN for everyone! Partnering with an occupational medical provider can get injured employees back to work and back to life as they know it. “Always treat your employees exactly as you want them to treat your best customers.” –Stephen R. Covey

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