1. The Role of the Occupational Medicine Provider in Managing Risks Melinda E. Wagner RN, BSN, MS, MBA

2. Agenda The Employee Risk Continuum The Employee Risk Continuum Designing the Right Workplace Designing the Right Workplace “Getting the Right People on the Bus” “Getting the Right People on the Bus” Managing Work Place Safety Managing Work Place Safety Managing Workers’ Compensation Injuries Managing Workers’ Compensation Injuries Managing Employee Productivity Managing Employee Productivity Managing Health Benefits Managing Health Benefits Managing Post Employment/Retirement Programs Managing Post Employment/Retirement Programs Motivating Your Occupational Provider into your Business Partner Motivating Your Occupational Provider into your Business Partner

3. “The first step in the risk management process is to acknowledge the reality of risk. Denial is a common tactic that substantiates deliberate ignorance for thoughtful planning.” Charles Tremper, CIO AAHSA

4. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

5. Workplace Design Consultation

6. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

7. Value of Employment Screening Improved Job-Worker Match Improved Job-Worker Match Establish Organizational Culture Establish Organizational Culture Improve Employee Retention Improve Employee Retention Improve Risk Management Improve Risk Management Reduce Costs Reduce Costs Eliminate One Back Injury---Pays for Program for Years! Eliminate One Back Injury---Pays for Program for Years!

8. Helping you “Get the Right People on the Bus” Pre-Employment Screening Pre-Employment Screening Substance Abuse Cognitive Levels Background Checks Post Offer Screening Post Offer Screening Substance Abuse Functional/Medical Evaluations Pre-Placement Screening Pre-Placement Screening Honesty/Integrity testing Functional/Medical Evaluations Reporting Reporting

9. What to Expect from Your Post Offer Functional Testing Program Expect ADA/EEOC Compliance ADA/EEOC Compliance Process Process Job Specific Testing Protocols Job Specific Testing Protocols Safety Safety Initial Pass/Fail Report Initial Pass/Fail Report Statistical Analysis Statistical Analysis On-going Updates On-going Updates Better Job-Worker Match Better Job-Worker Match Accommodation Guidance Accommodation Guidance Avoid “Cookie Cutter” Programs “Cookie Cutter” Programs Job Category or Standardized Testing Protocols Job Category or Standardized Testing Protocols Copy of Complete Test Results Copy of Complete Test Results Impairment Ratings Impairment Ratings Programs without Maintenance Programs without Maintenance

10. Role of the Occupational Provider Program Development Program Development Program Implementation Program Implementation On-going Program Evaluation & Updates On-going Program Evaluation & Updates

11. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

12. Workplace Safety and the Role of the Provider Physician & PT Worksite Evaluations Physician & PT Worksite Evaluations Medical Surveillance Medical Surveillance Review of injury trends by job types Review of injury trends by job types Education Education Safety committee Safety committee Selling safety to leadership Selling safety to leadership

13. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

14. Managing the Injury Goals - Quality Care, Prevent Disability, Expedite Recovery, Eliminate Unnecessary Costs Goals - Quality Care, Prevent Disability, Expedite Recovery, Eliminate Unnecessary Costs SPICE Treatment Model SPICE Treatment Model Simplicity - Base treatment on objective findings-- most cases should be resolved in 2-3 weeks Simplicity - Base treatment on objective findings-- most cases should be resolved in 2-3 weeks Proximity - Keep the worker mentally and physically engaged in work Proximity - Keep the worker mentally and physically engaged in work Immediacy - Set timeframes based on clinical guides Immediacy - Set timeframes based on clinical guides Centrality - Lots of agenda’s, but everyone must focus on the same goals – use the Provider to help you control all other providers Centrality - Lots of agenda’s, but everyone must focus on the same goals – use the Provider to help you control all other providers Expectancy - Create the expectation on day one for the employee to fulfill Expectancy - Create the expectation on day one for the employee to fulfill

15. Involve the Provider in Effective Return to Work Programs Policies promoting RTW can improve outcomes by as much as 15 weeks Policies promoting RTW can improve outcomes by as much as 15 weeks WCRI Study on return to work factors: WCRI Study on return to work factors: Age impacts RTW Age impacts RTW Education level impacts RTW Education level impacts RTW Most consistent predictors--Patient’s perception of the initial severity of the injury and effectiveness of their recovery - which include RTW Most consistent predictors--Patient’s perception of the initial severity of the injury and effectiveness of their recovery - which include RTW

16. Managing by TOTAL Cost Evaluate cost based on total costs and outcome Evaluate cost based on total costs and outcome Workers’ Compensation Direct Medical Costs are rising 9-12% Workers’ Compensation Direct Medical Costs are rising 9-12% NCCI Study suggests workers’ compensation pays more than group health to treat comparable injuries NCCI Study suggests workers’ compensation pays more than group health to treat comparable injuries Utilization differences dominate price differences explaining 80% of the cost variance Utilization differences dominate price differences explaining 80% of the cost variance Evaluation & management codes, radiology and PT costs are higher due to utilization Evaluation & management codes, radiology and PT costs are higher due to utilization

17. Understanding the System Variances to Understand the Cost Variances Work Comp Work Comp Focuses on pre-injury productivity Focuses on pre-injury productivity Management of entire claim Management of entire claim State mandated benefits State mandated benefits Employer is the payer Employer is the payer Patient disincentives Patient disincentives Multiple parties Multiple parties Group Health Group Health Focuses on termination of care Management of medical only Benefits controlled by policy Employee is a payer Patient incentives Provider & patient

18. Understanding the Costs Work Comp Total Costs Work Comp Total Costs Medical Medical Wage Replacement Wage Replacement Settlement Settlement Lost Productivity Lost Productivity Fraud Fraud Workplace Changes Workplace Changes Administrative Costs Administrative Costs Employee Retention Employee Retention Employee Morale Employee Morale Lost Business Lost Business OSHA issues OSHA issues Group Health Total Cost Group Health Total Cost Total Medical Costs

19. Communications with Your Occupational Provider Communication Communication Measure Results on Total Costs and Outcomes Measure Results on Total Costs and Outcomes More Communication More Communication

20. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

21. For Profits You Need People Who Perform Cost of absenteeism Cost of absenteeism $30.5 billion due to just asthma, diabetes and hypertension $30.5 billion due to just asthma, diabetes and hypertension Cost of “Presenteeism” Cost of “Presenteeism” Estimated to cost as much as $180-250 billion Estimated to cost as much as $180-250 billion Lost Productivity is estimated 7.5% greater than absenteeism Lost Productivity is estimated 7.5% greater than absenteeism In study of 800 managers 76% report Low Productivity as their #1 challenge In study of 800 managers 76% report Low Productivity as their #1 challenge

22. Incorporating the Occupational Provider into Resource Management Developing Culture Developing Culture Developing Management Programs Developing Management Programs Medical Monitoring Programs Medical Monitoring Programs Public Safety Positions Public Safety Positions Voluntary Voluntary Return to Duty Return to Duty Fit For Duty Fit For Duty Knowledge of a medical condition linked to performance or “direct threat” Knowledge of a medical condition linked to performance or “direct threat” Managing by the data Managing by the data

23. Incorporating the Occupational Provider into Resource Management Family Medical Leave Act Family Medical Leave Act About 62% of all workers are qualified for FMLA About 62% of all workers are qualified for FMLA Over 50 million have taken FMLA Over 50 million have taken FMLA 80% take over 40 days 80% take over 40 days Provider Role Provider Role Review of certification Review of certification Consideration of second opinions Consideration of second opinions Benefit & Preventive Health Program development based on data Benefit & Preventive Health Program development based on data

24. Incorporating the Occupational Provider into Resource Management Disability Disability 7.5 million on disability Average age 52 90% are disabled workers Obese adults almost twice as likely to become disabled

25. Red Flags In Disability Inconsistent symptoms & physical finding Inconsistent symptoms & physical finding Exaggerated pain complaints absent physical findings Exaggerated pain complaints absent physical findings Restrictions inconsistent with diagnosis Restrictions inconsistent with diagnosis Significant discrepancies between multiple treating providers Significant discrepancies between multiple treating providers Certifying physician outside scope of practice Certifying physician outside scope of practice Non compliance with treatment Non compliance with treatment Doctor shopping Doctor shopping Pending life change: divorce/layoffs/job loss Pending life change: divorce/layoffs/job loss No objective testing No objective testing

26. Incorporating the Occupational Provider into Resource Management Occupational Provider’s Role Occupational Provider’s Role Medical Record Review Medical Record Review Independent Medical Exam Independent Medical Exam Functional Capacity Evaluations Functional Capacity Evaluations Productivity Studies Productivity Studies Consultation with the Attending Physician to get an accurate and complete statement Consultation with the Attending Physician to get an accurate and complete statement Identify and address “Red Flags” Identify and address “Red Flags”

27. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

28. Incorporating the Occupational Provider in Health Benefits Planning Analysis of health care trends Analysis of health care trends Education programs Education programs Implementation of benefits Implementation of benefits Focused preventive health programs Focused preventive health programs Designing programs that generate returns Designing programs that generate returns Disease management programs Disease management programs

29. The Occupational Provider Impact Workplace Design Hiring/Placement Workplace Safety Workers’ Compensation Employee Productivity Health Benefit s Exit/Post Employment The Employee Risk Continuum

30. Incorporating Your Occupational Provider into the Exit Process Exit Physicals Exit Physicals Retirement Benefits Retirement Benefits Prevention/Health Management Programs Education Education Connection to your workplace Connection to your workplace

31. Engaging Your Provider to Be Your Partner Provider Selection Provider Selection Communication Communication Feedback Feedback Ongoing Involvement Ongoing Involvement Reimbursement Reimbursement Policy Development Policy Development

32. Questions and Discussion