Waldo Insurance and Saltzer Medical Group present

A Recipe for A Recipe for Successful Successful

Management of Management of Occupational InjuryOccupational Injury

Today’s Presenters & Moderator

Howard W. Shoemaker, MD

Dave Waldo, Pres/CEO Waldo

Insurance

Tony KahmannWaldo Insurance

Welcome!

Dave Waldo, Pres/CEO Waldo Insurance

• Discover some key, additional issues that drive the “total cost of risk”

• Identify the key drivers of increased time loss in injury claims

• Present a refreshing approach to managing workers comp claims and reducing costs

Goals for Today

• “Isn’t Workers Compensation just another entitlement program?”

• “What is the impact of, and what can we do about “unsubstantiated claims”?

Common Questions

• “Are we too small to implement a claims management system?”

• “How can we control the outcome of claims?”

Common Questions

Today’s Featured Presenter

Howard W. Shoemaker, MD

Where did Idaho and Oregon rank nationally inworkers compensation premiums in 2008?

Polling question

Idaho:a.3rd

b.13th

c.34th

d.46th

Oregon:a.7th

b.15th

c.39th

d.43rd

Inspiration Inspiration for recipefor recipe

• A truth-inspired tale that inspired me to create a “Recipe for a Comprehensive Unifying Strategy” (CUS) that employers could follow to assure successful outcomes in workers comp

• One woman gained success by cooking all 524 recipes in Julia Childs’ book “Mastering the Art Mastering the Art of French Cookingof French Cooking”

Inspiration

• What was interesting (besides being a good movie)– Followed recipe/attention to detail– Hand selected ingredients– Successful outcomes assured

• Did not recreate the wheel/invented nothing

Inspiration

• Recipes are made of ingredients– Employer– Insurance– Provider– Broker

Recipes

• Develop a team approach for success– the ingredients are your partners/team members

• Ingredients are hand-selected: knowledgeable, equal partners

• Requires active participation• Not every employer has what it takes to be a

Master Chef

This Recipe

• One key ingredient: Providers• In order to be part of the employers CUS, we

need a CUS of our own to treat work comp patients

Ingredients

• Trained• Experienced• Commitment• Knowledgeable

Preventing iatrogenic disability is at the core of Preventing iatrogenic disability is at the core of CUS for providersCUS for providers

Characteristics of a Worthy Provider

“Despite remarkable advances in health care and increased emphasis on safety, ergonomics, and general employee health, the incidence and cost of workers’ compensation and disability claims continue to increase.” ( A. Colledge)

Safety – Ergonomics – Awareness

All of these focal points have improved, yet costs and disability claims continue to rise.

Introduction

• Current literature supports growth in disability unique to the modern western culture.

• Prevalence of discomfort – 45% world wide.

• Disability is virtually nonexistent in third world countries

• Disability is increasing in third world countries as western medicine is being introduced

Disability

• Patient’s ability to tolerate discomfort can depend on:• The level of biological stimulus (discomfort)• Existing psychological distress• Current personal social stress

• Studies indicate that people who seek healthcare report more life stressors• Conclusion: These results imply that psychological

&/or social distress can manifest as physical complaints that create a perceived need for professional health care

Psychosocial Issues

• 90/10• Out of 106,961 WC Low back injuries -

• 86% of the cost was incurred by 10% of the claimants• (The Ninety/Ten Rule – A small percentage of the people

generate the overall cost)

• From Washington State• 5% of their claims (84% of the cost) were from non-

verifiable muscle & back complaints

Psychosocial Issues

Minimal PsychosocialMinimal PsychosocialProblemsProblems

Discomfort is acceptable

Medical intervention might be sought

(Claim might be filed)

(Recovery is as expected)

(No disability)

RecoveryRecovery

Significant PsychosocialSignificant Psychosocial ProblemsProblems

Discomfort is unacceptable

Medical intervention occurs – claim is filed

Recovery is delayed

Additional medical intervention is sought

Minimal resolution of symptoms

Subjective complaints exceed objective findings

DisabilityDisability

The Disability Cascade

• Entitlement• A number of published reports have recognized

such iatrogenic (system-induced) disability occurring within entitlement systems and suggest the need for appropriate policy and management reforms.

• Work Comp is an entitlement system

Psychosocial Issues

• Medical treatment coverage• Clinical care, services and supplies

• Indemnity payments• Replacing wages during recovery

• Death benefits• Weekly payments to surviving spouse & children

• Impairment settlement • Compensation for permanent physical loss

• Disability benefits

Automatic Benefits Under WC

Just The TipPersonal Health Costs

• Medical Care• Pharmaceutical Costs30%

70%

Sources: Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study", JOEM.2009; 51(4):411-428. and Edington DW, Burton WN. Health and Productivity. InMcCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott

“This predicament is not the result of an inadequate fund of available information with which to address the matter. Instead the problem emanates from a the lack of a comprehensive and unifying problem-solving strategy.”

LaRocco

Summary of Causative Factor

• Don’t reinvent the wheel – the wheel already exists

• Forward Treatment Method• Military developed

• Comprehensive• Unifying• Dynamic

Solution

The US Military, in a study of modern warfare, found that soldiers with simple physical complaints who received inappropriate treatment for battle-related stress tended to become permanently & totally disabled.

Combat-induced anxiety and stress caused the protective psychological reserves to erode and defense mechanisms formed.

Forward Treatment

• A plan for successful treatment was needed• Forward Treatment model was developed

• Proactive and comprehensive

• Developed with over 100 years of experience of military physicians world wide

• Developed to prevent system-induced disabilities

• Forward Treatment lead to the SPICE model

Forward Treatment

• Both groups are basically healthy and intelligent• those with pre-existing disabilities are screened out

• Both groups are expected to function as a “team” rather that as individuals (as a rule)

• Both groups have legally mandated entitlement programs for on-the-job- injuries

Military vs. Civilian Personnel

SPICE

It’s not just for cooking anymore!

• Comprehensive application of SPICE is meant to facilitate effective treatment, reduce workers’ compensation cost, and reduce system-induced disability.

• SPICE was originally published in 1993 in The Journal of Occupational Rehabilitation and updated in 2000.

SPICE

SS = Simplicity

PP = Proximity

II = Immediacy

CC = Centrality

EE = Expectancy

The SPICE Model

Simplicity • Use simple/uncomplicated terms

• Treating potential benign conditions in a complex manner can have adverse affects on the employee’s recovery

• Avoid over medicating and over treatment• Give reassurance and simplistic advise

SSPICE

• Diagnosis• Provide an explanation of the probable pain

mechanism

• Reassurance the condition is not a serious disease

• Present a favorable prognosis and history of the disorder

Simplicity

Proximity • Keep the employee physically and emotionally tied

to the workplace

• Maintain the employer/employee relationship

• Normalcy of everyday activities

• Create meaningful light duty

SPPICE

• A challenge to employers

• Developing a “work family”

• Assisting their employees in coming to work ready to give 100%

• Managing life stresses

• Fulfilling individual goals & purposes in life

Proximity

• Return to Work• The longer an injured worker is kept from the

worksite, the less likely it becomes that he/she will ever return to productive employment

• Return to work takes a combined effort of the patient, the healthcare provider, and the employer

Proximity

Immediacy • Deal with the injury in a timely manner

• Avoids establishing “disabled” behavior• Delays in treatment can have considerable effects

on psychosocial issues and may encourage a delay in the recovery

• Return to full duty as quickly as possible

SPIICE

• CConsistent approach

• CContinuity of providers

• CCoordination of the “care team”• Therapists, Specialist, Adjusters, Case Managers

• CCommunicate• Employer – Carrier – Patient – Providers – Care Team -IC

CCentrality

• Primary Treating Provider• Establishes a point of contact for the treatment

of the injured employee.

• Provides a link with a network of providers involved with ongoing treatment.

• Coordination of patient care

Centrality

• A study shows 50% of injured workers had received no information from the employer about where to go to get medical care for their work related injury.

• Majority of Comp related litigation arises from the frustration, ignorance, unrealistic expectations, and/or fear level of the injured workers.

Communication

Expectancy

• Injured workers typically accomplish the clinical expectations set for them

• Objectively state what is expected in terms of treatment and case closure and Maximum Medical Improvement

• Proactive RTW goals are set in the beginning

• Promote accountability and motivation on the part of the patient

SPICEE

• EExpertise• Patient confidence

• EExperience • Credibility

• EEducation

• EEncouragement• Ability not Disability

Expectancy

Studies have shown that using a Board Certified Occupational Medicine Specialist can reduce the average workers compensation claims costs by:a. 10%b. 25%c. 50%d. I was not aware that using a Board Certified Occ.

Medicine Specialist could reduce our claims costs

Polling question

The SPICE model will provide the needed structure for comprehensive problem-solving strategies that:

• Decreases employee disability

• Maintains worker productivity

• Reduces workers compensation costs

***

In Summary

“Treatment of the part should never be attempted without treatment of the whole. This is the error of our day, separation of the body from the soul.”

Aristotle

In Conclusion

In Conclusion

Waldo Agencies Four-step Process

If you would like more information on:• Saltzer Medical Group’s Occupation Medicine program

• Contact: Tom Mears, Director of Occupational Medicine, at 208.463.3146, or tjmears@saltzermed.com

• Workers Compensation Risk Reduction Services, through Waldo Insurance

• Dave Waldo: 800.829.0305, ext 213; cell 208.707.3333; dwaldo@waldoagencies.com

This webinar will be posted and available for viewing soon. Confirmation and a link will be posted on our agency website

at www.waldoecg.com

Next Steps

Thank You for Attending!Thank You for Attending!

Colledge, A., S.P.I.C.E. – A model for reducing the incidence and costs of occupationally entitled claims. Occupational Medicine: State of the Art Reviews, Vol. 15, No. 4 , Oct-Dec 2000. Philadelphia, Hanley & Barfus, Inc.

Colledge, A., A model for the prevention of iatrogenic disease associated with work-related low back pain. The Journal of Occupational Rehabilitation, 1993 & 2000, Plenum Publishing Corporation, Springer Netherlands

Colledge, A., Holmes, E., Pack, R., Johnson, H. I., DeBerard, S., Management of occupational low back injuries

Bigos S, Nachemson AL. Work for all: For those with low back pain as well. Clin Orthop 179:77-85, 1983

• Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study", JOEM.2009; 51(4):411-428. and Edington DW, Burton WN. Health and Productivity.

• McCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott

References