How to Gain Control Over Your Occupational Medical Costs

How to Gain Control
Over Your
Occupational
Medical Costs
Session 9.4.51
Presented by:
Arlene Guzik, DNP, ARNP-BC, COHN-S, FAAOHN
Objectives
„
„
„
„
Discuss the importance of quality health care
and its impact on corporate health cost
control
Define the role of the occupational health
provider in managing employee health
List the expected service outcomes of a
quality occupational health provider
Explain the value of establishing
complementary relationships when managing
employee health
Copyright
This presentation is a copyright protected
document.
All rights reserved. Permission granted to AANP
April 2009. No part of this presentation may be
reproduced, stored, or transmitted in any form
(other than as provided for this presentation)
or by any means without written permission of
the author/copyright holder.
– Permission may be obtained by contacting the author at
a.guzik@verizon.net
9.4.51
a
g
n
i
h
s
i
l
Estab ophy
Philos ion
is
and V
Philosophy
„
Safe, healthy and productive workforce
– Hire people who are fit-for-duty
– Maintain a safe workplace
– Maintain a productive workforce
• Health workers
• Maximize workers’ potential
– Return injured/ill employees back to work
in a most expedient manner
TEAM APPROACH
Shared philosophy and vision
Occupational Health Nurse/NP
WC/Safety Managers
Risk Managers
Human Resources
Supervisors/Managers
Medical Director – Occ Doc
Healthcare Providers
Insurers/TPAs
Legal Counsel
9.4.51
Vision
The Occupational Health Team is
firm, fair and consistent in handling
employee situations, with clear and
effective communication in all
directions while abiding by all
applicable regulatory standards
and medical guidelines
Communication
Vision
Healthcare Provider
Adjuster
Case Mgr
Medical Care
Coordinator
HR
Management
Legal
Employees
WC/Safety
Consistency
Fair and firm
Company Responsibility
„
„
„
Have clearly written policies and procedures
for all aspects of occupational health and
safety
Supervisory and employee training and
communication
Select quality-oriented providers
– Healthcare providers
– Insurer (adjuster, case manager, legal counsel)
„
Accountability
9.4.51
Service Outcomes
Internal
OHN
Safety
WC Administration
Risk Managers
Human Resources
First Responders
Supervisors
Managers
„
„
„
„
„
Establish and apply
policies and procedures
consistently
Respond to employee
needs in an efficient
manner
Render quality services
Communicate clearly
Apply disciplinary
procedures as
appropriate
Service Outcomes
External
„
Medical Director
Healthcare Providers
Insurers/TPA
Legal Counsel
„
„
„
Quality care/service
Efficient and effective
services
Message consistent
with company
philosophy
Strong focus on
customer service
Key Aspects of a Quality Provider
Provide quality health care
Maintain productivity
Focus on customer satisfaction
•
•
Patient/employee satisfaction
Employer satisfaction
Control costs
9.4.51
Best Practice:
Occupational Health Provider
„
„
„
„
„
„
„
Determine fitness for duty
Pre-existing conditions considered
Co-morbid conditions considered
Support return to work with medically
appropriate restrictions
Direct medical care within reason
Knowledge of regulations, standards,
guidelines
Appropriate disability ratings
Quality Medical Care
„
To provide quality care in a cost
effective and efficient manner
– medical services are in accordance with
established practice parameters and
protocols
– assure medically appropriate interventions
and referrals
Appropriate Medical Testing
„
Sophisticated testing procedures can
have an adverse effect on the patient's
illness behavior by reinforcing the
severity of the “illness” or “condition”
9.4.51
Causation
„
Determine causation as it relates to the
mechanism of injury and medical
findings
– provide medical decision making as related
to claim compensability
– understand essential job duties and
mechanisms of injury
– knowledge of epidemiology and toxicology
Managing Care
„Pre-selected providers for referrals –
who you can work with best
„Use the same provider from preemployment evaluations to injury
management
– Medical records capture it all
„Quality oriented is best
Strong Customer Relations
– Visit job sites
– Know essential functions of jobs
– Know the regulatory requirements
that impact employers and employees
– Familiar with company health and
safety policies and procedures
9.4.51
Strong (return-to) Work
Philosophy
Take the “return” out of
“return-to-work”
People are not taken off work
Focus on medically
appropriate restrictions only
Accommodations are
provided by company within
reason
„
„
„
„
Expectations of the
Occupational Health Provider
•
Knowledge of regulations
•
Consistent philosophy
Common goals
Teamwork
Support for corporate
mission
•
•
•
•
WC, OSHA, CDC, FMLA, ADA, etc
Work With a Company
Medical Director
„
„
Specially trained in occupational
medicine
– Or one who subscribes and supports
the philosophy
Demand return to work…if not
– Increases disability costs
– Decreases employee morale
– Becomes a contagious disease
9.4.51
Employment Physicals
„
„
„
„
„
„
Right person in the right job
Able to perform essential functions, with or
without accommodation
Pre-placement
Regulatory
Safety sensitive, performance sensitive
Fitness for duty
– Performance
– Return from medical leave
Pre-placement Screening
„
Serves to:
– Assure the candidate can perform the
essential job functions with or without
reasonable accommodation
– Establish baseline medical data for
comparison throughout course of
employment
Drug Free Workplace
„
„
„
„
DFWP policy in place
Employee training
Supervisor training
Substance testing
–
–
–
–
–
9.4.51
Pre-placement
Random
Reasonable suspicion
Work Injury
Rehabilitation
Safe Workplace
„
Regulatory compliance
– OSHA
– CDC
„
Strong safety philosophy
– Top down
– Upstream
Workers’ Compensation Injury
Management
„
„
Written policy and procedure
“Incident” reporting
– Including near misses
„
„
„
„
Early reporting
Immediate medical evaluation
Stay at work philosophy
Aggressive claims and case
management
Injury Management
„
„
„
„
„
Trained injury response team
Directives for medical care
Trained incident investigation team
Modified duty work plan
Implications for non-compliance
9.4.51
DIRECT ACCESS TO CARE
„Pre-selected providers
„From pre-employment evaluations to
injury management
– use same provider
„Quality oriented is best
„Big discounts may compromise quality
FMLA & ADA Management
„
„
„
„
Assure consistency and fair treatment of
all legitimate health issues
Evaluate all requests for medical
accommodation
Evaluate all requests for medical leave
Appropriate, confidential communication
with medical provider and employee
Putting the
9.4.51
to it
Program/Project
Cost Analysis
„
Conducting a business cost analysis
in order to sell the role of the OHNP
and program scope
– Gathering the data
– Using BizHealthCheck
– Comparing to national
data/benchmarking
Quantitative Cost
Benefit Analysis
„
Achieve most impact for the least cost
– yield the most value
– achieve the program objectives.
„
Compare to competition and
alternatives
– which has most power to achieve
outcomes
Qualitative Analysis
„ Perceived
health
„ Morale
„ Satisfaction
„ Process
9.4.51
analysis
Communicate Your
Effectiveness
Service Type
Audiogram
Cost of
service
#
EEs
Sum
Outside clinic
$25
100
$2,500
On-site - outsourced
$15
100
$1,500
$0
100
$0
OHN
PFT
Outside clinic
$45
100
$4,500
On-site - outsourced
$45
100
$4,500
$0
100
$0
Outside clinic
$45
100
$4,500
On-site - outsourced
$45
100
$4,500
$30
100
$3,000
Cost AFW
Total
Savings
$100
$10
1
$1,000
$3,500
Equipment
$10
0.3
$300
$1,900
$1,600
$10
0.3
$300
$300
$3,200
Audiometer/booth $3000
$100
$10
1
$1,000
$5,500
$10
0.3
$300
$4,900
$600
$10
0.3
$300
$300
$5,200
Spirometer/printer $1500
$100
$10
1
$1,000
$5,500
$10
0.25
$250
$4,850
$650
$10
0.25
$250
$3,250
$2,250
$10
1.5
$1,500
$6,500
Lab and MRO fees
Includes Basic DOT Physical
Outside clinic
$50
On-site - outsourced
OHN
Post Offer PE
Hrs
AFW
Includes collection, 5 panel UDS and MRO fees
OHN
DOT PE
EE hourly
pay
Includes OSHA History and PFT
OHN
UDS
On-site
Fee
Includes history, ear exam and audio
100
$5,000
$50
100
$5,000
$0
100
$0
$100
$10
0.5
$500
$5,600
$900
$10
0.5
$500
$500
$6,000
DOT forms
Includes review of health history, brief PE, refer red flags
Outside clinic
$35
100
$3,500
na
na
na
$5,300
On-site - outsourced
$35
100
$3,500
na
na
na
$3,600
$0
100
$0
na
na
na
$0
$5,300
$35
10
$350
na
na
na
$350
$4,950
OHN
10% referred
$100
TOTAL SAVINGS
$1,700
$21,600
2008
Decrease in lost days
Increase in modified duty days
Worker’s Compensation Comparisons:
Lost days decreased
„
2005 lost days
112
„
2006 lost days
112 (=)
„
2007 lost days
36 (-68%)
„
2008 lost days
1 (-99%)
Modified days increased
„
2005 modified days 442
„
2006 modified days 382 (-14%)
„
2007 modified days
78 (-82%)
„
2008 modified days 111 (-75%)
9.4.51
PE forms
Injury Type Comparison
A. Injury Type
Repetitive Motion
Sprains/Strains
Cuts/Contusions
Dermatitis
Amputation
Fracture
Insect Bites
TOTAL
2003
7
13
13
0
0
3
0
36
2004
5
1
10
0
0
2
0
34
2005
2
9
8
0
0
3
0
22
2006
1
10
7
0
0
3
0
21
2007
2008
0
0
1
3
9
6
1
0
1
0
1
3
0
2
14
14
Trend Analysis
„
Top loss source for 2008 again was cuts/contusions.
„
Sprains/stains are no longer presenting as an issue at the VMC.
„
67 % occurred on the third shift. Interesting since the first shift
represents the larger number of headcount.
„
The most frequently occurring severe injuries experiencing lost
or modified days were related to falls. Additionally we had other
falls treated at HC and not recorded on the OSHA log. Several
of these would have been recordables without the OHN(s).
„
The highest incidence of claims continues to be experienced in
areas where a higher incident rate was anticipated due to
number of employees or job duties of those involved (i.e., Press
and Machine Maintenance in 2008).
Injury Recap
2003
2004
2005
Injuries
36
34
22
# EE Lost Wk Days
3
3
3
# EE Mod Wk Days
9
14
19
# EE Hours
2,540,949
2,577,875
Incident Rate
2.60
2.66
9.4.51
2,412,650
2.64
2006
2007
2008
21
14
14
2
3
1
10
4
3
2,442,114
1.58
3,455,289 2,825,364
.81
.99
Return on Investment of OHN
Providing occupational health services on site
provides immediate injury care.
„ In 2008, our OHN(s) provided health care
triage eliminating the need for outpatient
treatment resulting in savings of
approximately $1,000 per incident.
„
Total savings represented is
$76,000.00
Additionally, due to intervention and case management by
OHN(s), Six (6) cases were denied by guarantor or because of
OHN’s intervention were not required to be sent and hence were
not work related. Avoided costs (not including potential costs of
time away from work or modified duty) are estimated below:
1 Contusion (R) Middle finger
1 Lac (L) Hand
1 Complained of Back/Hand Pain
1 Contusion/Laceration finger
1 Soft Tissue Injury
1 (R) Knee Strain
1 (R) Foot Injury
$ 5,000
$ 5,000
$90,000
$ 5,000
$10,000
$ 40,000
$ 30,000
Total savings approximated at
No Referral required
Care on site
Pre existing/denied
Tx OTC Meds
Not Recordable
Pre existing
Pre existing
$185,000
Total Savings to Company
Result of On-Site Nurses
„
Savings related to care on-site
– $76,000.00
„
Savings related to case management
– $185,000
„
Total net savings
– $261,000
9.4.51
Structure
Process
Outcome
Program Components
STRUCTURE
„
PHILOSOPHY
– Provision of health care
– Wellness initiatives
– Disability management
– Medical confidentiality
„ Integrate services of
employee health, safety and WC
„ Common reporting structure
„ Maintain productivity
STRUCTURE
OHNP Role
„
– Identifying and comparing
alternatives
– Prioritizing expectations
– Organizational
responsibilities
– Program partners
9.4.51
PROCESS
„ Medical
evaluations
„ Disability management
–WC, FMLA, ADA
„ Wellness
programs
„ Policies & procedures
„ Action plan
Outcomes
„ Quality
„ Utilization
„ Access
„ Cost
Quality
„
„
„
„
Best value for $$$
Outcome oriented
Safe, effective, appropriate
QI strategies
– Benchmarking
– Service measures
9.4.51
Utilization
„ Right
provider
„ Right place
„ Right time
Access
„ Timely
„ Appropriate
„ Productive
Cost
„ Controlled
„ Predictable
„ Benchmarked
9.4.51
Cost Continuum
Health
Prevention
Treatment
Wellness
Illness
$$
$
$$$
Safety
Prevention
Accidents
Advantages
„
Tangible benefits
‹ improved
productivity
‹ reduced absenteeism
‹ reduced health
benefits costs
‹ reduced WC costs
‹ reduced disability
costs
‹ reduced turnover
„
Intangible benefits
‹ enhanced
‹ increased
morale
loyalty
Arlene Guzik, DNP, ARNP-BC, COHN-S
VP, Business Development & Consultant Services
Lakeside Occupational Medical Centers, Inc.
7527 Ulmerton Road
Largo, FL 33771
(727) 586-0138
aguzik@lakesideoccmed.com
www.lakesideoccmed.com
9.4.51
References
•Colledge, Alan L and Johnson Hugh I., "The S.P.I.C.E. model for return to
work."Occupational Health and Safety 69:2 (February 2000): 64-69.
•Dasinger, Lis K., et.al., "Doctor Proactive Communication, Return-to-Work
Recommendation and Duration of Disability After a Workers' Compensation
Low Back Injury." Journal of Occupational and Environmental Medicine 43.6
(June 2001): 515-525.
•Dasinger, Lisa K., et al., "Physical Workplace Factors and Return to Work
After Compensated Low Back Injury: A Disability Phase-Specific Analysis."
Journal of Occupational and Environmental Medicine 42.3 (March 2000): 323333.
•DiBenedetto, D.V. Informatics: Finding disability related information on the Web.
AAOHN Journal. January 2003, 10-12.
•Guidotti, T.L. & Rose, S.G. Science on the Witness Stand. OEM Press. Beverly
Farms. 2001.
•Walker, J.M. Disabler: A game occupational health nurses cannot afford to play.
AAOHN Journal. October 2003, 421-424.
Web Resources
www.aaohn.org
www.acoem.org
www.ohsonline
9.4.51