Now on to the real stuff – deep research into issues of interest only to we real work comp geeks.
Dr Bogdan Savych started off this brief and information-stuffed session.
Across 15 states, 14 percent of workers with lost time injuries didn’t have a substantial and persistent return to work (this is PRELIMINARY and subject to change) – why? what drives this?
Among the biggest drivers – workers who strongly agreed that they were afraid of being fired or laid off had “worse outcomes.” As over a quarter of workers fell into that category, that’s a big issue. There are both literal interpretations of this – perhaps the worker was justified in fearing a layoff and broad interpretations of this – perhaps the work environment was low trust. These workers were also more likely to hire an attorney.
Takeaway – the employee’s work environment, and interpretation of that environment, is a major driver of “permanent disability.” So, think less about medical issues, and much more about these “other” drivers.
Glenn Pransky of Liberty Mutual was next up. Dr Pransky is one of the industry’s leading researchers on disability issues (kudos to Liberty for continuing to support the Center for Disability Research and similar efforts.
Glenn noted that one driver was the patient’s communications with the payer. Workers were sometimes thrown off by negative language used by the claims adjuster in the initial encounter or call. If they feel their needs aren’t being taken into account or they are being treated unfairly they are more likely
The top return to work coordination skill – communications. That’s the result of research conducted in Canada about a decade ago, research that is very likely true today. In fact, Glenn and others conducted a study a few years back that evaluated the impact of improving the initial contact with the case manager, focusing the patient on problem solving and not using words like “claimant, investigation, liability, etc.
What’s interesting here is this is – in large part – old news, yet we still need to hear this.
More importantly, to paraphrase the previous White House, we need to STOP doing stupid stuff.
Clearly we KNOW this language, the style of communication, the employee’s workplace satisfaction are critically important to disability. Yet far too often we still talk to patients not as people but as “claimants”, and treat patients as legal claims, not as people.
Takeaway – treat patients as you would want to be treated.
Great summation, although a huge part of return to work is getting the employees to the right Occ-Med physicians who know that they must win the trust of the injured employee. The provider needs a stay at work/return to work focus from the initial visit. These urgent care centers cropping up on every corner just don’t get it. As Occ-Med docs we train our employers to show care and concern for the “real injuries” and develop a plan to keep them on-the-job.
With the exception of payment methods, medical care should not be different for comp or general health care patients. You would not treat a heart attack victim the way many treat the injured worker, so until we recognize the worth and dignity of injured workers is the same as the worth and dignity of the heart attack or cancer victim, this will not change. You are right. Treating as a case and not as a person is the problem.