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An integrated workers' compensation management system
At a glance:
In this study return to work was improved and workers' compensation costs were reduced by:

Using a small network of skilled health care providers
Maintaining constant communication between all parties (health care providers, work supervisors, employers and injured employees).
This study demonstrated that return to work can be improved by a company focusing on active management. Traditionally, return to work has been thought to be dependent on the medical condition. The medical condition is important, particularly in clearly diagnosed conditions such as a laceration, or a fracture. However over the last 10 years a number of studies have shown that many factors play a role in return to work.

It is important for an individual's long-term well-being that return to work occurs early. If your employer does not have a strong company program, you can be an advocate for change. Encourage your employer to look at systems to improve return to work, both for your case and others.

Good communication, a team approach, and positive input from all involved help people back to work and improve long term health outcomes.
This study show that a coordinated approach to return to work can produce significant improvements in:

Lost time
Claim costs
Lost time injuries
Medical expense claims
Permanent disability

This effective approach considers the employees' physical and psychological well-being and includes early reporting, prevention of injuries and a strong system of return to work management.

There is no one right way to manage return to work. This and other studies have shown that a whole of company approach, involving employees, management and fostering a team approach with other stakeholders produces more positive outcomes. Key elements of this program were good medical care through experienced and trained treating practitioners and a strong focus on follow-up through a case manager. All of the company staff, such as supervisors and human resource officers and other professionals, were involved in the case and claims process. The level of cost saving was highly significant.

The system was not difficult to introduce, but required a high level of focus. Senior management engagement is an important factor in the implementation of such a system.
Workplace factors are major determinants of return to work outcomes. Treating practitioners need to provide quality medical care that supports and focuses on return to work. However major improvements in return to work can be made through strong workplace systems.

Treating practitioners can encourage employers to understand that return to work management is best undertaken through a coordinated approach. Companies are more likely to embark on this type of initiative when they understand the benefits. Explaining that improved health outcomes can be achieved through such a system increases corporate awareness and the likelihood a company will adopt such an approach.
This study shows the benefits of a company-wide coordinated approach to managing work disability. Outcomes are improved if all the ‘players are on side'. In this case safety staff, supervisors, human resources, and employees were all involved and active participants. Senior management commitment makes implementation of such a system easier and more successful. Encourage your employers to look at adopting improved company-wide systems to manage return to work.
Original Article, Authors & Publication Details:
E. J. Bernacki1 and S. P. Tsai1 (2003).

Ten years' experience using an integrated workers' compensation management system to control workers' compensation costs. Journal of Occupational and Environmental Medicine; 45:508-516

1Division of Occupational and Environmental Medicine, Department of Medicine, John Hopkins School of Medicine, Baltimore, Maryland.
Background, Study Objectives, How It Was Done:
Between 1987 and 2000, employers' costs for workers' compensation in the U. S. increased from $38 billion to $56 billion, about 4% per year. However, the number of compensated injuries decreased by 2% per year over the same period. This suggests that while working conditions are improving (reducing the number of workplace injuries), the cost of medical care and disability after injury has increased.

Governments have tried to reduce the costs of workers' compensation by instigating managed care programs, with varying degrees of success. This study describes the refinements made over 10 years to a program that allows safety professionals, adjusters and medical and nursing providers to collaborate in a process of preventing accidents and effectively identifying and treating conditions to help people return to the workforce.

The study followed the John Hopkins Workers' Compensation Program between 1992 and 2002. The majority of people insured by this program were from the City of Baltimore, Maryland, with 21,000 employees covered by the program in 1992 and 39,000 in 2002.

Under the Maryland Workers' Compensation System all employees have the right to choose their medical provider. Medical care and payments for lost wages (if the injury can't be accommodated within the workplace) are paid by the employer's workers' compensation plan.

Features of the John Hopkins Workers' Compensation Program:

At the end of 1991, the John Hopkins Workers' Compensation Office was placed within the Health, Safety and Environment Department. This meant that health, safety and occupational medicine were managed along with claims.

1. All parties (safety staff, employees, supervisors, human resources officers, medical and nursing professionals, insurers and attorneys) were encouraged contribute in the claims process.

2. Early reporting, prevention, patient support and facilitation of care were encouraged in managing claims.

3. An injured employee's psychological and emotional needs were considered an important part of treatment.

4. A small network of physicians, trained in occupational medicine, gave workers' compensation patients specialty care. Medical management guidelines were constructed by this group of doctors.

5. A medical management workshop met twice a month and a claims management workshop met once a month to plan the best management for each employee.

6. A nurse case manager reviewed all cases and referred the employee to specialist doctors for opinion. The nurse was responsible for authorisation of diagnostic testing, medical treatment, surgery etc.

7. The program was highly integrated, with information communicated in workgroup meetings or by fax until 2002 when new software was used that allowed access by all parties to information relating to their discipline. Occupational medicine physicians provided primary care, the nurse case manager followed the patient's progress, safety professionals assessed workplace environments in which strain or accidents occurred, and worked with the nurse case manager to help injured workers get back to work.

8. All employees with work-related conditions were directed by their supervisors to report immediately to one of four occupational injury clinics for evaluation and treatment. They were asked to fill in an incident form describing the location and circumstances of the accident. The Health, Safety and Environment department were contacted to investigate significant accidents.

All employees who filed a workers' compensation claim for a work-related injury or illness between 1992 and 2002 were included in the study. Information was obtained from the John Hopkins Workers' Compensation Program files, the Maryland Workers' Compensation Commission, the Treasurer's Office of each employer and the John Hopkins University and Health System financial offices.
Study Findings:
Between 1992 and 2002:

1. The number of employees covered by the John Hopkins Workers' Compensation Program almost doubled, from 21,000 to 39,000

2. The number of lost time claims decreased from 457 to 195

3. Rates of lost time claims decreased from 22/1000 employees to 6/1000

4. Rate of medical only claims decreased from 155/1000 employees to 61/1000

5. The number of work days lost fluctuated, but overall decreased from 34,200 to 14,500

6. The number of work days lost per 100 employees decreased from 163 to 37

7. Overall expenses were reduced from 81c per $100 of payroll to 37c per $100 (54% reduction)

8. Temporary/total losses per $100 of payroll decreased from 18c per $100 to 7c per $100

9. Permanent/partial losses per $100 of payroll decreased from 19c per $100 to 7c per $100

10. Workers' Compensation Hearing rates decreased from 5.3/1000 employees to 2.5/1000, suggesting that conflicts between managers, supervisors and claimants had decreased.
The John Hopkins Workers' Compensation Program attempted to reduce injury rates and the cost of workplace injury by implementing an integrated system for reporting and management of workplace injury. By using a small network of skilled health care providers who addressed each individual's psychological, as well as physical needs, closely following patients' progress and maintaining constant communication between all parties (health care providers, work supervisors, employers and injured employees), the costs of workplace injury were significantly reduced.

Lost time claims were reduced by 73% over 10 years using and improving the program, three times the decrease observed in the rest of the state. Likewise, medical only claims were reduced by 61% between 1990 and 1999 while remaining unchanged in the rest of the state.

In September of 1994 a survey was conducted (by an independent consulting company) to study the satisfaction of claimants in the John Hopkins Workers' Compensation Program. The survey asked participants to rate the program on a scale of 1 to 5, and the average score was 4.36.
PubMed Abstract