DrJ’sPrescriptionforBetterResultsThinkLikean.ppt

1、A New Paradigm for Workers Compensation evidence is weak The questions are often NOT answerable with typical information provided, 2007 60 Summits Project, Inc.,Result: Needless Work Disability, Job Loss, uncertain about medical care Vulnerable; concerned for safety / comfort Uncertainty about the f

2、uture Their supervisors Workplace disruption Personnel management issues, 2007 60 Summits Project, Inc.,4 General and 16 Specific Recommendations,Adopt a disability prevention model. Address behavioral and circumstantial realities that create or prolong disability. Acknowledge the powerful contribut

3、ion that motivation makes to outcomes, and make changes to improve incentive alignment. Invest in system and infrastructure improvements., 2007 60 Summits Project, Inc.,1. Adopt a Disability Prevention Model,Increase awareness of how rarely work disability is medically-REQUIRED. Urgency is required

4、because prolonged time away from work is harmful.,Shift the Focus: Is This Work Disability Really Necessary? How Can It Be Averted?,Shift the Focus: Is This Work Disability Medically Required? How Can We Prevent It?, 2007 60 Summits Project, Inc.,Results of First Physician Survey,THE KEY QUESTION: B

5、ased on your clinical experience, what fraction of workers with work-related injuries and illnesses who seek medical care really need to be off work for more than a couple of days for strictly medical reasons?, 2007 60 Summits Project, Inc.,Workers Compensation Cases Requiring More Than A Couple of

6、Days Lost From Work,MD Opinion 90% of surveyed doctors said 10% of cases 50% of surveyed doctors said 5% of cases,Actual 25% - 30% of cases, 2007 60 Summits Project, Inc.,Results of Second Physician Survey,THE KEY QUESTION: What fraction of your patients with a condition that is not work-related and

7、 who have asked you to sign a form excusing them from work really needed to be off work for more than a couple of days for strictly medical reasons?, 2007 60 Summits Project, Inc.,Non-Occupational Cases Requiring More Than A Couple of Days Away From Work,MD Opinion 80% of surveyed doctors said 10% o

8、f cases 54% of surveyed doctors said 5% of cases,Actual 100% of cases, 2007 60 Summits Project, Inc.,Disability Is Medically-REQUIRED When . . .,Attendance is required at place of care Recovery requires confinement at home or in bed Acute response to injury Risk of contagion - Quarantine Need for pr

9、otected environment Work or commute is medically-contraindicated Will worsen medical condition or delay recovery, 2007 60 Summits Project, Inc.,Disability Is Medically- DISCRETIONARY When . . .,Could do something useful but . . . . “No way to get worker to work” “Worker is incapable of any substanti

10、al work” “Effort required to support the worker is more than makes sense” “Cant figure out how to provide work within these limitations” “Company policy / labor contract prohibits light duty”, 2007 60 Summits Project, Inc.,Disability is Medically-UNNECESSARY When . . .,Medical care is inadequate or

11、delayed “Medical” time lost from work is really due to: Communications delay / poor information flow Ignorance or resistance (patient, employer, doctor) Administrative / procedural delay Other problems masquerading as medical Flabby management, poor accountability, 2007 60 Summits Project, Inc.,1 Mi

12、nute RTW Screening Test,1. What impact is the problem with your _ going to have on your ability to do your usual job the regular way? 2. Have you figured out a way to work around it while you recover? 3. Are you going to have any problems with your boss or co-workers about that?,No YES Yes NO No YES

13、,No/low risk Risk/refer, 2007 60 Summits Project, Inc.,Restrictions and Limitations,RESTRICTIONS A MEDICAL issue RISK - What the worker SHOULD NOT do What the employer SHOULD do May be modified only by the MD If not followed, medical harm may occur.,LIMITATIONS An ABILITY issue CAPACITY - What the w

14、orker CAN do today MD is serving as an objective assessor May be modified by agreement Little/no medical harm if not followed,Are chronic pain and fatigue really medical issues or humanitarian ones? “Tolerance”, 2007 60 Summits Project, Inc.,The Grocery Store Test,If s/he owned his/her own “mom n po

15、p” grocery store, would s/he be able to find a way to work safely? If YES, then absence from work is probably not medically required. That means a NON-MEDICAL aspect of this situation, not the medical condition, is creating the disability., 2007 60 Summits Project, Inc.,Time Is Of The Essence,At 12

16、weeks, employees have only a 50% chance of ever returning to work., 2007 60 Summits Project, Inc.,Work Disability Prevention = Reduce Needless Absence,Medically REQUIRED Disability,Medically DISCRETIONARY Disability,Medically UNNECESSARY Disability, 2007 60 Summits Project, Inc.,2. Address Behaviora

17、l and Circumstantial Realities,Peoples normal human reactions need to be acknowledged and dealt with. Investigate and address social and workplace realities. Find a way to address psychiatric conditions effectively., 2007 60 Summits Project, Inc.,3. Acknowledge Motivation and Align Incentives,Pay do

18、ctors for disability prevention work to increase their commitment to it. Support appropriate patient advocacy by getting treating doctors out of a loyalties bind. Increase availability of on-the-job recovery and transitional work., 2007 60 Summits Project, Inc.,3. Acknowledge Motivation and Align In

19、centives (contd),Reduce distortion of the medical treatment process by hidden financial agendas. Be rigorous, fair and kind to reduce minor abuses and cynicism. Devise better strategies to deal with bad faith behavior., 2007 60 Summits Project, Inc.,4. Invest in System and Infrastructure Improvement

20、s,Educate physicians on how to play their role in preventing disability. Disseminate evidence on the benefits for recovery of staying active and at work., 2007 60 Summits Project, Inc.,4. Invest in System and Infrastructure Improvements (contd),Improve and standardize methods of information exchange

21、 between employers / payers and medical offices. Improve and standardize the methods and tools that provide data for SAW/RTW decision-making. Increase the study of and knowledge about SAW/RTW.,Compare Traditional Paradigm (Claims Processing) vs. New Paradigm (Work Disability Prevention), 2007 60 Sum

22、mits Project, Inc.,Traditional Assumptions Underlie the Claims Processing Paradigm,When they are injured, people will receive appropriate medical care and will know how to manage the life and work disruption that goes along with it. Since workers comp is a medically-driven legal system, our main job

23、 is to observe and evaluate the situation, administer the law, and pay benefits when they are due., 2007 60 Summits Project, Inc.,Traditional Assumptions (contd),Work absence or disability is necessary after illness and injury. The duration of work absence reflects the severity of the illness or inj

24、ury. Work avoidance assists in recovery from illness or injury, so it is good. Tragic situations and “bad people” cause most loss costs., 2007 60 Summits Project, Inc.,New Assumptions Underlie the Work Disability Prevention Paradigm,Much of todays work disability could be foreshortened or averted en

25、tirely because work absence is usually not medically required for more than a few days after illness and injury. Being active during convalescence speeds recovery, while extensive work avoidance and “rest” tend to delay it., 2007 60 Summits Project, Inc.,New Assumptions (contd),Prolonged absence or

26、permanent withdrawal from work is usually bad for peoples well-being - mental, physical, social and economic. Prolonged withdrawal from work is usually being driven by non-medical factors instead of medical ones, especially lack of suitable work., 2007 60 Summits Project, Inc.,New Assumptions (contd

27、),Today, many people may need instruction, advice, or even one-on-one assistance in: how to navigate the healthcare system; how to select doctors who provide effective care; how to cope best with a health-related employment situation. The majority of problematic high cost claims begin as innocuous a

28、ppearing medical problems, and go south because of the way non-medical aspects of the situation have been handled., 2007 60 Summits Project, Inc.,Sad Sam Lucky Lou,Bad disc; surgery Mediocre work history Weak supervisor Supervisor never called: “They will handle it” Teasing by co-workers Disabling d

29、octor “Stay home until youre able to do your job.” PERMANENT DISABILITY,Bad disc; surgery Mediocre work history Good supervisor Supervisor kept in touch: “We need you” Support from co-workers Function-oriented MD “Stay active; be useful” Transitional duty; adaptive equipment BACK TO WORK IN 6 WEEKS,

30、About The 60 Summits Project, 2007 60 Summits Project, Inc.,History,ACOEM WDP Guideline approved Now what? Create a mechanism to get the recommendations ADOPTED and IN USE Not an ACOEM project First an impulse, now a non-profit, 2007 60 Summits Project, Inc.,The Idea,Goal: Propagate the new paradigm

31、 across North America. Create a mechanism to get the guidelines off the paper and into action. Convene meetings in 50 US states + 10 Canadian provinces At the Summits, get people inspired, collaborating, and then get them in action creating positive change, 2007 60 Summits Project, Inc.,How Does It

32、Work?,Feasibility Session Local team decides to hold a Summit Planning Phase Local team plans event and invites stakeholders The Summit Meeting Multi-stakeholder event; workshop format Use the Guideline as a discussion framework Small groups consider each recommendation Do we want to do this? How ca

33、n we make it happen? What is a concrete first step? What starts tomorrow? Follow-up groups Make it happen!, 2007 60 Summits Project, Inc.,Progress to Date,Summits already held (2006 -8) : OR (2), NM, Northern CA, ND (4), MN Summits scheduled (2008): OH, MT (3), AZ, FL New Summit planning groups: BC,

34、 MA, MI Next states: TX, TN, ME, SC?, 2007 60 Summits Project, Inc.,Recap,ACOEMs Work Disability Prevention Guideline A new (improved) paradigm A blueprint for process improvement A framework for building: a shared positive vision a “first class” workers compensation system The 60 Summits Project A mechanism to propagate the new paradigm, 2007 60 Summits Project, Inc.,How to Prevent Needless Work Disability In ANY Kind of Claim,Speed recovery from the medical