Case management slashes workers' comp costs
Safework program reduces lost days by 74%
A program of aggressive case management - including appropriate medical evaluation, transitional duty, and injury analysis and prevention - has significantly reduced lost time and workers' compensation costs at The Christ Hospital in Cincinnati.
The Safework program was launched in January 1995 when administrators became determined to gain control of injuries and costs.
"In 1994, individual costs for workers' compensation were the highest they had ever been," says Mary Anderson, RN, COHN, nurse case manager in the occupational health department at the 3,600-employee facility. "Administration wanted to make an all-out effort to do whatever we could to bring those costs down."
That effort has paid off in a savings of $696,000 in total workers' compensation costs in the program's first three years. (See chart detailing savings on p. 76.) Workers' comp cases decreased from 112 in 1994 to 70 in 1997, with lost days falling from 1,608 missed days of work in 1994 to 411 missed days in 1997, a 74% reduction. Those results earned The Christ Hospital a 1997 Workers' Compensation Innovation Award, one of only three presented in the United States by the National Managed Workers' Compensation Institute.
Anderson, an employee health nurse at the hospital for 15 years prior to holding her present position, follows injured worker cases from start to finish. One essential key to the program's success is light-duty or transitional work for employees who are unable to return to their jobs at full duty for medical reasons. While approximately 70% to 80% of injured workers can be accommodated in their own departments, Anderson maintains an extensive list of light-duty jobs throughout the hospital for those who cannot.
"We have job descriptions for all of the light-duty jobs," she explains. "The list includes the location of the job, what it involves, the hours, the dress code, and all the general information we need to know - most importantly the physical requirements of the job. I match that up with the [employee's] restrictions and skills. I try to get a good match and keep them here at work as much as possible."
Light-duty jobs might involve help with office work, such as filing, copying, and stuffing envelopes. Registered nurses often can be placed in risk management and quality assurance jobs, while other employees with suitable skills can greet visitors, answer phones, or work at computers.
Anderson says she locates jobs by sending memos and e-mails to managers, who often are grateful to get additional help.
"Managers are more open now to making accommodations for people with restrictions to come back to work. They realize there are a lot of things injured workers can still do for them," she notes.
Injured employees generally are eager to cooperate as well. "It's all in the presentation," she says. "I have a real song and dance that I do. When people understand all the advantages, they realize that this is an opportunity for them."
One major advantage is remaining on full salary instead of a reduced wage under workers' compensation, but Anderson says injured employees who return to work right away also recover faster and avoid the tendency to magnify their symptoms and become depressed, withdrawn, and isolated at home. Most employees can return to work in a light-duty job less than a week after being injured, she adds. (See related story, above.) The average time on light duty is two to three weeks.
Workers on light duty are paid by the departments for which they worked when injured, a policy that "keeps safety on the manager's priority list," says Mary Jo Wakeman, MD, Safework's medical director and an occupational health physician. "It's always a cost to the system, but if you have the accounting on a separate budget, then the manager has no incentive to get that person back. If you let people get back, they do better. If everyone stays healthy and functional, the manager's life is better."
Wakeman notes that the return-to-work program is only one of three main components of the Safework program. Aggressive case management also involves evaluation and treatment by physicians who understand injury care.
"What happened before [the Safework program] is when someone got hurt they went to their family doctor or the emergency department or someone else; it was very self-directed. They didn't necessarily end up in the care of physicians who are accustomed to treating and returning injured workers. We found [doctors] with a musculoskeletal focus and a safe return-to-work focus who understand that we're more interested in the person getting better and getting back than in micromanaging the dollars of the case," Wakeman says.
Working with treating physicians is an entire case management team, she points out, consisting of a representative from human resources, a workers' comp case manager, Anderson as nurse case manager, a physical therapist, an occupational health nurse practitioner, and Wakeman as the medical director. The team meets weekly to discuss each injury case and keep care on track.
Prevention is the program's third component. It begins with understanding the physical requirements of each job and hiring "the right people" into jobs to minimize injuries, Wakeman says. A screening questionnaire helps in the hiring process. Prevention also involves constantly monitoring injury reports to find and analyze injury clusters.
"We have to keep looking for where the injuries are," Wakeman explains. "That changes over time. We're constantly looking for hot areas where there might be a problem. Is there an extra-high patient load? Is staffing down? Has there been a change in management style? Once we found injuries that were clustering around a 450-pound patient, but injuries can be unexpected if any patient passes out or falls or moves suddenly."
Low back and shoulder injuries from patient lifting and transfer are the most common injuries reported, and prevention of future accidents might require retraining by physical therapists.
Prevention efforts continue when employees have returned to regular job duties. To ensure that they are able to stay at work, the nurse case manager makes follow-up calls to check on their condition. In cases of serious injury, physical therapists might perform a job-site analysis to evaluate jobs and coach employees on a safe return to work.
The Christ Hospital will soon expand its Safework program to four other associated health care institutions in the Health Alliance network. Wakeman says the program's efforts have paid off in more ways than one.
"The greatest benefit is the injury that never happens," she says.
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