By John R. Anderson, D.O., Senior Vice President – Medical Operations, Concentra
Editor’s Note: Click Here to read Part 1.
The Workers’ Comp Solution Comes Full Circle
In the current landscape of workers’ compensation, many clinicians lack the training to recognize that they could play a role crucial to good outcomes by promoting early return to work. They often don’t realize that by keeping someone off work when it is not medically necessary, they could well be creating a “disability mindset” in that patient, thus making eventual return to work so much the harder. And since they have not experienced it, they often don’t appreciate that a partnership between the treating clinician, the injured worker and the employer is beneficial for all.
We know that medically unnecessary disability exacts a high price from patients, employers and payers, and is one of the huge frustrations with “the system.” When not working, injured workers lose out on the self-respect that comes from earning a living, the sense of identity that comes from their occupation and social relationships with their co-workers. With a decrease in physical activity, they also lose muscle strength and tone. Medically unnecessary disability burdens employers with higher costs, and adds indemnity and administrative costs to payers as well.
We understand that the dissatisfaction and disappointments engendered by this type of avoidable waste have led to some of the multi-pronged solutions which impose checks on physicians, erect barriers to expedited care, and increase the complexity and complications as a case unfolds. This has led to a situation in some states where dealing with the WC system has added such burdensome and costly administrative requirements to a medical practice that navigating the system can at times seem a tortuous and torturous process.
Khalil Gibran said, “The obvious is that which is never seen until someone expresses it simply.”
To us, it seems obvious that return-to-work could and would become a relatively smooth and simple process if employees, employers and payers worked with physicians who have demonstrated clinical excellence when an employee with a work-related injury or illness needs medical evaluation and treatment. It also seems plausible that when working with experienced clinicians savvy about workers’ compensation, many of the expensive administrative solutions promoted might well become unnecessary much of the time.
And we don’t think we’re being naïve when we see this as a possibility, rather than an impossible dream. Granted, there is a lot of work to be done. But we have many colleagues across the country, both within our system and working with other healthcare systems, who are deeply committed to and desirous of providing care that is truly “best-in-class.” There are medical leaders working with other WC stakeholders as part of a grassroots movement to stamp out medically unnecessary disability, not just in the United States, but in Canada, England and Australia as well. There are already large numbers of clinicians who understand that their commitment to avoiding disability makes them employers’ natural allies in keeping down costs.
Given the relative paucity of Occupational Medicine residency programs, the inclusion of disability management training in other primary care specialties should be an objective. And since most medical training programs rely in part on public funding, we can all ask our political leaders to require that medical schools and post-graduate programs add training in medical disability management to the curriculum.
Employers and payers should seek clinicians who have had exposure to this information, who practice accordingly, and whose outcome data demonstrates effective application of these principles. Moreover, both employers and employees would also benefit from training in the benefits of Return-to-Work/Stay-at-Work programs, and such training could help establish a foundation for the therapeutic patient-physician alliance that is needed to optimize medical and financial outcomes.
T.S. Eliot said, “Sometimes things become possible if we want them bad enough.” To that, we would add, cost-effective, high quality medical care in the WC arena is possible if enough of us are willing to work together in the effort to attain clinical excellence, and to make it widely available.
About Dr. John Anderson
John Anderson, D.O. is Concentra’s Senior Vice President of Medical Operations, and serves as a key expert of business health issues and planning to many Fortune 500 companies. Dr. Anderson oversees the company’s occupational medicine practice, has served on the quality oversight committee, and is involved with the company’s coding and chart audit initiatives.
He helped to develop the workplace health and wellness model to improve access to medical care for employees and reduce employer health care costs. He is board certified in both occupational medicine and health care quality management. He has served as an appointed member of the Michigan Workers’ Compensation Advisory Council and Wayne State University’s Occupational Medicine Resident Advisory Committee. He is co-editor and an author of the acclaimed book: Low Back Pain: An Evidence-Based, Biopsychosocial Model for Clinical Management.
Dr. Anderson is a graduate of John Carroll University and Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine.
Concentra, a subsidiary of Humana Inc., is a national health and well-being organization delivering effective health care solutions with innovative technology platforms, patient-first focus and clinical excellence. As a leader in consumer health care services, the company offers an expansive destination for great medical care with primary and urgent care services, physical therapy, occupational medicine, and preventive care and wellness services. With its exceptional patient experience, more than 330 national medical centers, 270 workplace health clinics and direct-to the patient services, Concentra is improving America’s health, one patient at a time.