By John R. Anderson, D.O., Senior Vice President – Medical Operations, Concentra
Problems and the Beginnings of a Possible Solution
Over the last several decades, the workers’ compensation system has become increasingly complicated and complex. Not only are there myriad stakeholders (employers, employees, payers, third-party administrators, nurse case managers, physicians, attorneys, adjudicators, and others), but there are also very different regulations imposed on these stakeholders by each state, resulting in a varied patchwork of treatment guidelines, fee schedules, and rules of engagement.
Therefore, it is not surprising that many of the solutions to problems identified in the current state of workers’ compensation have also been complicated and complex. These problems, ranging from issues like medically unnecessary disability, to poor communication between stakeholders, to administrative inefficiencies, are part of a long inventory, with an even longer list of suggested remedies.
Yet, we would do well to remember that through the ages, gifted people ranging from Leonardo da Vinci to Albert Einstein have extolled the benefits of simplicity. And versed in both arts and sciences, Hans Hofmann said, “The ability to simplify means to eliminate the unnecessary so that the necessary may speak.”
In dealing with workers’ compensation injuries and illnesses, “the necessary” is the therapeutic relationship between the physician and the injured worker, his patient. The worker who becomes a patient is at the center of the entire system.
Unfortunately, some of the current and proposed remedies to high costs, lost time, and other often mentioned problems could well have negative effects on patients, the very people who are at the heart of this debate. Changes that could potentially slow down or interfere with the injured worker’s journey of recovery on the way to resuming “normal life” should be reconsidered, given the risk of the unintended consequences of even further delayed recovery, acrimony, litigation, and more avoidable disability.
It seems to us that a solution to many of the woes and frustrations in the worker’s compensation system is simply clinical excellence, with medical care provided by physicians skilled in both the practice of evidence-based medicine and the management of the process of return-to-work.
Clinicians who understand their role in the process of return-to-work fully appreciate that their goal is to provide the best treatment in a timely manner, while encouraging and helping their patients to stay as active as possible within parameters appropriate to the injury or illness. This proves to be in the employers’ and payers’ best interests, as well the patients’.
However, simplicity is rarely easy to achieve. Indeed, it is often much harder to attain than complexity. The “clinical excellence” solution calls for clinicians who do not merely pay lip-service to evidence-based medicine, but actually practice it, and who are willing to work with both patient and employer to expedite return to work. Executing this also requires a partnership with other stakeholders in the process. Clinicians cannot get to the best outcomes alone, but need employers and payers who aspire to the same goal of helping patients “get their lives back.” And they need patients who are educated and informed about the workers’ compensation system, so they understand how to proceed after an injury, and do not feel like they are alone, lost in a dark, dangerous place, living with fear and pain as constant companions.
We are aware of the fact that this is a challenging goal. It is no secret to anyone who has dealt with workers’ compensation cases that knowledge about the best practices in getting patients back to work is a missing link in general medical education.
The reality is that most clinicians get very little (if any) formal training in Occupational Medicine or workers’ compensation, either in medical school or during their post-graduate experience. Nor have most even had access to informal training which might have established a foundation for an understanding of the crucial psychosocial factors needed to effectively manage WC cases.
They are rarely taught about the research which shows that returning to normal activities as quickly as possible after a work injury is critical for a patient’s physical and emotional recovery, as well as his economic well-being. And since their training didn’t cover writing appropriate activity restrictions and limitations, many clinicians find it safer, quicker, and easier to keep patients off work until they are ready to return to their regular duties.
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.
About Concentra
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.