Strategies for a Better Return-to-Work Process

That costs escalate as work loss persists is an obvious truism in workers’ compensation. Facilitating a quick return to work after an injury yields better outcomes for both the employer and employee. While a majority of claims result in a prompt return to work (RTW) and closure, those that stretch out month after month can wreak havoc on costs as well as the perception of the system. So what kind of strategies can be employed to assist the RTW process?

Stop injuries before they happen. RTW is not an issue if the injury never occurs. While workplace safety initiatives have been around since the invention of the wheel, the trend is toward advocating for better health and well-being of employees. Financial incentives to lose weight or stop smoking and on-site gyms or walking trails promote better lifestyle choices. Healthier cafeteria and vending machine options promote better nutrition. The introduction of wearable fitness technologies—such as the Fitbit device that measures and reports daily steps, heart rate, sleep patterns, and more—is increasing the awareness of fitness and becoming part of the dialogue on wellness.

Engage early. Workers’ compensation is filled with stories where a relatively benign injury becomes physically and financially catastrophic over time due to inappropriate care, inattentiveness, or a poorly motivated employee. Early intervention can keep small issues from becoming large and expensive ones. These can include clinical resources at the jobsite or telephonic nurses triaging the injury. Addressing injuries expeditiously and ensuring the availability of appropriate treatment options from the best providers can help reassure employees that they are valued, which lessens the chance of an attorney becoming engaged. According to the Workers Compensation Research Institute’s 2012 annual report, costs are higher and RTW outcomes are poorer when employees select providers, so providing the best care sooner delivers great value.

Get back to work. For a large number of Americans, work provides a sense of self-esteem, achievement, and socialization that typically cannot be found elsewhere. In its absence, anxiety, depression, and decreased motivation can complicate whatever physical issues may have arisen from the injury. Lack of activity, reduction in cognitive stimulation, and remoteness in relationships can soon follow. So finding a job—any job—that will return an injured employee to the workplace is important. The state of Washington actually pays employers 50 percent of the base wages and the costs of training for returning the employee to a light-duty or transitional job in its Stay at Work program. According to a July 19, 2012, article on EHStoday.com, Washington State Department of Labor & Industries reimbursed $2.5 million to 568 employers and helped 1,200 injured workers remain on the job within the first year of the program.

Limit opioids. An April 2009 study published in PAIN, the journal of the International Association for the Study of Pain, of nonspecific low back pain workers’ compensation claims found that the use of Schedule II opioids increased the possibility of chronic work loss (defined as greater than 90 days) by six times. Any opioid used for longer than a 90-day period increased the odds of chronic work loss by 11-14 times. At three years post-injury, the cost of claims for patients prescribed at least one Schedule II opioid averaged $19,453 more than those patients not prescribed the drug.

Educating physicians and employees on the impact of opioid use is paramount. Utilizing the tools offered by a pharmacy benefit manager, such as analysis for identifying trends, letters to physicians based on pharmacological triggers, or a custom drug formulary with a prior authorization mechanism to prompt intervention, can be very helpful. Knowing how to leverage jurisdictionally specific tactics, such as utilization review, independent medical examinations, or peer reviews, also is important.

Focus on function. Post-surgery rehabilitation tactics increasingly have emphasized restoring activity quickly (e.g., the patient is made to walk to the bathroom soon after surgery). Moving is often the best restorative option for the human body after surgery or injury. While “work hardening” is a term that has fallen into disfavor due to past practice abuses, the concept of restoring function by replacing lethargy with activity still is very sound. Whether it is physical therapy, aqua therapy, yoga, or just walking to the mailbox, activity and the endorphins that come from exercise will result in a quicker return to function and, thus, a quicker RTW. All evidence-based medicine agrees: active, conservative therapy is the best healer.

Psychosocial. Workers’ compensation, and health care in general, traditionally has focused on the biomedical concept of fixing what is physically wrong. However, there is an emerging realization that a biopsychosocial paradigm—addressing what is wrong with the body plus what is happening between the ears plus what is happening at home—is the best approach for restoring health and function. A tool that is becoming more accepted is cognitive behavioral therapy (CBT), which assesses and addresses attitudes and behaviors that can impact and, in some cases, sabotage the RTW process. Issues such as catastrophic thinking (when patients say pain is 473 on a scale of 1 to 10), perceived injustice (retribution is required), or history of childhood abuse (which predisposes people to addictive behaviors) can strongly impact an individual’s ability and even willingness to get better. Identifying psychosocial issues early in the claim can help identify injured employees who will benefit from additional assistance in their recoveries.

Being proactive and intelligently applying tactics that best fit a workplace can save not only time and money, but also the relationship between the employer and employee.