Thursday, October 3
Izabela Schultz, PhD – Evidence-Informed Approach To Early Identification And Intervention In Occupational Disability
Occupational disability is preventable by targeting modifiable predictors of return to work. Research has accumulated to develop an integrated biopsychosocial approach to high risk claim identification and early intervention in musculoskeletal pain, mental health and neurological disorders, the key drivers of nonvisible disability epidemic. This presentation will discuss current advances in applying best existing research evidence to practice in workplace, insurance, compensation and clinical contexts.
- Describe the significance of identifying modifiable and non-modifiable predictors of occupational disability for improved outcomes of early intervention and return to work.
- Explain the types of individual and workplace predictors of disability that may be targeted by early intervention.
- Discuss how employers, insurers and clinicians can work together and separately to achieve early effective intervention and improve return to work outcomes by targeting modifiable risk factors for disability.
Carrie Davino-Ramaya, MD – Taming the ‘Elephant’: Reducing Intermittent FMLA Using Medical Appropriateness Criteria and a Centralized Medical Review Team
The adverse impact of FMLA on productivity continues to be a major challenge facing employer groups. While attempts to address these challenges administratively continue to rise, so too does FMLA utilization. Our evidence based medical review process applies a comprehensive assessment of the patient’s medical record in relation to the FMLA request with the goal of reducing medically unnecessary ill time while capturing the member’s voice. Our emphasis on “medical ability” keeps members engaged in work activities when appropriate. Our model demonstrates that FMLA is not the “elephant in the room” but is just one part of the treatment plan when medically appropriate.
- Explain the role of a centralized medical review team as an extension of all medical teams to review FMLA.
- Discuss the importance of tool(s) to document ability; ill time; modified duty, return-to-work.
- Describe the systematic evidence-based approach in determining medically appropriate FMLA, etc.
- Discuss the medical appropriateness review and its impact on monitoring treatment plans; decreased ill time and importance of capturing patient’s voice.
- Summarize the role of the centralized medical review team in decreasing clinicians’ time spent on paperwork.
- Evaluate the impact of ill time & value of the centralized medical review team processes on employer group cost savings/satisfaction.
- Discuss the concept that ill time absence is NOT the endpoint and is only one part of the treatment plan with emphasis on “ability” rather than disability.
Linda Riddell, MS – Did it work? Using accurate, meaningful measures to choose and sustain successful programs
Everyone wants to know what works and what doesn’t, but how to get there? In this presentation, Linda Riddell, a population health scientist, will go through the elements of measures and explain how to tell good and valid from high and hyped. With these skills, a person can weed out ineffective, low value programs and focus on high impact ones instead. This conserves time, money, and manpower and can ultimately lead to better employee health and safety.
- Explain how to demand and get solid evidence that the program has led to the results claimed
- Define a target population
- Describe whether a measure meets basic requirements of validity
- Assess the reasonableness of the results claimed
Rana DeBoer – The Employer’s Role and Connection in Preventing Disability: Can We Radically Reduce Workplace Disability Through Humanistic Leadership?!
If you ask any employer to describe their role in injury prevention and the return-to-work journey, they typically talk about tactical processes. Few employers can talk about how integrating health and human performance elements support and guide the whole person through optimal recovery and return-to-work. The human elements to a thriving work and life include both physical and psychological, from leadership and culture to job sculpting and the physical environment to relationships and self-efficacy. However, and most importantly, is the employer role and connection of these elements. An employer can facilitate an ideal recovery environment by focusing on the drivers of engagement and creating understanding and collaboration among all parties for human-centered care. Gone are the days of primarily pushing paperwork, today employers must learn the conditions for human flourishing and create strategies to adopt these into the work environment, for the radical reduction in workplace disability. Told through the real-life experience and learnings of an employer.
- Discuss the role and goal of an EAP program to overall employee and organizational functioning, and identify when and where it fits into the pre-, during, and post-injury process.
- Explain the insights – successes, failures, and opportunities – of real-life business stories of EAP integration
- Describe EAP as tool and not just a service, one that organizations can deploy with employees and supervisors; evaluate internal opportunities for the EAP-Work Comp connection (worksheet discovery, then open up for sharing for deeper learning)
Thursday, October 4
Mark Pew – Impairment <> Disability
Often impairment is treated as being synonymous with disability. While someone can certainly be disabled from being impaired by drugs or alcohol (a very real concern to employers and law enforcement), in the healthcare setting they are two separate concepts. Impairment is what you cannot do. Disability is what you think you cannot do. How else to explain how some people with catastrophic injuries or illnesses continue to live a productive (albeit in a different manner) life while others retreat into the abyss? Some impairment can be prevented – don’t drink too much, don’t take those drugs – while some cannot – reduced cognition with age or psychosocial co-morbidities from the past/present. Some disability can be prevented – resilience, individualized coping mechanism, positivity – while some cannot – a broken neck, Parkinsons. This session will highlight ways in which preventable or overcomeable impairment and disability can be encouraged by our bosses, colleagues, healthcare provider, family and friends. And ourselves.
- Discuss that we live in a society that is impaired, voluntarily and involuntarily, physically and psychologically
- Describe the various methods of impairment – Injury, Rx and illicit drugs, alcohol, psychosocial issues, aging, etc.
- Explain that impairment does not have to equal disability
- List methods by which impairment can be identified and managed, corporately and individually
- Describe steps to create an action plan for establishing resilience in ourselves and others, our workplaces and our society
Chris Stewart Patterson, MD – Coherence Analysis on Work Disability
Assessment of validity with disability case files review can be challenging but both clinical research and current medical guidelines suggest there are potential clinical indicators to be vigilant for.
Coherence Analysis is included in the American College of Environmental and Occupational Medicine practice guidelines and constitutes a comprehensive review of the clinical data using multiple themes to see if the data provides an integrated presentation. In disability evaluations attention must be paid to the consistency of the history, congruency of the symptoms with both the diagnosis and reported level of function and also effort regarding participation in treatment and investigation. The issues of symptom exaggeration with a bonafide medical condition, secondary gains and contributing non-medical factors must also be considered in an unbiased fashion.
In formulating an opinion as to whether or not the individual has bonafide medical impairment, the following themes can be of assistance in analyzing the clinical data especially for clinical conditions where most of the data is subjective:
Continuity of clinical findings, Consistency of clinical data, Congruency of diagnosis with reported disability, Compliance with treatment and investigation, Comorbidity (the impact of concurrent diagnosis), Causation of injury or illness, and Cultural factors affecting the clinical presentation.
- Recognize what parts of a medical history can be indicative of validity
- Develop an organized approach to assessing validity on file review
- Discuss how a solid functional history aids in validity assessment
- Explain the definition and the prevalence of malingering
Paul Farnan, MD – CANNABIS REVISITED – What is the North American landscape looking like one year after Canada’s legalization?
Since it was first introduced in Canada some would summarize that cannabis was initially demonized, then medicalized (2001) and in October 2018 it was legalized for recreational use. In contrast, cannabis remains a Schedule I drug under the Controlled Substances Act in the United States, defined as a drug with no currently accepted medical use and a high potential for abuse (DEA 2017).
Whether the issue is cannabis use for medical or for recreational purposes, there continue to be concerns in both the US and Canada regarding bona fide recommendations for medical use, potential associated workplace impairment, whether legalization might be a net positive or negative for public health and other important related implications for employers, insurers, and the rehabilitation industry.
- Review cannabinoid neurochemistry, the recognized risks and benefits of medical use, along with safety challenges in the workplace.
- Describe, although it is still early, what Canada has noted since legalization of cannabis and what might be relevant for the United States.
- Assess information necessary to reduce confusion, increase transparency and ensure safe and healthy work environments by examining and rethinking policies or lack of policies, tied to marijuana usage.
- Discuss practical challenges such as determining impairment due to marijuana use at work and other guidance related to safety-sensitive workplaces.
Amanda Young, PhD – Understanding Expectations for Returning to Work
During this presentation, we will address the discovery and importance of injured worker’s expectations for returning to work following an injury resulting in participation restrictions. We will discuss the role of the expectations of others, what people say influence their projections and ways of assessing the worker’s expected outcomes. In addition, we will talk about the accuracy of projections as a function of time, as well as trends in estimation errors.
- Discuss the predictive power of workers’ expectations for returning to work.
- Describe who and what is important in forming workers’ expectations for returning to work.
- Discuss the potential sensitivity of the topic with an emphasis on how to go about gaining a specific estimate of the worker’s return to work expectations.
Geralyn Datz, PhD – Modifying worker expectations – what works and what doesn’t
Expectations of recovery are one of the most important predictors of return to work. Yet shaping these expectations remains elusive for many employers and carriers. Attendees will learn about how workers expectations are formed, and how language and behavior immediately post injury plays a pivotal role in shaping workers and employers expectations. Using principles from psychology, the influence of the work context, the injury itself and the treating providers will be explained in terms of how positive vs negative expectations are formed. How to use expectations to guide healthy, non-delayed recovery will be explained.
- Explain how language influences workers expectations positively vs negatively
- Discuss the effectiveness of early intervention strategies
- Identify practices to engage and monitor employees that reduce the impact of psychosocial factors on recovery