Distortion and Abuse Reduction in the Stay At Work/Return To Work Process

Preventing Needless Work Disability by Helping People Stay Employed

Revision: March 29, 2012 Author: WIM Workability In Michigan Distortion and Abuse Subgroup

Workability In Michigan

What is WIM Workability in Michigan?

Advocacy group with a wide variety of stakeholders. Grass-roots approach to transform:
Disability benefits Workers compensation systems and the outcomes they produce.

Workability In Michigan

ACOEM GUIDELINES
American College of Occupational and Environmental Medicine (ACOEM)
Preventing Needless Work Disability by Helping People Stay Employed

Workability In Michigan

Recommendation 1
Adopt a Disability Prevention Model
1. Increase awareness of how rarely disability is medically required 2. Urgency is required because prolonged time away from work is harmful

NOTE: After 12 weeks off, an employee has only a 50% chance of ever returning to work.

Workability In Michigan

Recommendation 2
Address Behavioral and Circumstantial Realities That Create and Prolong Work Disability
3. Acknowledging and dealing with normal human reactions 4. Investigating and addressing social and workplace realities 5. Finding a better way to effectively address psychiatric conditions 6. Reducing distortion of the medical treatment process by hidden financial agendas Workability In Michigan

Recommendation 3
Acknowledge the Contribution of Motivation on Outcomes and Make changes to Improve Incentive Alignment
7. Paying physicians for disability prevention work to increase their professional commitment 8. Supporting appropriate patient advocacy by getting treating physicians out of a loyalties bind 9. Increasing real-time availability of on-the-job recovery, transitional work programs, and permanent job modifications 10. Being rigorous, yet fair in order to reduce minor abuses and cynicisms 11. Devising better strategies to deal with bad-faith behaviors Workability In Michigan

Recommendation 4
Invest in System and Infrastructure Improvements
12. Educating physicians on Why and How to play a role in preventing disability 13. Disseminating medical evidence regarding recovery benefits of staying at work and being active 14. Simplifying/standardizing information exchange methods between Employers/payers and medical offices 15. Improving/standardizing methods and tools that provide data for Stay-at-work and Return to-work decision-making 16. Increasing the study of and knowledge about Stayat-work and Return-to-work
Workability In Michigan

Distortion and Abuse Prevention

6. Reduce distortion of the medical treatment process by hidden financial agendas; Pay/reward physicians for Disability Prevention Work to increase Professional Commitment; and

7.

10. Be rigorous, yet fair in order to reduce minor abuses and cynicism.
Workability In Michigan

Top 4 Abuses and Distortions

1. There is limited or no financial, productivity or other benefit to a manager or supervisor to participate in the Stay-atWork/Return-to-Work process; 2. Physicians are often not paid or rewarded for their participation in Stay-at-Work/Return-to-Work management process; 3. The reimbursement/liabilities gaps between work-related and non-work-related benefits results in abuses to achieve the most beneficial option; and 4. Treatment providers are chosen to manipulate the desired outcome.

Workability In Michigan

#1: There is limited or no financial, productivity or other benefit to a manager or supervisor to participate in the Stay-at-Work/Return-to-Work process. TYPICAL ABUSES AND DISTORTIONS:
Restricted workers are more burden than value in the work place. Restrictions increase the burden on the employer Managing disabilities requires extra time Disability management is not reflected in department performance assessment.

Workability In Michigan

#1: There is limited or no financial, productivity or other benefit to a manager or supervisor to participate in the Stay-at-Work/Return-to-Work process. REALITIES:
Supervisors/Managers lack RTW/SAW education. Duration of the absence changes motivations & behaviors Focusing only on financial and productivity demands may not improve disability management. Disability management can often be inconsistent with organizational culture Workability In Michigan

#1: There is limited or no financial, productivity or other benefit to a manager or supervisor to participate in the Stay-at-Work/Return-to-Work process. RECOMMENDATIONS:
Educate managers and supervisors in SAW/RTW Establish measurable standards of performance Hold managers & supervisors accountable for measureable quality disability management. Provide appropriate integrated programs to support managers

Workability In Michigan

#2: Physicians are often not paid or rewarded for their participation in Stay-at-Work/Return-to-Work management process TYPICAL ABUSES AND DISTORTIONS:
Extra or fair compensation is not provided Lack of a perceived value for participating

Workability In Michigan

#2: Physicians are often not paid or rewarded for their participation in Stay-at-Work/Return-to-Work management process
REALITIES:
We should be compensating and rewarding Physicians for efforts

Workability In Michigan

#2: Physicians are often not paid or rewarded for their participation in Stay-at-Work/Return-to-Work management process
RECOMMENDATIONS:
Remember to say Thank You Reward Physicians with repeat business

Workability In Michigan

#3: The reimbursement/ liabilities gaps between work-related and non-work-related benefits results in abuses to achieve the most beneficial option TYPICAL ABUSES AND DISTORTIONS:
Workers Compensation versus disability plans

Benefit Durations Social Security Disability Insurance Impacts Medical Reimbursements

Workability In Michigan

#3: The reimbursement/ liabilities gaps between work-related and non-work-related benefits results in abuses to achieve the most beneficial option REALITIES:
Workers compensation is statutory Solutions are limited

Workability In Michigan

#3: The reimbursement/ liabilities gaps between work-related and non-work-related benefits results in abuses to achieve the most beneficial option RECOMMENDATIONS:
Discourage plans that provide 100% pay while off work Consider Employee Funded Buy-Ups Narrow gap between disability pay and WC Manage time-off on non-work related disability to pay for increased benefit Workability In Michigan

#4: Treatment providers are chosen to manipulate desired outcomes TYPICAL ABUSES AND DISTORTIONS:
Employees choose providers who conform to their needs and wants; and Employers choose providers who conform to their needs and wants.

Workability In Michigan

#4: Treatment providers are chosen to manipulate desired outcomes REALITIES:

There are treatment providers: Who will keep employees off of work when not medically necessary; and Who will provide medical opinions that enable system manipulation.

There are also treatment providers: Who are reputable, skilled, and objective.

Workability In Michigan

#4: Treatment providers are chosen to manipulate desired outcomes RECOMMENDATIONS:

Identify and only select treatment providers who are reputable, skilled, and objective; and Educate employees.

Workability In Michigan

THANK YOU! For more information or to get involved:

www.workabilityim.org

Workability In Michigan