Nursing: One Of The Most Dangerous Jobs In America

 

Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks? In One of America’s Most Dangerous Jobs, the Washington Post’s Petula Dvorak shines a spotlight on the dangers in the nursing profession, specifically around the violence nurses encounter on the job. Citing a recent GAO report on violence in the healthcare profession, the article notes that, “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.”

Here’s one excerpt from the article:

“In Massachusetts, Elise’s Law, which is named for the nurse who was attacked in June, is already on the fast track to set state standards for workplace protection. Legislators were working on this months before Wilson was stabbed.

Nurses in Massachusetts were attacked more frequently than police or prison guards. When association members testified about the violence epidemic this spring, they said nurses had been threatened with scissors, pencils or pens, knives, guns, medical equipment and furniture in the past two years alone, according to the Massachusetts Nurses Association.”

OSHA reports that in surveys conducted by various nursing and healthcare groups:

  • 21% of nurses and nursing students reported being physically assaulted and over 50% verbally abused in a 12-month period
  • 12% of emergency department nurses experienced physical violence and 59% experienced verbal abuse during a seven-day period
  • 13% of employees in Veterans Health Administration hospitals reported being assaulted in a year

New Jersey is one of 26 states that have safety standards aimed at combating violence in health care facilities. The “Violence Prevention in Health Care Facilities Act,” enacted in 2008, lays out detailed requirements for hospitals (including psychiatric hospitals) and nursing homes. However, with more than 2,000 hospitals, nursing homes and health care facilities in New Jersey, there is ample opportunity for workplace violence to occur.

Notwithstanding the Act, at Work Comp Psych Net, our clinicians are asked  to treat healthcare workers who are victims of workplace violence or abuse. The mental health complications of these injuries can leave lasting damage, which, if untreated, will only worsen over time. We advise claims adjusters and nurse case managers to pay particular attention to the possibility of a mental health comorbidity complicating a workplace violence injury.

NIOSH worked with various partners – including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. – to develop a free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes “resume-where-you-left-off” technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses, and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Related

Workers’ Compensation and SSDI Dual Eligibility: Costly Changes Coming?

In 2014, workers’ compensation loss costs (indemnity wage replacement plus medical benefits) totalled $62.3 billion, nationally, while Social Security Disability Insurance (SSDI) paid $141.5 billion in wage replacement benefits to disabled persons and their dependents. In the same year, 10.3  1.3* million disabled workers qualified for both workers’ compensation and SSDI wage replacement. They are dually eligible for both programs given their on the job injuries.

If a worker becomes eligible for both SSDI and workers’ compensation cash benefits, one or both programs will reduce benefits to avoid making excessive payments relative to the worker’s past earnings. Social Security amendments passed in 1965 require SSDI benefits to be reduced so the combined total of payments does not exceed 80% of the injured worker’s pre-injury wages.

However, prior to the 1965 amendments, fifteen states, including New Jersey, had passed what are called “reverse offset” laws, which required that it is the workers’ compensation benefits, rather than SSDI’s, which are reduced to stay under the 80% cap. The reverse offset laws were grandfathered into the 1965 amendments. This produces millions of dollars in savings per year for insurers and employers.

A bristly fly has just done a swan dive into the reverse offset ointment. President Trump’s proposed budget calls for eliminating the reverse offset law. If this provision makes it into the final budget proposal, New Jersey employers would face the prospect of not insignificant increases in total loss costs. Thousands of injured workers in the state are dually eligible for workers’ compensation and SSDI benefits. No one knows for sure the exact number, because Social Security doesn’t have a good verification program. The president’s budget estimates eliminating the reverse offset law would save $164 million over ten years, all of which would come from the 15 states that would lose the reverse offset advantage.

If you’d like to know more about the reverse offset inside baseball game, the National Academy of Social Insurance has an excellent description on page 48 of its October, 2016, workers’ compensation annual report.

Thanks to Work Comp Central’s Elaine Goodman for a story on this issue (subscription required).

*Thanks to Mathematica’s Yonatan Ben-Shalom for catching this typographical error.

News Of Note

 

Bit of a dreary day here in the northeast, so why not get yourself a good mug of tea, sit for a moment, put your feet up and dive into the latest health care news. If you want insights from people who really understand what’s happening – from across the political spectrum – Health Wonk Review is the must-read.

Steve Anderson at HealthInsurance.org hosts this month’s edition – and what a health care month it has been.

Among the posts are Charles Gaba’s view of Congress’s Keystone Cops act at Trump, Ryan, McConnell & Price will owe my family $2,000 next year. Pay up, jerkweeds. Title pretty much says it all.

Louise Norris’s How Would the BCRA Impact Deductibles and Out-of-Pocket Costs? tells us why the Better Care Reconciliation Act is a double whammy.

And Kelley Beloff, a medical office manager, offers her insights about two healthcare systems, and two very different outcomes, with A Tale of Two Health Systems.

Lots more. Thanks to Steve for hosting.

And for more reading close to the New Jersey homefires, this morning’s Work Comp Central told the story of a North Jersey doctor who authorities accuse of providing oxycodone and Xanax to a group of South Jersey drug dealers. Dr. Craig Gialanella, 53, of North Caldwell was arrested last week along with 17 members of the alleged drug ring.

From Work Comp Central’s story (subscription required):

Gialanella is accused of writing prescriptions to the members of the drug ring run by Douglas Patterson, 53, of Egg Harbor Township; his ex-wife, Mary Connolly, 54; and her three children, Michael, 33, Robert, 31, and Lauren, 28, prosecutors say.

Patterson and Connolly allegedly ran the drug ring’s supply and distribution activities, while Lauren Connolly allegedly served as an intermediary among her mother, ex-stepfather and the street dealers.

New Jersey’s prescription monitoring program showed that in 2016 alone, Gialanella wrote 413 prescriptions for oxycodone to 30 people from the Atlantic County area, which is more than 100 miles away from his office, prosecutors say.

Those 413 prescriptions contained roughly 50,000 30-milligram pills, which the alleged Patterson-Connolly ring referred to as “blues” and sold for between $18-$25 each. Gialanella also allegedly provided Xanax prescriptions to members of the drug ring, who sold the anti-anxiety pills for $5 each.

The New Jersey Attorney General’s office detailed the charges here.

News Of Note – Health Wonk Review

 

Early in 2006, a few of America’s leading health care policy experts decided it would be beneficial if they banded together to create a bi-weekly compendium of the best of the nation’s health care blogs. Thus was Health Wonk Review born.

Those health care thought leaders also decided in order to sustain the effort they should spread the responsibility around. The way to do that, they thought, would be to have each of them, in sequence, take responsibility for finding the more notable published work over the prior two week period. The job would then be to read it all, select the very best, write a brief summary of each work and publish the compendium on their own sites. This meant Health Wonk Review would rotate through the various sites of the participating health care hunter/gatherers.

The first Health Wonk Review was published 24 February 2006, and it’s been going strong ever since. As you can imagine, it’s a daunting task if it’s your week, but the founders dedication has never wavered (our friends at Workers’ Comp Insider were among the founders). As health Wonk Review gained national notoriety, the founders decided to lighten their load by requiring authors to submit their work for consideration. That’s how it works now. In this way, it’s become quite an honor to have your work included.

The topics covered are all over the health care map, and they include workers’ compensation. But workers’ compensation is a tiny caboose at the end of the great big health care train, so the Review focuses primarily on everything about the ACA (the Affordable Care Act, otherwise known as Obamacare), the AHCA (the American Health Care Act, otherwise known as Trumpcare), the expansion of Medicaid, health care research and economics and a whole lot more. However, because workers’ compensation is so heavily influenced by the greater health care debate, the Review is an excellent way to stay up on the latest trends and thinking.

Health Wonk Review is published every other Thursday, and we have a new edition today. It’s up at XPOPSTFACTOID, and the blog’s host is Andrew Sprung. Give it a look. Andrew has assembled a lot of important information that we in the workers’ compensation arena need to know. His summaries are excellent.

Being A Mental Health Worker Can Be Hazardous To Your Health

Mental health workers face myriad challenges, both physically and psychologically, dealing with sometimes out-of-control people. Many are injured in the process, some die. Society doesn’t much notice and, sadly, society doesn’t much care.  The following piece was written six years ago by our friends at Workers’ Comp Insider. We bring it to you today, because in the intervening six years nothing has changed. Absolutely nothing. The tragedies described below happened in Massachusetts, but they could have happened anywhere in America (and have – many times). Yes, here in New Jersey, too, where in the first nine months of last year 50 mental health hospital workers were injured seriously enough to lose time from work.

Continuing budget cuts to New Jersey mental health services can be very hurtful – in more ways than one. Here’s the piece from the Insider.

Sometimes, system redress seems painfully inadequate.

Such is the case with the $7,000 OSHA penalty recently imposed for inadequate safeguards related to the case of murdered mental-health worker Stephanie Moulton. $7,000 is the maximum fine available for “a serious violation of the agency’s “general duty clause” for failing to provide a workplace free from recognized hazards likely to cause serious injury or death.” It’s not just that the dollar amount seems paltry in light of the loss of life – it simply doesn’t seem substantial enough to have any deterrent value.

And in truth, while the OSHA citation points to the employer, one could make the case that the employer is also a victim of an economic squeeze play, which has resulted in inadequate staffing and safety controls. State budget cutbacks worry mental health workers – a scenario that is no doubt playing out throughout the country – in mental health budgets, in public safety budgets, and in regulatory enforcement, just to name a few areas that affect the health and safety of workers — and of the public.

Stephanie Moulton was working alone at one of the North Suffolk Mental Health Association’s group homes in Revere, Massachusetts, when she was brutally murdered by a patient with a violent record. A week later and just miles away at the Lowell Transitional Living Center, a shelter for the homeless, a worker named Jose Roldan was also killed by person who had slipped through the cracks in the mental health system. Both these murders were discussed in-depth in stories that appeared in The New York Times: A Schizophrenic, a Slain Worker, Troubling Questions recounted Moulton’s death, and Teenager’s Path and a Killing Put Spotlight on Mental Care discussed the case related to Roldan’s death.

An investigation into Moulton’s death resulted in the issuance of a report in June: Report of the Massachusetts Department of Mental Health Task Force on Staff and Client Safety. The report found that:

  • Years of budget cuts have negatively impacted service delivery and safety issues in the following areas:
    –Inadequate numbers of, and inadequate pay for, direct-care staff
    –Inadequate numbers of clinical staff with relevant training and experience
    –Deficiencies in the overall number of acute and intermediate hospital beds and community-based services and beds
    –Decrease in the role of psychiatrists and other highly-trained professionals in the care and treatment of individuals with the most serious mental illnesses
    –Requiring some staff to work under conditions that do not provide for adequate safety
  • There is an absence of system-wide use of a well-designed risk assessment process
  • There is lack of clarity in policies and procedures for incorporating risk variables into Individualized Action Plans
  • There is lack of sufficient access to and sharing of critical safety information
  • There is lack of adequate coordination of care across different components of the service system

OSHA’s citation includes recommendations the employer could take to address the workplace violence issue:

  • Creating a stand-alone written workplace violence prevention program that includes implementation of workplace controls and prevention strategies; hazard/threat/security assessments; a workplace violence policy statement outlining and emphasizing a zero tolerance policy for workplace violence; incident reporting and investigation; and periodic review of the prevention program.
  • Establishing a system to identify clients with assaultive behavior problems and train all staff to understand the system used.
  • Putting in place procedures to communicate any incident to staff so that employees without access to client charts are aware of previous violent or aggressive acts by a client.
  • Identifying the behavioral history of new or transferred clients, including conducting criminal and sexual offender records checks.
  • Conducting more extensive training so that all employees are aware of the facility’s workplace violence policy and where information about it can be found, including training employees to clearly state to clients that violence is not permitted or tolerated; how to respond during a workplace violence incident; recognize when individuals are exhibiting aggressive behavior and how to de-escalate the behavior; and identify risk factors that can cause or contribute to assault.
  • Installing and positioning panic buttons, walkie-talkies, recording security camera systems and smart phone GPS applications to better monitor employee safety and increase staff communication and support; implement and maintain a buddy system on at least the second and third shifts, based on a complete hazard assessment.

Mouton’s family is rallying for enactment of Stephanie’s law, which would mandate panic buttons in mental health facilities. A good start and one among recommendations issued by OSHA in their Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. But such measures may be woefully inadequate in the face of reduced staffing. In an ongoing climate of budget cuts and a strong public appetite for decreased regulatory controls, mental health workers are likely to continue being at greater risk — along with public safety workers such as police, firefighters, and healthcare workers, who also face dire staffing shortages.

Attorney Involvement In New Jersey: We Get The Silver Medal

There are perhaps four organizations conducting the most important and highly respected research into workers’ compensation in the country. The Workers’ Compensation Research Institute (WCRI), located in Cambridge, Massachusetts, is one of them. The others are the National Council on Compensation Insurance (NCCI), the International Association of Industrial Accident Boards and Commissions (IAIABC) and the California Workers’ Compensation Research Institute (CWCRI).

This morning, the WCRI released an 18 state study looking at how the various states compare with respect to the degree of attorney involvement in workers’ compensation claims. Attorney involvement occurs when a worker hires an attorney to handle a work injury claim.

These 18 states were selected for this study because they are geographically diverse, represent a range of system features, and represent the range of states that are higher, near the middle, and lower on costs per claim.

New Jersey’s claims adjusters and defense attorneys don’t have to be told that an awful lot of cases are disputed and wind up before a judge. They intuitively sense this happens in NJ more often than in other states. However, the WCRI’s study moves intuition to fact.

Only Illinois, a state with perhaps the most messed up workers’ compensation system in the country, has more cases  handled by attorneys.

The US did not create workers’ compensation. That honor belongs to Germany and dates from 1884. Britain followed suit shortly thereafter, but it wasn’t until 1911 that Wisconsin was able to enact the first legislation in America (note that of the study states Wisconsin, with 13%, has the lowest level of claims where attorneys become involved).

It is ironic, indeed, that one of the primary reasons state-based workers’ compensation systems were created was to get the lawyers out of the picture. Until then, with no system at all, injured workers were forced to sue their employers when they suffered work injuries.

How far we’ve come since that grand vision. Now, with 49% of all work injuries disputed by warring attorneys, New Jersey stands near the top of a motion-filled mountain. If anyone thinks that’s going to change anytime soon, we have some choice real estate for sale in Florida (just as soon as the tide goes out).

You can access the WCRI study here (free for WCRI members; $5.00 for all others – a bargain).

The Buzz Is Getting Louder

 

“We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality, or even litigation. It is the negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury.

This suite of roadblocks is classified as “psychosocial” issues – issues which claims leaders now rank as the number one barrier to successful claim outcomes according to the Workers’ Compensation Benchmarking Study’s 2016 survey – and they drive up claim costs far more than catastrophic injuries, mostly due to delayed recovery.”

That’s the beginning of a new White Paper authored by friend and colleague Peter Rousmaniere and Rising Medical Solution’s Rachel Fikes. The Paper, How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity, reports on Rising’s 2016 Benchmarking Survey and describes how the workers’ compensation claims management community is ever so slowly coming to realize the leading cause of delayed recovery for America’s injured workers is psychosocial in nature and that efforts to deal with this have, up to now, been woefully inadequate.

Rousmaniere and Fikes point to enlightened employers and insurers who are leading their companies to a greater acceptance of the need for competent, professional intervention to help injured workers overcome mental and emotional barriers delaying their return to employment.

They cite the work of Denise Algire, Director of Risk Initiatives and National Medical Director for Albertson Companies, a grocery chain with more than 250,000 employees. They also report on efforts by The Hartford, Nationwide Insurance and CNA.

All of the progressive actions undertaken by these organizations have one thing in common: the development of an empathic interview methodology devoted to understanding the “whole person” to discover which claims will need more intensive and specialized intervention.

At The Hartford, Medical Director Marco Iglesias reports 10% of claims fall into this bucket, but they consume 60% of total incurred costs. He says adjusters now ask each injured worker an important question: “When do you expect to return to work?” The Hartford’s analytics indicate any answer longer than ten days is a red flag for the future.

Nationwide Insurance, under the direction of Trecia Sigle, VP of Workers’ Compensation Claims, is building a specialized team to address psychosocial roadblocks. Nationwide’s intake process will consist of a combination of manual scoring and predictive modeling, and then adjusters will refer red-flagged workers to specialists with the “right skill set.”

Pamela Highsmith-Johnson, national director of case management at CNA, says the insurer introduced a “Trusted Advisor” training program for all employees who come into contact with injured workers. CNA’s Knowledge and Learning Group helped develop the training with internal claims and nurse staff.

This White Paper adds to the now undeniable research indicating the psychosocial problem is the biggest one facing the workers’ compensation claims community. The leading experts agree that empathy, soft talk and the advocacy-based claims model is the method of choice for helping injured workers whose claims carry a psychosocial dimension. The experts cited in the White Paper all agree that adjusters will require extensive and repetitive training to learn the new techniques.

However, all of this is a heavy lift for an adjuster community overburdened and overwhelmed with work, a group for which the average lost time claim load is often north of 150. Even with better training, they can’t do it alone. To really turn the psychosocial tide will require a well-rounded team of claims adjusters, nurses, case managers and external, well-trained clinicians working together with transparent, technologically advanced communication.

The missing links thus far are those well-trained clinicians and the advanced communication. And that is why Work Comp Psych Net exists.

We have to say, boast really, that it’s nice to get the solid validation found in this compelling White Paper. Writing today from Berlin, where he’s vacationing, Peter Rousmaniere said, “The article was timely and definitively supports your program.”

So, yes, the buzz is getting louder.

 

Reader Reactions To Last Week’s Psychosocial Issues Series

We received a number of reader comments to our psychosocial claim issues series of last week. Our series highlighted the difficulty in dealing with these sometimes intractable claims where recovery is delayed and costs exacerbated.  In Part One, we listed the litany of challenges facing claim managers; in Part Two we described how we had built Work Comp Psych Net  in New Jersey to overcome those challenges.

A few readers pointed out that we paid scant attention to the “social” in psychosocial. These adjusters and nurses wrote that too often they’d seen and handled claims where life and “societal issues,” the social, seemed to get in the way of recovery.

Sue Separa, who has overseen workers’ compensation claims for more than 30 years in 40 states and jurisdictions, put it this way:

Employee loses car, loses license, loses driving privileges and can’t get to work, but still needs a source of income;

Employee is having daycare issues and needs to be home, but also needs a source of income;

Employee has a sick relative or child they need to stay with/watch, but still needs a source of income;

Employee is attending school to better themselves, has a heavy school schedule, but still needs a source of income;

Employee has a comorbid or health situation that requires medical care and possibly surgery or absence from work, and has not secured short term disability, or it is not available with the employer; 

Employee has asked for vacation time and it is denied due to no time left, or not eligible, or because someone else is off work at the same time.

And she’s right. Of course these real life situations occur. However, they’re present and happen all the time without injuries, too. They are non-physical, “social” comorbidities; things that can easily impede and delay return to work. Unless, that is, claim adjusters are trained and experienced enough, as Ms. Separa is, to dig a little deeper, find them and address them appropriately.

We also heard from our friend Robert Aurbach who wrote from Down Under to say, while he “applauds” our efforts and thinks “they are valuable,” he suggests “perhaps they don’t go far enough.” Rob believes the “problem is partly the system itself;” we create the harm our series cited. As that great American philosopher, Pogo, opined on Earth Day, 1971, “We have met the enemy and he is us.” The system is iatrogenic (system caused).

Rob Aurbach also sent a paper he authored in late 2015 for the Injury Schemes Seminar, put on bi-annually by the Australian Actuaries Institute. In the Paper (opens in pdf), titled “Better Recovery Through Neuroscience: Addressing Legislative and Regulatory Design, Injury Management and Resilience,” (bit of a mouthful that, but it won the Taylor Fry Award for the Seminar’s best paper) Rob explores Neuroplasticity, a theory dating from the 1800s and recently confirmed by functional Magnetic Resonance Imaging. Neuroplasticity is the process by which our brains continually rewire themselves throughout life due to environment, behavior, thinking and emotions. In short, it’s true; our brains are malleable. Rob writes that when work is disrupted through injury (or, through anything, really) for a long enough period, Neuroplasticity begins rewiring the brain to adapt to the new situation – being out of work. In other words, our brain creates a new “facilitated neural network.” This can happen in as little as 12 weeks, as Rob points out:

Timing is everything. There is a substantial research literature demonstrating that if a worker does not return to work within 12 -16 weeks, the probability of eventual return is reduced to 50% or less.

Rob Aurbach’s paper is a valuable contribution to understanding how easily a claim can deteriorate to the point where an injured person’s life is forever changed, and not for the better. We urge you to read it. It’s well-researched, well-written and profoundly thoughtful. It comes in at twenty-seven pages, the last seven of which are endnotes and references. We found the first half of the text compelling and enlightening. His common sense recommendations that follow are pretty simple, but wickedly difficult to implement: Claim managers and adjusters should intervene early, demonstrate respect for the injured worker, promote early return to work, align incentives that encourage recovery, restrain negativity, listen attentively to the worker’s story, etc. In short, all the things managers, nurses and adjusters like Sue Separa know they should be doing, anyway. Trouble is, for these often overworked professionals, each managing a steamer trunkful of claims, there isn’t a lot of time to devote to Rob’s prescription. The iatrogenic system isn’t built to allow it.

And that’s where behavioral health clinicians and therapists, for the most part underused and undertrained, ought to be helping far more than they are now. Part Two of last week’s series catalogued how, recognizing the difficulties, we built Work Comp Psych Net and trained our clinicians to help anyone confronted with these demanding and formidable claims get to the right outcome sooner, faster and smarter. Injured workers, as well as the professionals charged with helping them, deserve no less.

Workers’ Compensation’s Costly Psychosocial Issues (2)

Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. Whistling a happy tune, we  picked up our saw and confidently walked out on the proverbial limb to suggest this thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

Taking a large gulp after writing this, we listed the serious factors that make finding a solution to this looming crisis tremendously difficult.

But early in 2015 in New Jersey two Neuropsychologists, Mary Ann Kezmarsky and Richard Filippone, had an idea. Over a couple of decades, they’d treated a number of workers’ compensation claimants and had been appalled by what appeared to be the lack of a coherent system to deal with the issues they saw in their patients. They weren’t exactly sure what to do about it – they didn’t know much about workers’ compensation – but they saw it as a business opportunity. Well, they are “we,” and here’s what we did with that idea.

We contacted Tom Lynch, of Lynch Ryan, a nationally recognized consultancy in workers’ compensation, and over the next year and a half created a company, Work Comp Psych Net (WCPN), and built a systemically organized and integrated specialty network of workers’ compensation clinicians and therapists to treat injured workers in New Jersey who might have behavioral health issues delaying recovery. With Tom’s help, here’s how we did it:

  1. During the the last half of 2015, we recruited, credentialled and vetted 44 mental health professionals covering 55 offices throughout New Jersey’s 21 counties. Providers within WCPN’s network include psychologists and neuropsychologists, as well as cognitive rehabilitation and biofeedback specialists. All of the clinicians and therapists gave up a weekend to attend Lynch Ryan training in workers’ compensation. They learned about the New Jersey law, as well as the way workers’ compensation works – how a premium is constructed and  what indemnity and medical benefits are. They now understand experience modification, maximum medical improvement and the law regarding injuries “arising out of and in the course of employment.” Further, they have been educated regarding early return to work and have agreed to work with employers, adjusters and nurses to effectuate modified duty wherever possible.
  2. We built (with difficulty, because it wasn’t easy) the nation’s first electronic Claimant Intake & Referral Portal that allows claims adjusters, nurse case managers and attorneys to refer a claimant instantly. The paperless portal’s referral system is geographically and specialty based, meaning that referrers are assured that claimants will not have to travel far to reach their assigned clinician. In the past, referrals and appointments took weeks, even months, to arrange, but now they can be finalized within minutes. In Beta Testing from May through October, 2016, the longest time from referral to Provider scheduled appointment was 27 minutes.
  3. We built (with even more difficulty) the nation’s first mental health Electronic Health Record system for workers’ compensation. The EHR is set up as a roadmap for all WCPN clinicians to follow, meaning reports have a consistently structured form. The EHR is paperless, HIPPA-compliant and cloud-based. Initial Psychological Evaluations and subsequent treatment reports reach claims adjusters in pdf form within five business days.
  4. Our clinicians are all highly qualified and experienced; they know how to treat workers with mental health issues delaying recovery. But to make the system work we needed to understand the needs of adjusters and defense attorneys who would be referring the injured workers the clinicians would treat. Consequently, we conferred with experienced adjusters and defense attorneys. After doing so we decided that every referral would begin with a thorough Initial Psychological Evaluation (IPE), which, although not technically an IME, would be done at the IME level (we priced the IPE at $450, and, since nobody’s complained, we now think that’s too low, but we’re sticking with it). If the Initial Psychological Evaluation determines the presence of one or more mental health issues which are deemed to be work-related and requiring treatment, the treatment prescribed is initially authorized for up to 12 sessions unless medically justified, extraordinary circumstances are present. Additional treatment requires the approval of the referring party.

We officially launched in November, 2016. Over the intervening three months  we’ve learned two things (among a lot of others): First, our solution works extremely well; referrers have been highly receptive and pleased. They appreciate the ease of referral, the EHR reports and the fact that claimants do not have to travel far to see a qualified clinician. Even more, they appreciate that our clinicians and therapists have been trained in workers’ compensation.  Second, this could be a national solution.

So, our solution is working in New Jersey, but every state workers’ compensation system is grappling with how to deal with psychosocial issues that frequently hobble recovery. This may be work comp’s final frontier. Time will tell whether our template and software could help others. Regardless, we will continue to improve our solution at Work Comp Psych Net, as well as report on our outcomes.

It’s taken us nearly two years to get to this point, but, for the sake of the many injured workers suffering psychosocial comorbidities, as well as the claims adjusters who work tirelessly to help them, we think it’s been worth it.

Psychosocial Issues: Costly Problems Delaying Recovery

According to the New Jersey Workers’ Compensation Rating & Inspection Bureau, over the most recent five-year period total incurred costs for head injuries were $113,000 per claim; per claim costs for concussions during the same period were $83,000. Those costs suggest a lot of time away from work for New Jersey’s head-injured workers.

Many of the injuries involved psychosocial issues not identified until well into the claim. Research shows that these issues significantly delay and impede recovering and returning to work.

With that as background, let us propose a thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

The issue is compounded by the way claim adjusters, supervisors, nurses and defense attorneys view psychological issues. No one wants to ”buy a psych claim,” and many  believe that referring a claimant for behavioral health treatment does nothing more than create a lifetime annuity for a psychologist. Time and again this view has been proven correct.

What to do about that? Ay, there’s the rub. For in that question lies a host of difficulties. These, for instance:

  1. Most mental health professionals do not understand workers’ compensation. They do not realize either its statutory requirements or the concept of maximum medical improvement. They have spent many years being trained to treat the entire person. The players are the patient and the therapist, and it is like sitting on a two-legged stool. They do not fathom that, in workers’ compensation, the stool has five legs, with the other three occupied by the employer, the treating physician and the claim adjuster.
  2. Too often, by the time an adjuster or nurse recognizes that psychosocial issues may be impeding recovery and return to work the claim may have gotten a little long in the tooth; it could be months old, or more.
  3. It can take a claim adjuster weeks, in rare cases, months, to find a psychologist and schedule an appointment. It can also take weeks or months for a report to make it back to the file. Moreover, finding a clinician with even a smattering of workers’ compensation knowledge or experience is often problematic (See 1, above).
  4. Because there is no mental health electronic health record system for workers’ compensation, every report is its own island, sometimes good, sometimes bad.
  5. Everything is paper-based, which wastes claim adjuster time and increases expense.¹
  6. Although psychologists understand the value of work as therapy, many see no reason to help coordinate early return to work with employers, claim adjusters or medical providers

These are deep and difficult considerations. Tomorrow, we’ll describe how we created an entirely new approach that successfully addresses each of them.

¹ Claim adjusters also report that a not insignificant number of these reports are essentially unreadable, because they are handwritten.