Category Archives: Best Practices

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.

When Should Adjusters Refer Claims For Mental Health Evaluations?

As we roll out Work Comp Psych Net to New Jersey’s insurers, third party administrators, self-insured employers and defense attorneys, we are often asked how to tell if a claim needs referring, as well as how to how to decide where to send the referral.

Well, in order to provide the best possible service, we believe whoever you send claimants to for psych evaluations and/or treatment should understand a few things. Here’s what we understand:

  • We understand MMI, and we know you want your claimants to reach it as soon as possible. We do, too. In a limited number of sessions we can achieve MMI sooner, faster, and smarter.
  • We understand Permanency Benefits, credits and the importance of a deeply detailed patient history. In our first session we will dig down to discover in as much detail as possible the background of the person we are seeing. This information is vital to bringing the claim to a fair and reasonable outcome for you and the claimant.
  • We understand that there is an epidemic of head injuries in New Jersey today and that most head injuries can reach MMI satisfactorily and quickly given the right treatment.
  • We understand that you need information in real time, which is why we’ve built New Jersey’s first online Claimant Referral and Electronic Health Record system for mental health issues.
  • We understand that most claimants who need mental health treatment can return to work in some modified duty capacity as they recover. That’s why our clinicians have been trained in how to work with you, the claimant and the claimant’s employer to find the right modified duty, thus lowering the cost of indemnity payments immediately.
  • Finally, we understand that, although claimants may benefit from mental health treatment, in many cases the cause of their distress is not work-related. In our Initial Psychological Evaluation we are expert in determining if a mental health issue “arose in the course of employment.”

When should you make a referral to us? The answer is when you notice in the claim any of the following:

  • Complex head injury
  • Concussion diagnosis
  • Chronic and/or continuing acute pain
  • Severe depression
  • High anxiety
  • Fear of returning to work
  • PTSD diagnosis

We understand that therapy has to fit the person. We are expert in:

  • Cognitive Rehabilitation
  • Biofeedback
  • Psychotherapy
  • Neuropsychology

We would welcome the opportunity to explore all of the ways Work Comp Psych Net can work for you. Your time is precious. We won’t waste it.

This is our pledge to you ­– Recovery: Sooner, Faster, Smarter.

Modified Duty: An Employer’s Silver Bullet

Time away from work can be frightening and debilitating for injured workers. They often begin to think of themselves as “disabled.” The longer they stay out of work, the harder it becomes to even approach getting back into the work routine. When that happens, depression and other mental health issues rear their heads.

Consequently, it is crucial to speed recovery through the use of modified duty, one of the most important tools an employer has to reduce lost time and costs. This is just as true for injuries compromised by behavioral or mental health issues as it is for the common slip and fall.

Modified duty is a bridge back to full duty, keeping workers active and part of the team. If you’re an employer, you should instruct your medical provider to focus on what the employee cannot do while injured, clearly delineating work restrictions.

To prove the point, for a moment, put yourself in the skin of the injured worker and imagine you are talking with your doctor about your injury. Would you want the doctor to list for you the potentially countless physical tasks you could actually still do while injured? Or, would you want the doctor to tell you the realistically few things you should not do? The latter approach is the one doctors prefer, too.

Once you have the medical restrictions, work with your supervisors to develop progressive, short-term transitional jobs and tasks. Most important, make sure that injured employees and supervisors carefully follow the physician’s restrictions: The goal is to speed recovery, not aggravate the condition and make things worse. As medical treatment continues and your medical provider gradually lifts restrictions, increase job demands to ease the employee back to his or her original job.

Until now, the traditional method for mental health clinicians to counsel injured workers was to approach the thing as if sitting on a two-legged stool. It was the clinician and the worker. Pretty precarious and often ineffective. But the clinicians and therapists at Work Comp Psych Net know they are sitting on a solid, five-legged stool held up by the worker, the clinician, the employer, the claims adjuster and the medical provider. Our clinicians have been trained in the proper use of modified duty. They know that their job also involves helping the worker return to the workplace as soon as possible with appropriate medically supervised work restrictions.

And they will work with you to make that happen.

This is good for the worker and produces large cost savings for the employer.

That is one more way we keep our pledge to you: Recovery: Sooner -Faster – Smarter.

 

Early Intervention: Good For The Injured Worker, And It Saves Money, Too

It’s long been known that workers’ comp claims in which behavioral health issues are present cost more than those without such issues. Often a lot more. This month’s issue of Health Affairs reports on a Canadian Study that found that the average cost for a “mental health high-cost patient” was roughly 33 percent greater than the average cost for other high-cost patients. The authors suggest that intervening early when behavioral health issues are first detected can mitigate these higher costs.

Also, the Robert Wood Johnson Foundation’s Health Policy Snapshot, published in March 2013, examined the prevalence of mental disease in the U.S., and described how early treatment and intervention can improve lives and ultimately lower related health care costs.

Patients and payers are best served when screening occurs during the first month of any workers’ comp claim involving head injury or when the claimant is depressed, overly anxious or fearful. These can delay return to work and increase the cost of the claim. Intervening early leads to Recovery: Sooner, Faster, Smarter.