Return-to-Work

Return-to-Work: It Works and Here's How

When a workplace injury occurs, the cost to employers begins to add up immediately. The direct costs alone of occupational injuries and illnesses exceed $60 billion annually. And those costs are just "the tip of the iceberg"; indirect costs can be 3 to 10 times as much as the direct costs.

What can you do to stem the tide of rising costs? Prevention is the first line of defense, of course, and immediate, appropriate treatment is also essential. Then it's time to focus on facilitating an early return to work, which benefits employers in reduced costs and improve morale; and promotes faster recovery and workplace re-integration for employees.

The Ohio Bureau of Workers' Compensation (BWC) has taken several measures to encourage employers to adopt return-to-work programs. These include:

• Offering Transitional WorkGRANT$ program, which reimburses employers up to 80 percent of their transitional work-related costs.

• Making vocational rehabilitation services available for all types of claims, not just lost-time cases as in the past.

• Introducing the concept of "presumptive authorization," under which medical providers have authority to conduct some basic medical procedures early on in a case without MCO preauthorization.

• Carefully tracking the return-to-work performance and degree of disability management (DoDM) of MCOs, and measuring physician outcomes and utilization.

• Standardizing the MCOs' approach to preauthorization of medical procedures.

• Permitting the use of generic equivalents for prescriptions.

The DoDM has become a particularly important tool, as BWC now uses it as a key measure to evaluate how well employers and MCOs are doing in preventing and managing disability and facilitating return-to-work. For the state to consider a return-to-work successful, the worker must have no re-injury for at least 90 days.

The DoDM system was invented by Milliman & Robertson, a Seattle-based health care management consulting firm, which also publishes the widely respected Healthcare Management Guidelines for work-related injuries and other health care specialties. DoDM and the Guidelines identify optimal return-to-work targets (benchmarks) for numerous occupational injuries.

For each type of injury and for activity levels ranging from light to heavy, the guidelines identify the range of expected days off before RTW and the benchmark. For example, for localized low back pain, the benchmark for low-activity jobs is one day off; seven days for medium-activity jobs; and 28 days for unlimited activity such as material handling.

For DoDM to be managed effectively, employers need to offer transitional work opportunities for recovering employees. Otherwise, Milliman & Robertson said, lost time may exceed DoDM ranges and benchmarks.