Posted by Mike Crone on Tue, Dec 08, 2009 @ 03:14 PM
THIS IS PART 2 OF A 2 PART ARTICLE
Traditional disability management programs have been slow to embrace these findings as:
- Rehabilitation Facilities retained by the WCB to perform secondary/ tertiary assessments profit from referring employees into their own ½ day to full day rehabilitation programs. GRTW programs allow these rehabilitation providers to profit from placing injured employees into costly rehabilitation programs while appearing to support accommodation of an effective Modified Work plan.
- Attending Physicians and Employers do not fully understand the impact Modified Work placements have on reducing disability claim durations.
- Employers do not understand the financial impact of time loss payment and rehabilitation referrals. The experience rated
cost of a single WCB claim referred for secondary assessment with referral to rehabilitation and a 6 week graduated return to work program can result in $15,000.00 in future assessment premium cost.
It should be noted that the Rehabilitation / GRTW model is appropriate in treating more serious injuries with extended full return to work goal-dates. Although more aggressive medical treatment plans from the time of injury, would typically promote physiotherapy throughout the period of disability to prevent muscle de-conditioning and deterioration thereby eliminating the need for a comprehensive tertiary care program.
Unfortunately, these models are being utilized on shorter term disability as neither Attending Physicians, Employers, the WCB nor other Insurance carriers are providing adequate medical management from date of injury. Even if these interventions were 100% effective in achieving FTW outcomes, the programs cannot be cost rationalized.
Posted by Mike Crone on Wed, Dec 02, 2009 @ 02:03 PM
THIS IS THE 1ST OF A 2 PART ARTICLE. THE SECOND PART WILL BE FORTHCOMING
Secondary and Tertiary assessments are performed by the Workers' Compensation Insurer's contracted Rehabilitation Centers. These private organizations employ Physicians, Chiropractors and Rehabilitation Consultants, but the majority of care is left to the rehabilitation coordinators / physiotherapists. These programs effectively transfer care away from the Attending Physician to the rehabilitation facility which restarts the entire medical recovery process from square one. 
Almost all assessments made by a Rehabilitation Center result in referrals to an 8-12 week tertiary care program (comprehensive rehab programs) in its own facility, followed by a recommendation for Graduated Return to Work (GRTW). GRTW plans normally commence with a 2-4 hour a day placement with defined medical restrictions and gradually increase to full work hours over a 6-8 week period.
While GRTW plans are better than having no work approval, the principle of GRTW harkens back to the infancy stage of disability management theory twenty years ago. Recent studies have indicated that GRTW programs are not meeting Full Return to Work (FRTW) outcomes (<40% of employees maintain FRTW status after having been discharged from these programs). In fact evidence is showing GRTW may be extending average claim durations as Physicians, and rehabilitation providers commonly allow employees to determine their own timelines for FRTW readiness. This is evidenced by the fact that 50 % or more of all employees engaged in GRTW programs do not meet their full return to work goal-dates. Increasingly, employers are being forced to accommodate more temporary and permanent work placements.
Current medical data indicates that maintaining injured/disabled employees on sedentary or light duties at full hours, as opposed to a GRTW plan, is far more effective in achieving FRTW goal-dates and reducing average claim durations.
PART 2 COMING SOON!