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December 2002

By Christopher A. Park, OTR, FABDA

Occupational injury prevention professionals are continually on the lookout for new and innovative methods of reducing their clients’ work-related injuries and the associated workers’ compensation costs. According to the Department of Labor’s Occupational Safety and Health Administration (OSHA), workers’ compensation costs for the nursing home industry alone amount to over $1 billion.¹ Rarely is a single technique or intervention successful in meeting all of the complex needs and issues of both employees and employers. Thus, a multitude of intervention strategies are becoming the preferred way of developing relationships with employers for the long haul, thereby creating opportunities for success.

ON-SITE INTERVENTION STRATEGIES

If you are looking for a place to begin, there is no better opportunity than at the workplace. As outlined by the American Occupational Therapy Association in 1997, “providing job-specific, productive rehabilitation at the work site will increase the likelihood that a worker will successfully return to work.”²

The demand for on-site occupational injury prevention services continues to grow despite the failure of the passage of an OSHA Ergonomics Standard. James Herzog, an OT for international manufacturing company MeadWestvaco in Sidney, NY, says this company “realizes that an ergonomics standard may be proposed again and if not passed, the workers’ compensation insurer may require a company-wide ergonomics program. They see the benefit of the cost savings by operating as if the standard exists.”

Traditionally, on-site injury prevention services for such interventions as ergonomic assessments, job analysis, and employee educational training have been offered in a fee-for-service or pay-as-you-go manner. However, opportunities exist for both PTs and OTs to be employed by large corporations. The advantages of this type of arrangement are numerous and include contact with both employees doing the work and management. Time is saved and interventions can be more effective due to improved communication, quick recognition of symptoms, timely treatment, and, perhaps most important, a routine expectation and understanding that both employees and management follow through with recommendations and restrictions.

The presence of the PT or OT on-site “creates an opportunity to get things done,” says Jason Baxter, an OTR at North American Lighting Inc, Flora, Ill, a manufacturer of automotive lights and fixtures. “I have a direct link with management for raising and resolving concerns. Also, the employees and management are more aware of issues because of my presence on-site,” he says.

The fee-for-service or fee-per-hour therapist may miss a very important variable during a brief on-site tour, such as an issue related to employee culture, willingness of employees to communicate, or how job demands may differ when production rates are adjusted or staffing levels and environmental factors change. Herzog worked as an OT and industry consultant through an outpatient facility prior to joining MeadWestvaco. “Being here full-time allows me to be more effective,” he says. “As a consultant, you may or may not get to see all of the job duties.” On-site therapists can be more efficient with their time and will be in tune with the employee culture, expectations, production rate, and demands of the work environment. As Baxter says, “I have the ability to get things done with my presence.”

On-site interventions need not be limited in scope. In addition to traditional industrial rehabilitation strategies, PTs and OTs can expand their horizons to include on-site Functional Capacity Evaluations (FCEs); postoffer, preplacement testing; setting up and overseeing ergonomic committees; completing injury prevention training for new employee orientation; and managing a temporary alternative duty program.

This last strategy may require case management skills in working and communicating with the treating physician, injured employee, and supervisor. Baxter finds that he can be particularly helpful when he discovers that a supervisor is not following work restrictions placed on an employee by the attending physician. Not only does this improve the likelihood of a positive rehabilitation outcome and recovery, it demonstrates the employer’s level of commitment and concern for the employee. The much too common alternative is a failure to adequately apply the restrictions set by the treating physician, resulting in a continuation or exacerbation of symptoms, increased recovery time, increased time away from full duty, and decreased productivity. Baxter emphasizes early and timely intervention. “One point I try to make to supervisors is that recurrent pain and symptoms are signs of a production inefficiency,” he says. “I think they understand that language.”

On-site strategies can include direct care to employees, ranging from basic first aid to occupational and physical therapy treatment. The Eugene Water and Electric Board (EWEB), Eugene, Ore, employs a PT who is responsible for many of these services. The position also focuses on direct treatment of employees for both work-related and non-work-related injuries via a treatment room located in the employee fitness center. The primary goal for EWEB is to offer a unique service and benefit to its employees. All injuries are evaluated and treated in a timely manner, thereby reducing costs for both workers’ compensation and the employee medical plan.

TREATMENT AND TRANSPORT

Another innovative cost-containment strategy is being used at American Medical Response (AMR) of Portland, Ore. AMR operates Mobile Health Care, a quick response work injury treatment and transport service provided by qualified emergency medical technicians (EMTs) and paramedics.

“Mobile Health Care is a way for employers to reduce workers’ compensation costs by treating nonemergency injuries at the work site,” says David Jackson, business development manager for AMR.

Such injuries can include strains, sprains, foreign body in the eye, abrasions, and contusions. A treatment protocol was developed with physicians for determining emergent versus nonemergent care. Workers with significant injuries are transported to an occupational medicine facility of the employer’s designation.

According to Jackson, Mobile Health Care has a 40% treat and release rate. “That is, our EMTs respond to the call, evaluate, and treat the patient with no time lost from work approximately 40% of the time,” he says. “This is considered first aid treatment and does not involve filing workers’ compensation claims.”

The advantages of this type of intervention are numerous. Workers’ compensation claims are reduced, and timely treatment is offered to employees. Lost production of the employee, as well as of a supervisor or coworker who may accompany the patient to a medical facility for treatment, is significantly reduced. The employer’s liability is reduced in this circumstance as well, as the judgement call on whether to seek medical treatment is put into the qualified hands of the EMTs.

An added benefit of this type of intervention is containment. The employer is providing the medical treatment and can designate a facility in which the employee will be treated. This can be advantageous if the medical facility is familiar with the employer and the type of business. Realistic work restrictions, improved communication with the employer, and, if necessary, referral to physical or occupational therapy (either on-site or at the medical facility) all contribute to timely treatment within a seamless continuum of care. This can prevent the circumstance of employees leaving work and seeking treatment on their own.

Perhaps the greatest benefit of Mobile Health Care is cost savings. “The average cost for an emergency visit is $1,000,” says Jackson. “Mobile Health Care’s average cost of a work site visit is $200.”

He says Mobile Health Care has saved one local employer more than $100,000 in 1 year in workers’ compensation costs. Currently, Mobile Health Care provides work-related injury treatment and transport to 80 employers in the Portland metropolitan area.

On-site occupational injury prevention services are paid for directly by employers and can be a great way to add sources of revenue separate from the world of insurance and managed care. If you are on the lookout for something new to increase referrals, expand your practice, or improve your outcomes, then look no further. The opportunities are abundant. Occupational injury prevention professionals need to be creative and energetic as current intervention strategies are refined and improved, and new methods are identified.

Christopher A. Park, OTR, FABDA, is in private practice and can be reached at ctpark@aol.com

References

1. Ergonomics for the Prevention of Musculoskeletal Disorders. Draft Guidelines for Nursing Homes. Washington, DC: Occupational Safety and Health Administration; 2002. US Department of Labor.
2. Ellexson M. Work Site Rehabilitation Programs: The Future of Industrial Rehabilitation? Work Programs Special Interest Section Quarterly. Bethesda, Md: American Occupational Therapy Association; 1997;11(2).

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December 2002