Transcript HomeTown Health 3.16.2010

Workers Compensation Program
HomeTown Health HR Workshop
March 16, 2010
presented by
Ron Graves, Assistant Vice President Loss Control
Anne Burleson, Director of Workers Compensation
Sandy Carroll, Claim Supervisor
Key Risk Insurance Company
Key Risk Management Services, LLC
Physician Panels
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GA 34-9-201
At least six physicians
One orthopedic surgery
No more than two industrial clinics
Employee selection
One change allowed
Employer Responsibility
• Post the panel according to guidelines
• Ensure employee understands function
• Provide proper assistance
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Plaintiff Attorney
• Request copy of panel with notification
of representation
• Verify providers taking patients and still
practicing
• Name authorized treating physician if
panel is found invalid.
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Medical Authorizations
• 34-9-207
• Refusal of an employee to sign release
for medical information may effect his
entitlement to compensation.
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State Board of Workers Compensation
Changes at the board:
• Two new Board Directors:
a) Chairman Rick Thompson
b) Judge Steven Farrow
• Office closings
a) Gainesville
b) Rome
• No longer hearing cases in Forest Park
• Administrative Law Judges – rotation
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A Transitional Duty Program Is...
• A managed care system designed to return injured
employees back to their original job with minimal time
lost
• Designed to return injured workers to full capacity with
minimum disability and maximum cost savings
• Designed to help injured employees recover and return to
medically approved work as soon as possible after an
injury. This is a joint responsibility of:
– The employer
– The workers compensation claims adjuster
– The medical case manager
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Benefits of a Transitional Duty Program
• To the employer
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Increased productivity
Improved morale
Reduced overtime
Reduced temporary
help
– Reduced claims costs
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• To the employee
– Improved financial
stability
– Faster recovery
– Eliminates separation
– Positive self esteem
– Continued work routine
The Aging Workforce
• U.S. work force is aging
• Medium age in 2008 was 41 vs. 37 in 1990
• Workers delaying retirement
*All stats are from U.S. Department of Labor
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• Older workers have more lost time from work
Ages 35-44
Ages 45-54
Ages 55-64
Ages 65 +
8 days
10 days
11 days
12 days
• Workers 65 and over are working full time jobs at a
higher rater. In 1995 it was 44%; in 2007 it was 57%.
• The older the employee, the greater potential for more
complications in the healing process from co-morbidities.
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Medical Cost Drivers
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Increase in severity
Patient care extending longer than normal period of time
Surgical recommendations increasing
Narcotic medications used earlier in treatment plan and
ongoing
More medical disciplines involved in treatment, ex
orthopedic, pain management,
More contentious litigation
Protection of Medicare's interest
Reduction of bringing employees back to work –
economy
Medical Bill Adjudication
• Our medical bill adjudication system utilizes a
sophisticated rules based system in combination with
the expertise of our trained medical bill review team.
• CompCareLX™ is Key Risk’s layered network
program.
– Your clients’ utilization of the layered network drives network
penetration resulting in additional savings when an injury
occurs.
– GA network penetration exceeds 93% (as of Jan 2010).
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Medical Bill Review Process
Each bill is systematically reviewed and fee
schedule rules are interpreted and applied, the
system marks bills needing additional review
Each bill is adjudicated to State Fee Schedule or the
usual and customary rate schedule
Orthopedics
& Sports Medicine
– GA
Total Charges:
$7,827.50
BillStandard
Details: Fee Schedule Reductions - GA
- $758.65
Dx1: 840.4 Sprain Rotator Cuff
Additional Reductions from applying Key
Risk Audit Rules Charges
Proc Code Description
- $3,353.89
23412
Repair Cuff
$2,699.00
Additional
Reductions
from Key1,903.00
Risk's
29826-59
Arthroscopy
Shoulder
Medical bills are analyzed by a Medical Savings
Auditor, including Registered Nurses, for
“Additional Savings”
Each bill has Network Discounts applied where
appropriate
Nurse Review
of Treatment and Bill
Coding
Arthroscopy Shoulder
1,660.00
- $898.39
29825-59
23412-80
Repair Cuff
674.75
Key Risk’s
CompCare
LX Savings
29826-80
Arthroscopy
Shoulder
475.75
29825-80
- $1,334.72
Arthroscopy Shoulder
Total Charges
415.00
$7,827.50
Total Savings: $6,345.65
Paid Charges: $1,481.85
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Working Together.
Delivering Better Outcomes.
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Additional Resources:
Loss Control: Resources for our clients
• Library of training videos
• Links to helpful websites
• Web Based Tools
Claims: Claims Management Tools
• CompCare provider network
• Web Tools – Network Pharmacy Locator, Employer/Employee
• Procedures, Authorization for Release of Information
Visit our website at www.keyrisk.com.
State Board of Workers Compensation Website – www.sbwc.georgia.gov
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SB 1788
“Nurse and Health Care Worker Protection
Act of 2009”
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Sponsorship and Referral
Mr. Franken, Sponsor
Committee on Health, Education, Labor, and
Pensions
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Purpose
To reduce injuries to patients, direct-care
registered nurses, and all other health care
workers by establishing a safe patient
handling and injury prevention standard.
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Background
• Direct care nurses rank 7th in the number of
cases of musculoskeletal disorders resulting in
days away from work
• Nurses aides, orderlies, and attendants sustain
the second highest frequency of musculoskeletal
disorders of any occupation
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Study Results
52% of nurses complain of chronic
back pain and 38% suffer from pain
severe enough to require leave from
work.
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Premise
• Patients are not at optimum levels of safety
while being lifted, transported, or repositioned
manually.
• Mechanical lift programs can substantially
reduce skin tears suffered by patients and the
frequency of patients being dropped.
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Facts
• A growing number of health care facilities have
incorporated patient handling technology and
have reported positive results.
• As a result, the number of lost work days due to
injury and staff turnover has declined.
• Assistive patient handling technology
successfully reduces workers compensation
costs for musculoskeletal disorders.
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Premise
Establishing a safe patient handling and injury
prevention standard is a critical component in:
1) Protecting nurses and other health care workers
2) Addressing the nursing shortage
3) Increasing patient safety
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Rulemaking
• Within one year of the enactment of this Act,
OSHA shall propose a standard on safe patient
handling and injury prevention.
• Within two years of the enactment of this Act, a
final standard shall be promulgated.
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Requirements
• Engineering controls shall be used to perform
lifting, transferring, and repositioning of
patients.
• Manual lifting of patients by direct care nurses
and all other health care workers shall be
eliminated.
• The lone exception is where the safe use of
patient handling practices can be demonstrated
to compromise patient care.
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Timing
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Develop and implement a safe patient handling and
injury prevention plan within six months of the
promulgation of the standard that includes:
1) Hazard identification
2) Risk assessments
3) Control measures
Purchase, use, maintain and have accessible an
adequate number of safe lift mechanical devices within
two years of the promulgation of the standard.
Employee Participation
Each employer shall obtain input from
health care workers in developing and
implementing the safe patient handling and
injury prevention plan, including the
purchase of equipment.
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Data Collection
Establish and maintain a data collection
system that tracks and analyzes trends in
injuries and make such data and analyses
available to employees.
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Documentation of Exceptions
Document each instance when safe patient
handling equipment was not used due to legitimate
concerns about patient care and generate a written
report in each instance that includes:
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The work task being performed
The reason the equipment was not used
The nature of the risk posed to the worker
The steps being taken to prevent a similar situation
Training Frequency
Train nurses and other health care workers
on safe patient handling and injury
prevention policies, equipment, and devices
at least annually.
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Training
• Include information on hazard identification,
assessment, and control of musculoskeletal
hazards.
• Conducted by an individual with knowledge
in the subject matter
• Delivered, at least in part, in an interactive
classroom-based and hands-on format.
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Posting Requirements
Post a notice that:
• Explains the standard
• Includes information on policies and
training
• Explains procedures to report patient
handling-related injuries
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Annual Evaluation
Conduct an annual written evaluation that
includes:
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Handling procedures
Selection of equipment
Engineering controls
Assessment of injuries
New safe patient handling and injury
prevention technology
Evaluation Team
The annual evaluations shall be conducted
with the involvement of nurses, other health
care workers and their representatives and be
documented in writing.
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Follow-up
Heath care employers shall take corrective
action as recommended in the written
evaluation
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Refusal of Assignment
A health care worker may refuse to accept an
assignment from a health care employer if:
• The assignment would subject the worker
to conditions that would violate the
standard.
• The worker has not received the required
training.
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Worker Protection
• No employer shall discharge, discriminate, or retaliate in
any manner against a worker based on the worker’s
refusal of a lifting assignment.
• No employer shall file a complaint or a report against a
worker with a state disciplinary agency because of a
refusal of a lifting assignment.
• No employer shall discriminate or retaliate against a
worker who, in conjunction with another worker:
– Reports a violation or suspected violation of the standard
– Investigates, cooperates, or participates in an investigation
– Informs or discusses with individuals a violation or suspected
violation
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Notice
Health care employers shall include a notice
explaining the rights of workers and
including a statement that a worker may file
a complaint with the Secretary (OSHA)
against an employer that violates the
standard, including instructions for how to
file a complaint.
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Grants
The Secretary of Health and Human
Services shall establish a grant program that
provides financial assistance to cover some
or all of the costs of purchasing safe patient
handling and injury prevention equipment
for health care facilities.
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Grant Requirements
Hospitals, nursing facilities, home health care,
and outpatient facilities must show that
• Such equipment is required to comply with the
standard and
• Demonstrate the financial need for assistance with
purchasing the equipment.
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Authorization of Appropriations
There are authorized to be appropriated for
financial assistance $200,000,000 of which
$50,000,000 will be available specifically
for home health agencies or entities.
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Thank you for joining us today!
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