The American College of Occupational and Environmental Medicine and industry as a whole have called for the increased use of complementary and alternative medicine (CAM) services, because spiraling workers’ compensation costs, productivity losses and increased claims are all taking bites out of the average company’s bottom line profits.
These developments present the ideal opportunity for the chiropractic profession to take our rightful place in the occupational medicine equation.
Concerns by corporate and government managers are heightened, considering the following:
- Musculoskeletal disorders affect about 1 million U.S. workers and cost $45 billion to $54 billion per year (Jan. 2001, National Academy of Sciences report).
- About one-third of annual workers’ compensation costs are due to repetitive stress injuries (RSIs) (U.S. General Accounting Office/GAO).
- About two-thirds of workers’ compensation costs are for disability (GAO).
- U.S. employers spend at least $100 billion, in addition to workers’ compensation costs, on lost productivity, employee turnover, and other indirect expenses (GAO).
This changing climate has profoundly affected the field of occupational medicine. The combination of cost-effectiveness and quality of care has become the benchmark for the consequent drive behind the rise of health-care delivery systems. Industrial medicine is on the rise and the abilities of chiropractors are in demand.
Health-care providers must implement cost-effective programs that empower employers with tools to decrease workers’ compensation claims and ensure optimum performance from their employees. These programs must be customized to meet a company’s philosophy, procedure and budgetary guidelines, to ensure employee performance, injury prevention, and reduction of workers’ compensation costs.
These programs will also need to integrate an ergonomics management program in conjunction with Occupational Safety and Health Administration guidelines and the National Institute of Occupational Health Work Practices Guide. The programs must also comply with the objectives of the Americans with Disabilities Act.
Effective ergonomics management programs should implement computerized testing equipment protocols to perform objective evaluations and outcome assessments, with the aim of reducing companies’ workers’ compensation claims. An effective cost-containment program starts with post-job-offer employment screenings, which take advantage of objective testing. Post-offer screenings can determine applicants’ abilities to perform the proposed essential job functions. The testing and subsequent baselines will provide pre-injury status if employees become injured later. Applicants’ physical abilities and impairments are objectively evaluated and documented.
The applicants are made aware of the impairments and given the opportunity to address them. More importantly, applicants know their potential employer is aware of their impairments and have been notified that their impairments will be deducted in the event of future injury. In addition, the objectivity of the testing equipment and processes gives the applicant security that the health-care provider is neutral in the evaluation process.
Tests should be conducted using objective evaluation equipment, as employees are evaluated to identify restricted ranges of motion, areas of muscle weakness, and overall strength, such as grip and lifting capacity. Their abilities can then be accurately matched to a particular job’s essential functions to determine if the employee can perform them with a minimal risk of injury.
In the event of a work-related claim, the post-offer examination results are invaluable. By performing a physical examination and comparing it to a post-injury analysis, the overall acquired dysfunctions caused by the injury can be quantified. This significantly reduces fraud and symptom magnification.
An objective approach to injury evaluation can be used to quantify an injury claim. The claim can then be evaluated for its merit, using court-accepted databases and American Medical Association guidelines of impairment. If a claim appears to be without merit, meaning that the symptoms and objective findings are not consistent with the injury or there is no change in the baseline, the client and their insurance representatives would be notified of possible fraud.
If a claim does appear to have merit, conservative treatment is qualified, targeted, and initiated. Progress is closely monitored, which enhances early, yet safe, return-to-work strategies. This specific approach can help decrease the length of treatment, along with the associated direct and indirect costs.
Any resulting settlements, if any, can then be categorized based on a clearly identified level of dysfunction acquired by the injury — not a lump sum justified by non-quantifiable damages. Therefore, the medical report is based on an objectively framed conclusion that realistically addresses any residual factors of disability, with objectives and opinions based on the entire circumstances of the event.
In addition, job-specific instruction can be implemented to provide comprehensive training for employees to avoid injury, therefore lowering injury costs and incidence. Proactive injury management and back-to-work programs are also encouraged, ensuring maximum employee performance within the work place and reducing overall claims.
An effective occupational medicine program should include post-offer employment screening, physical evaluations, functional capacity evaluations (FCEs), and objective post-injury evaluations. These programs can reduce claims and fraud, and can therefore increase a company’s profitability immediately.
