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Picture this: You’re finally sending employees on their first work trips since the pandemic began.
For the first time in almost three years, they’re meeting clients in-person. Your employees are ready to relish in handshakes, fist bumps, days of face-to-face meetings and evenings of happy hours. They’re excited to explore the local food scene in a new city and make connections with new clients and colleagues.
The trip is off to a great start, until one worker trips over a piece of loose carpet on a flight of stairs. His arm lurches outward to break the fall, fracturing his wrist in the process. Now, he’s injured and he’s away from home.
“Statistically speaking, it’s not a common occurrence, but it does happen,” Tammy Bradly, senior director of clinical product marketing for Genex Services, said of workplace injuries that occur while an employee is away from home. “The more exposure you have, the more likely it could happen.”
How should workers’ comp respond in these cases? The answer: exactly like you would with any workplace injury, with compassion and determination that the worker’s wellbeing be put above all else.
When an employee is injured while away, there is an added dimension of difficulty to the claim, however. Workers’ comp case managers will have to work with the employee to decide whether they should be brought home or if they need to receive care where they are. Additionally, there may be language barriers or a need to transfer medical records if the worker is on an international trip.
Obviously, any normal vacation wouldn’t be eligible for workers’ compensation, but if a worker who is traveling for a conference or one who is temporarily on an assignment in another city or even country is hurt, then their injury may qualify.
Michelle Despres, vice president of product management and national clinical leader for physical therapy at One Call, knows first hand how difficult navigating a workplace injury while away from home can be. Earlier this year while attending the American Physical Therapy Association’s annual conference, she slipped, fell and fractured her leg.
Michelle Despres, vice president of physical therapy and national clinical leader, One Call
Her bone, she said, looked like a puzzle someone had dumped out of the box and onto a table. Fragments were everywhere.
The conference, which was held in San Antonio, Texas, was over a thousand miles away from her home in Jacksonville, Fla. Despres was away from her support system and her phone was dying as she was taken to the ER. She couldn’t help feeling alone and a little fearful.
“I was alone and in a place that’s not home,” Despres said. “I couldn’t call someone to just run over and give me a hand.”
Another scenario where workers’ compensation may have to step in and provide care for a worker who is in another country is when a worker who is a citizen of another country is employed by a U.S. company and working in the States.
Bradly shared stories of workers who, after experiencing permanent and total workplace injuries, wanted to move outside of the U.S. In one case a worker who needed home health care assistance decided to retire to Thailand with his wife. In another, a man whose injuries left him quadriplegic wanted to return to his home country, Costa Rica.
Both cases required Genex to navigate various challenges to providing care.
For the worker who wanted to retire to Thailand, Bradly explained that “home health care does not exist like it does in the U.S. in Thailand. Most often, if you need care, your family takes care of you.” So, Genex needed to figure out how to get him the services he needed. They ended up coordinating with a local hospital that could provide home care services.
The employee who wanted to return to Costa Rica faced similar challenges. He wanted to return to a remote town, where there were few health care resources in the immediate area. Genex found him a physician who was able to make house calls, so that his care wouldn’t be interrupted.
The primary question workers’ comp professionals will face when a worker is injured while away: should they be treated where they are or brought back home for care?
The answer will vary based on the severity of the injury and the worker’s preference. In Despres’ case the answer was a hybrid of sorts. She had her first surgery in San Antonio before being transferred by air ambulance to Jacksonville for the rest of her care.
Though claims numbers aren’t generated instantly, it’s important for case managers to initiate contact early on when a worker is injured while traveling. Workers who are away from home may experience more anxiety and other psychosocial factors since they’re in an unfamiliar environment and may not be able to be in touch with their support system.
When possible, try to make the recovery process easy for the injured worker. One of the actions Despres appreciated most was when her case managers anticipated her needs. She remembers arriving home after her second surgery to find that her workers’ comp team had installed a ramp, so she could get through her front door while in a wheelchair. They also acquired a shower chair and other medical equipment she needed.
“They anticipated what equipment I was going to need and that was so helpful,” Despres said. “It was a stressor I didn’t realize I had until I knew they solved it.”
If a worker is injured abroad, managing care becomes even more complicated. Case managers may face language barriers, a need to transfer or translate medical records and other challenges in these instances.
Bradly said these hurdles may present themselves whether a worker is temporarily traveling abroad or if someone with a long-term, catastrophic injury later decides they want to move to another country.
“In both scenarios, we’re dealing with people who may be recovering outside of the U.S.,” Bradly said.
Genex’s Care Abroad program is designed to help employers navigate these labyrinthine situations. The program helps manage logistics like transferring medical records or providing translation services and providing support to injured workers.
“Arranging for all of those things to occur is a pretty heavy lift for a claims handler who is not accustomed to dealing with business outside of the U.S.,” Bradly said.
“Oftentimes, these injured employees can’t speak the language, so they may be in a hospital or meeting with a provider, but they can’t communicate with the provider. We can assist and support that injured employee, making sure they have appropriate access to translation services and really helping them to understand what’s going on.”
Whatever the case, employers should approach workers who were injured while on work-related travel with compassion.
Despres recalls how caring her coworkers and case managers were — packing up her hotel room for her, anticipating her needs, calling and sending cards to check in — throughout the recovery process.
“On the employer side, everyone was reaching out,” she recollects. “I received cards. I got flowers. I was connected to my work people.” &
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When it comes to choosing an occupational health advisor, it’s imperative that companies choose a team where the clinicians are educated in the discipline of occupational health.
In this round-table discussion, three Concentra physicians — Dr. John Anderson, chief medical officer; Dr. Latha Brubaker, vice president of medical operations; and Dr. Maja Jurisic, vice president, medical director of strategic accounts — delve into the importance of choosing an occupational health provider with clinicians who have been specifically trained in the field.
John Anderson, DO FACOEM: Physicians trained in managing workers’ comp cases understand and appreciate the value of return to work and the many dynamics that can influence the outcome of a case. This training is not included in medical school curriculums, nor in residency training, with the exception of occupational medicine residencies.
Latha Brubaker, MD: In the same way you would choose a cardiologist to address a cardiac issue, you should choose an occupational medicine-trained clinician to take care of a work-related injury. The occupational medicine-trained clinician understands the medical aspect of work-related injuries as well as the injuries’ impact to the employee’s work performance and productivity.
Maja Jurisic, MD, CPE: I was an emergency physician for 11 years prior to joining Concentra. I was great at quickly evaluating injuries and coming up with an appropriate treatment plan. However, I knew nothing about managing the process of return to work, how important and beneficial it was to keep patients working in some capacity whenever medically possible, and how to write appropriate work restrictions. That’s not something you typically learn during medical training in fields other than occupational medicine.
As an emergency physician, I actually thought I was being “kind” to patients by taking them off work. It was the easiest and quickest thing for me to do, the patients were always very thankful to have the time off, and they often seemed to feel their employer “owed” it to them.
After I joined Concentra, I was horrified to learn that those times I had placed patients off work when it was not medically necessary, I had likely been promoting a disability mindset and potentially starting people down the path to delayed recovery.
Current estimates according to the AMA Guides to the Evaluation of Work Ability and Return to Work are that in 60% of the workers’ comp cases where injured workers are taken off work by physicians, it is not medically necessary.
Dr. John Anderson, Chief Medical Officer, Concentra
LB: Every Concentra clinician completes a new hire learning plan. This plan includes a thorough review of key occupational medicine topics which will help them approach each patient with evidence-based care.
There are continued learning opportunities through periodic clinical presentations and discussions. Our clinicians have opportunities to complete additional coursework through Concentra’s Occupational Health University (OHU).
This internal program has three levels, and upon completion, the participant receives a certificate as well as the opportunity to share their knowledge with their peers.
LB: The modern workplace is complex and has many stakeholders, particularly when working in a regulated industry or managing an employee who gets injured on the job. Distrust can quickly develop with the employee, supervisor, or safety officer if there’s a misstep in the delivery of care. It not only takes clinical expertise but also a deep understanding of these complexities both to deliver optimal care to an employee and to meet the needs of the employer. The transparent communication of clear, useful data is something that modern stakeholders are demanding more often. As part of our commitment to best-in-class occupational health care, Concentra provides structured reporting, customizable data, automated alerts, and other tools directly to employers and payors for more efficient and effective case management. Taking things one step further, we also offer employers the opportunity to discuss the status of individual cases – including treatment plans, referrals, functional job descriptions, and more – directly with our clinicians.
MJ: Occupational medicine physicians understand the workplace and the dangers inherent in certain types of jobs. They are knowledgeable about the ongoing and long-term effects of toxins and can perform the surveillance exams necessary to monitor those who work with toxic substances in compliance with OSHA regulations. That keeps workers safe and productive while helping employers remain compliant.
The United States spends more money treating musculoskeletal disorders than any other condition. In 2016, we spent $380 billion — more than the money spent on heart disease and cancer combined — and the costs have been growing by 5% per year.
Clinicians trained in occupational health care can work with employers to improve safety, decrease musculoskeletal injuries, and implement solutions to keep musculoskeletal aches and pains from becoming OSHA recordable injuries. For example, having athletic trainers on site in the workplace to provide first aid — a service offered by Concentra — can keep a minor problem from becoming a major one.
Dr. Latha Brubaker, Vice President of Medical Operations, Concentra
LB: Concentra has many subject matter experts (SMEs) in all aspects of occupational medicine, including Occupational Safety and Health Administration (OSHA) regulatory testing and examinations, Department of Transportation (DOT) examinations and certifications, injury care, and medical surveillance to name just a few. Our SMEs remain up to date on the latest recommendations for prevention and clinical treatment as well as the regulatory guidelines published by established health authorities.
MJ: Starting with orientation, we have a robust new hire learning plan that we update regularly. In fact, we are currently in the midst of our latest and greatest update.
We also have daily clinical messaging and a monthly clinical bulletin that goes out to all clinicians. These resources cover newly emerging trends in occupational medicine and injury care, updates to regulatory guidelines, and additional information that is current, relevant, and necessary to ensure our clinicians are using the most up-to-date practices and standards.
We have monthly clinician leadership meetings where our directors of medical operations (DMOs) receive updates on important regulatory guidelines, changes to those guidelines, new exposure hazards, and other critical information from internal experts. The DMOs then cascade this information down to center-level clinicians.
Last — but not least — we have medical expert panels (MEPs) who meet every month and develop formal guidance documents outlining best practices, topic reviews, and protocols in their areas of expertise. These materials are then reviewed by the clinical content committee, who also meets monthly and is composed of the medical vice presidents as well as some DMOs, prior to being promulgated.
It’s a lot of work (and it never stops), but it’s really important to Concentra that our clinicians have access to all the information and resources they need to help patients achieve the best possible outcomes. To us, talking about best-in-class outcomes is not just a string of nice-sounding words to be used in marketing; we put our time and energy into activities that we believe will provide our clinicians with the tools they can use to help employees renormalize their lives as smoothly as possible after they are disrupted by a work injury.
LB: A key opportunity is in leadership development through training courses, cross-disciplinary team collaboration, and one-on-one mentorship. Many clinicians have come to Concentra as center staff members and are now in key leadership positions. Learning is a constant in occupational medicine. Tenure certainly guarantees a level of expertise, but the learning never stops.
MJ: Clinicians can start at the center level and move up through the management path, all the way to vice president (at both regional and national levels) and then to chief medical officer. If a clinician is more interested in teaching or learning than practicing, there are opportunities to become a member of one of the expert panels we have. These clinicians can also grow through OHU courses and work on projects that will improve various areas of our practice. Unlike many hospital-based physicians, Concentra clinicians report to fellow clinicians all the way up the chain – not to administrators who lack formal training in medicine and patient care.
With tenure comes a deeper understanding of how things work both at Concentra and in the workers’ comp ecosphere as a whole. You learn how to get things done and how to help patients navigate the workers’ comp system and their return-to-work journey.
With tenure also comes a better appreciation of the roles of all the various stakeholders in workers’ comp. Over time, as you come to understand what their challenges and pain points are, you learn how to deal with employers and payors more effectively. After having been here for 30 years, I can do many things more quickly and easily than I could when I started.
Dr. Maja Jurisic, Vice President, Medical Director of Strategic Accounts, Concentra
LB: Immediate, thorough communication and diminished delays in care are significant advantages. The ability for a physician to walk down the hallway and speak with a physical therapist about their patient’s treatment plan or any identified barriers to healing is far superior in hastening a patient’s recovery. The convenience of receiving all their care under one roof is also an added benefit for the patient.
MJ: There is a “burden of care” that employees experience after an injury. Making appointments, getting to and from appointments, getting into physical therapy, and seeing a specialist can all be pain points for injured employees, exacerbating their typical stress levels. Clinicians whose practice is in the workers’ comp arena understand that these additional burdens can push vulnerable employees past the limits of their coping skills and result in a recovery plateau — with the employee failing to improve. That’s why we try to make our centers as close to a “one-stop shop” as possible – with continued efforts to optimize the patient registration, employer authorization, and scheduling processes.
JA: While the uncomplicated injury in a highly motivated worker can be medically managed by most clinicians, the additional focus on return to work by clinicians trained in the biopsychosocial model is what leads to optimal clinical and cost outcome — full recovery at the lowest possible total cost per case.
Having the ability to manage cost per case is the result of understanding the drivers of cost in workers’ comp cases: medical, administrative, indemnity, and legal costs for the employer and payor.
This is not taught in medical school, nor do typical urgent care centers have an infrastructure to convey this information to their clinicians. Having formal training or curricula that focuses on this knowledge enables the clinician to identify patients who may be negatively influenced by psychosocial issues and to work closely with that patient, the employer, and the adjuster to overcome potential barriers and achieve a successful return to work.
MJ: Taking a biopsychosocial approach to injury treatment, you look at your patient within the context of their environment and treat the whole person — not just the physical injury. The clinicians who take a biopsychosocial approach understand that emotional distress amplifies the patient’s experience of pain and therefore avoid the pitfall of going on an extensive and expensive search for a “pain generator” to “fix” with pills or procedures — when the problem is that the patient’s nervous system is perceiving danger when there is none or after it has passed.
Teaching clinicians to identify patients with psychological risk factors early on, such as poor recovery expectations, anxiety, pain catastrophizing, job dissatisfaction, perceived injustice, and lack of support systems, and then providing strategies known to be effective in addressing those issues – helps injured workers avoid prolonged disability and ultimately improves outcomes. That’s what we try to do.
Bringing Concentra’s core values into play — those being a healing focus, a selfless heart, and a tireless resolve — we seek to understand the patient’s beliefs and fears about their situation. Once we do that, we can help that individual reframe their mindset and adopt attitudes and beliefs that will better serve them in moving towards functional restoration and normal daily routines.
LB: Improvements include advancements in technology, such as electronic medical record systems, data delivery to employers, and real time reporting of key performance data. Concentra embraces these advancements and knows they are needed to successfully deliver high-quality care and to stand well above competitors in our field.
MJ: I am very proud of the fact that Concentra is helping our industry shift away from a focus on pain. We no longer use the visual analog pain scale as a gauge of tissue healing and recovery from injury. We are leading the way in focusing our conversations with patients on objective measures, functional recovery, and the triad of wellness (movement, sleep, and nutrition) rather than on pain. We have stopped assessing pain solely with a numeric scale after the initial injury visit, as we know that a quantitative measure of pain is not necessarily correlated with tissue injury.
Our FReSH (Functional Restoration and Status of Healing) approach was born in 2017 out of the realization that cases could stall if we based our treatment plans and activity progression primarily on the numeric pain scale. In cases where the patient’s pain severity didn’t make sense medically given the initial mechanism of the work injury, the treatment provided, the time elapsed, and the objective findings, our outcomes weren’t great when our focus was on finding and “fixing” the pain generator.
JA: While it’s hard to predict five to 10 years from now what might happen, we know that predictive analytics will be a game changer. With our current work in machine learning and artificial intelligence, I believe we will have the ability to understand which patients are at risk for poor outcomes and intervene earlier in the case to improve those outcomes. That’s what is most exciting for me. That will benefit all stakeholders.
LB: Further improvements in telemedicine will be an important consideration as younger generations age. These employees are comfortable with advanced technology and will most likely expect a telemedicine option as an access point for care.
MJ: As we continue to learn more from the neurosciences about the differences between acute and chronic pain, we will have better paradigms and approaches to treating acute injuries so that we can avoid having patients transition from acute and subacute pain to chronic pain.
In addition to clinical improvements, advances in technology will enhance communication and collaboration between all stakeholders in the workers’ comp space, ultimately supporting injured employees and leading to better overall outcomes.
Contributing to the growth, development, and transformation of an entire ecosystem requires one to understand not only where the industry has come from but, perhaps more importantly, where it’s going.
With an unparalleled history in occupational medicine – more than 40 years’ worth – and a nationwide team of 11,000 colleagues committed to excellence in workers’ comp care, Concentra continues to explore and innovate new ways to improve the health and safety of America’s workforce, one patient at a time.
To learn more, please visit: https://www.concentra.com/.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Concentra. The editorial staff of Risk & Insurance had no role in its preparation.
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