Work Solutions Insight

Your work injury management newsletter March 2010

Job Matching wins national award
Responsibility Leader award by Liberty Mutual goes to Judie Tsanopoulos

DSI Job Function Match (JFM) process was brought to St Joseph Health System by Judie Tsanopoulos, Director of Workers Compensation and Loss Control.   Before beginning the process in 2005, Judie wrote to Susan and Dennis Isernhagen her reasons for wanting to implement the system:
“As a large Health System, we face an ever growing frequency and severity issue associated with our industrial losses.  Determined to find solutions, we sought to find an innovative business partner that could develop a strategy…. for our losses during three stages: pre-placement, return from LOA’s and during the treatment phase of a disability.  DSI Work Solutions tailored a customized approach….This system assures that the applicant may safely execute the functions and identifies any modifications that can be crafted to safely perform the essential functions”

The award praises Judie Tsanopoulos in these words:
“If there is one thing that characterizes our Risk Innovators as Responsibility Leaders, it’s persistence…  (she) refused to give up on her efforts to ….ensure that workers can return to work. And, in the process, the changes improved employee morale and helped workers lose fears of reinjury during recover and return to work.  The result, besides employees returning to work more quickly, is fewer lawsuits and lower workers’ compensation costs. And healthy employees, too.”

“Taking the guesswork out of what an injured employee can and cannot do makes returning to work safer for employees and less risky for employers.”…Tsanopoulos...implemented the Job Function Matching Program, a system that measures the physical demands of each of the system’s 24,000 employee’s jobs and provides testing to measure the ability of injured employees who are returning to work to perform them. The program has significantly reduced modified workdays, from 3,642 in the first year to 672 in the third year.”

Leif Guerrero, manager of disability and employee health at Mission Hospital, part of the St Joseph system, states reports that in his hospital alone, the program has saved more than a million dollars in workers compensation costs in the first year of operation.

Objective job testing information assists with post-injury evaluations and with facilitating fair and quick resolution of return to work issues.  Weekly testing by the DSI trained St Joseph JFM physical therapist provides the physician, supervisors and workers with objective information to return the worker to the original job with or without temporary modifications.

Guerrero also states “Employee morale has noticeably improved.  Negative language describing a patient’s status has been replaced…  The idea of “work Restrictions” has been eliminated and now the idea “physical abilities” is emphasized.
Article quotes are from Risk and Insurance web newsletter, Liberty Mutual.

DSI congratulates Judie and the whole team at St Joseph for their commitment to insuring that their employees have the best hiring practices and return to work methods which also meet the intent of ADA and CA law..

Design of testing critical for non discrimination

By Susan J. Isernhagen PT
DSI Work Solutions inc
sisernhagen@dsiworksolutions.com

Recent legal cases and legislation provide clarity regarding use of functional testing and legal issues in return to work. What is required is selecting the appropriate test for the issue:

Performing the appropriate functional test: Indergard vs Georgia Pacific:  A worker, who was evaluated in a PCE-FCE, was not returned to work and claimed discrimination.  The defense stated that the PCE was not a medical test.  The court has correctly ruled that it was medical and will now determine if the worker did sustain discriminatory actions.  The following points can be used by referrers and therapists could help prevent discrimination:

• Medical information, in addition to the functional work information, was sent to the employer. While workers comp is technically not covered by HIPAA, but this is for the work comp injury, not medical health issues. The history, physical or FCE may contain medical findings covering both personal health and work injury.  Clear identification of what is desired and what should be sent, as well as obtaining patient consent protects all.  Some employers choose to only receive job ability information and the evaluator must separate medical from functional.
• The court questioned whether some tests were not job related.  To insure SAFETY of the worker to take the test, some preliminary history and physical is important. Testers, however, should avoid physical exam items that are non job or safety related. 
• A standard PCE with some job simulation components was done instead of a job specific test. The injured worker claimed that the PCE measured tasks not on the job and was discriminatory because it was not job related and consistent with business necessity. Most generic PCE/FCE’s do measure items not found on a job description.  Since the employer only wanted to know if the worker could perform 2 jobs, the problem would have been avoided with a job specific test.  
• The therapist and doctor indicated that the worker could not do the jobs in question. It is the employer’s responsibility to make the job placement determination.  The therapist should provide ability and job match information, but leave work return decision to the employer.
• In disability situations, the ADA requires the employer to seek accommodations for a worker.  A job specific test with accommodation recommendations could have been useful for the employer and the worker for their interactive dialogue on return to work.

The DSI newsletter will report on final results of this court case when it is resolved.

James v Goodyear Tire & Rubber Co.
In an unpublished decision, the 6th US Circuit Court of Appeals affirmed summary judgment for Goodyear in a former employee’s ADA suit.  The worker had a progressive disease.  For ten years he could perform his job.  Then, job difficulty and safety issues arose and were reported by supervisors and co-workers.  He was called in to discuss them.  The employer recommended an FCE but the employee decided to take disability retirement instead.  The operator sued under ADA saying that the FCE would have been a discriminatory adverse action.  The 6th Circuit ruled for Goodyear.  When an evaluation is job related and motivated by reasonable safety concerns, it cannot be an adverse action.  In order to identify if the evaluation would have been job related and consistent with business necessity, the court would evaluate the scope of the examination. Because the worker refused to take it, there was no evidence to show it would have been discriminatory.  Source: LRP publications 2010.

Avoiding discrimination:

• Determine whether the functional test used should be a job specific test or standardized FCE/PCE
• Get patient consent for records and focus on job ability results
• If job specific tests are indicated, measure job demands and design a job specific test
• For job specific evaluations, test only to the specifics of the job(s) required
• For either type of functional test, match the worker’s abilities to the job tasks.  Indicate if there is a match or not.  Leave employment decisions to the employer.
• When indicated, suggestions for accommodation/ modification are used in an “interactive dialogue” with the worker.

Functional evaluation information continues to be important in objectively matching workers and their jobs.  By choosing the correct test and providing non discriminatory information the therapist provides information consistent with laws and non-discriminatory return to work.

National Presentations
2009:
Feb 10, 2009: Dennis Isernhagen PT (DSI) and Manny Kiesser, Manager Cast Health Services, Disneyland Resort, CA: “A New Paradigm for worker productivity management”  National Business Coalition on Health: Los Angeles:  This process and outcomes presentation highlighted the Disneyland Resort success in implementing their program to bring workers back to work early through “Right Fit” (including job function matching).  The reduction in costs was compared for two initiatives throughout the park.  The first encompassed advancements in cast health including safety, prevention exercise, and ergonomics. The second matched set included job groups that had the prevention programs plus the job matching program.  Disneyland Resort’s proactive approach led to savings in workers compensation costs and lost time for both groups.  The group that had included job matching in return to work had significantly more savings.  Kiesser reported that Right Fit is a cohesive plan including prevention and case management stakeholders that work together closely.

2010: Two upcoming national presentations
May 3 2010, Dennis Isernhagen (DSI), Bruce Sherman MD (Global Medical Director Goodyear), Joseph Fortuna MD (Medical Director Delphi): Operationalizing Health Productivity in Management:  Orlando FL, American College of Occupational and Environmental Medicine. www.acoem.org

July 21, 2010: Susan Isernhagen (DSI) : Use, Abuse and Future of FCE’s: For worker’s compensation and occupational medicine:  Cape Cod MA, SEAK: www.seak.com

DSI PROVIDER UPDATE

DSI announces new providers and provides links to all current DSI providers. Employers, case managers, insurers, physicians, therapists, and referrers may use the website to identify experts within their geographic area. Contact Sue at sisernhagen@dsiworksolutions.com to find specific providers to meet your needs. If you wish to become a licensed DSI provider, also contact Sue to set training dates.

In October, we welcomed Excel Physical Therapy of Buffalo MN, Performance Physical Therapy of Bellingham Washington and Columbine Health System, Ft Collins CO.

In January we welcomed Premier Physical Therapy, Peoria IL, VSH Work Solutions (Vrinda Hatti), West Chester PA, and Physical Therapy and Wellness Institute, Plantation Florida.

In February we welcomed Door County Memorial Hospital, Sturgeon Bay, WI.

In March we welcome Enfield Health and Wellness, Enfield CT and ESD Work Solutions (Evangeline Sanvicente Dorsey) of Rockaway NJ.

In addition additional therapists were trained from the growing practices of Marshfield Clinic, Eau Claire WI and Rehab Authority, Pocatello ID.

In April, DSI will be holding trainings for new providers in the Midwest and the southwest. Openings are also available for the other US regions. Please contact DSI.

DSI providers can be found by this link

Webinars bring leading topics:
DSI webinars for all stakeholders in work injury management and prevention are very well received by participants.  They are fully recorded, and can be accessed through registering with DSI.  The topics for the 2009-2010 series are:

• Ergonomics I and II
• The Aging Worker
• The onsite injury management and prevention team
• Functional Capacity Assessment: the difficult clients
• Developing “early intervention” programs in industry
• Americans with Disabilities Act Amendment: New rules
• Office ergonomics that work

For more information and registration please contact Lisa Mertz or Sue Isernhagen at sisernhagen@dsiworksolutions.com