An Overview of Case Management

1. An Overview of Case Management 2013 East Central Iowa Safety & Health Conference Kirkwood College February 26th, 2013 Karl Schewe BA, MBA

2. Purpose • To ethically and legally: • Help participants prevent workplace aggravation of non-work-related medical conditions • Minimize OSHA Recordability and Lost Time for work-related medical conditions

3. Process • Discuss the ethical & legal framework for non-work-related Return to Work • Present a Job Requirements form that can be used to help facilitate medical clearance • Discuss the ethical & legal framework for OSHA Recordability • Present case-management strategies and tactics • Keep in mind that your company policies have bearing on what you can and cannot do.

4. Expected Outcome • That participants who need them will come away with some practical ideas and tools to help them with case management for both: • Employees returning to work from non-work-related medical care that could affect their job. • Work-related injuries and illnesses

5. Return to Work from a non-work-related medical absence • Why do we need to manage this? If you significantly aggravate it, you own it. A significant aggravation simply means something aggravated it to the point that it triggered OSHA Recordability.

6. Return to Work from a non-work-related medical absence • How do we approach this issue? • Ethical considerations: • Treat others the way you would want to be treated. • Be fair and consistent. • Legal considerations: • Know your company’s HR policies. • HIPPA – You are only interested in fitness for duty. • ADA - Are the restrictions temporary or permanent?

7. Return to Work from a non-work-related medical absence • Have a system: • What is “Fit for duty”? • Identify your job requirements ahead of time (see handout). • Help the personal physicians to have some “skin in the game”. • Communicate the expectations to employees. • Have supervisors give notice if someone appears to not be fit for duty.

8. Return to Work from a non-work-related medical absence • Be consistent in how you apply your system: • If you differentiate between work groups, be consistent within each group (salaried vs. hourly). • Temporary vs. permanent restrictions

9. Return to Work from a non-work-related medical absence • Questions???

10. Work-Related Injuries & Illnesses • Why do we need to manage this? • Patient Care • Worker’s Compensation costs • Company metrics • Recordable cases • Lost Time cases

11. Work-Related Injuries & Illnesses • Ethical Considerations: • Patient care is #1 • It’s the right thing to do. • Conditions can worsen. • Your company’s name is on the line. • Legal Considerations: • OSHA requires accurate recording. • You must be able to demonstrate good faith and defend your decisions. • OSHA Recordability normally tracks with Worker’s Compensation but not always.

12. Work-Related Injuries & Illnesses • How do we approach this issue? • Know the regulations: • 29 CFR 1904 (See handout for parts of it.) • OSHA Record-Keeping Handbook • Letters of interpretation • Consider a phone call to OSHA. (Ann Jackson in Iowa) • Is it work-related? • Watch out for special cases such as: • Parking Lots • Secondary injuries from personal events • Workplace violence • Does it trigger Recordability or Lost Time?

13. Work-Related Injuries & Illnesses • Case management strategies: • Know your care providers: • Do they know the regulations? • Do they care? • Do they know you? • Beware of conflicts of interest (WC tends to pay on time and sometimes pay more). • Know your supervisors: • Do they know the regulations? • Do they know you? • Ensure that employees know that they must report incidents promptly.

14. Work-Related Injuries & Illnesses • Specific steps that will help: • Work with Occupational Medicine providers & ER physicians. • Assure them that patient care comes first. • Verify that they know the regulations. • Educate them on your workplace exposures, and also the exposures that you do not have. • Discuss multiple visits vs. “what if” prescriptions. • Clarify restricted duty opportunities.

15. Specific steps that will help (continued): • Educate your supervisors • Accompany the employee to the clinic or ER. • Educate your employees • Never forget that patient care comes first. Never compromise your credibility or integrity by being unrealistic or unethical. Do the best you can, and realize that sometimes a situation simply is what it is.

16. Work-Related Injuries & Illnesses • Specific tactics - Patient care comes 1st!: • Pain meds vs. ice & OTC ibuprofen • “What if” antibiotics vs. follow-up visits • Butterflies or Steri-Strips vs. stitches, staples, or glue. • Rescinding a prescription • “Use as tolerated” vs. specific restrictions, but DON’T CHEAT. • Rigid vs. non-rigid means of support • ER – Time off vs. follow-up with company doctor

17. Work-Related Injuries & Illnesses • Questions???

18. Purpose • To ethically and legally: • Help participants prevent workplace aggravation of non-work-related medical conditions • Minimize OSHA Recordability and Lost Time for work-related medical conditions

19. Process • Discuss the ethical & legal framework for non-work-related Return to Work • Present a Job Requirements form that can be used to help facilitate medical clearance • Discuss the ethical & legal framework for OSHA Recordability • Present case-management strategies and tactics • Keep in mind that your company policies have bearing on what you can and cannot do.

20. Expected Outcome • That participants who need them will come away with some practical ideas and tools to help them with case management for both: • Employees returning to work from non-work-related medical care that could affect their job. • Work-related injuries and illnesses