Assessing Fitness for Duty

A state-sponsored occupational health program is teaching Washington doctors and employers how to get injured workers back on the job.

Assessing fitness for duty is one of the most important aspects of safely returning injured employees to work.

Determining when an injured employee can rejoin the work force, and in what capacity, is a cornerstone of a new program launched in three Eastern Washington counties by the state's Department of Labor & Industries (L&I).

A University of Washington (UW) study of the Eastern Washington Center of Occupational Health and Education (COHE) found injured workers treated by doctors enrolled in the center had less disability and lower medical costs, saving the state workers' compensation system an average of $447 per claim.

The study tracked 7,162 injured workers treated by physicians enrolled in the Spokane-based COHE between June 2004 and July 2005 and compared their outcomes to workers with similar injuries who weren't treated by a COHE doctor. Workers with back problems, in particular, had better outcomes. In all, the study found the program saved the workers' compensation system about $3.1 million.

In some ways, the results are similar to what UW found a year ago when it studied the Center for Occupational Health and Education sponsored by Valley Medical Center in Renton. UW found the Renton center saved an average of $566 per claim, with total savings of nearly $5.6 million on 10,000 claims.

"Employers who don't have light-duty work are the most common barrier to the program," says Diana Drylie, MHE, COHE project director. With appropriate treatment, good communication between all parties (worker, employer and doctor), an accurate assessment of fitness for duty and light- or modified-duty jobs when necessary, "there is a very real possibility of reducing long-term disability," she adds.

Best Practices

In Washington, injured workers are not required to seek treatment from L&I-certified physicians. The state workers' compensation program allows them to seek treatment from any medical provider classified as an "attending doctor," which can include physicians, chiropractors, advanced registered nurses and, for some simple claims, physician's assistants.

Drylie says a recent evaluation of the COHE program participants found them scoring their clinical care, treatment and satisfaction with their care as highly as did injured workers who sought their own medical providers and treatment programs.

The new Washington program is based on four occupational health principles:

1) Reporting the injury to L&I within 2 business days. "Until L&I knows that injury occurred, there cannot be any return-to-work planning," which includes establishing fitness for duty, says Drylie.

2) Training doctors to recognize and treat occupational-related injuries and illnesses, and to communicate with employers. "If a worker can't go back to his or her regular job, or if modified duty is necessary, the doctor needs to call and talk to the employer," says Drylie. "The employer knows what light-duty work if any is available, and the doctor knows what the employee can and cannot do." Doctors are encouraged to make the call while the employee is in the office, so there's no confusion about what is said, she adds.

3) An "activity prescription form," which includes restrictions and capabilities of injured workers, is completed.

4) When a worker is injured and unable to work for 4 weeks or more, the provider reviews barriers to return-to-work and works with the employee and employer to remove those barriers.

There are significant incentives for physicians participating in the program to follow the best practices. They are paid more when they discuss light-duty options with the injured worker's employer and when they fax the Report of Accident to L&I within 2 days.

There also are incentives for employers to cooperate with L&I and the physicians at the centers. According to Drylie: "The most common barrier to return-to-work is employers who don't have light duty. Many of those employers are small one or two employees and there aren't many jobs available. So, we look for ways to create an additional incentive for them lower insurance costs, for example if they offer light-duty. We also work closely with them to understand the importance of returning employees to work as soon as possible."

Employers who offer light-duty work have a responsibility to ensure the job tasks they have available meet the restrictions and capabilities placed on the injured employee. Drylie says the best way to do that is through a written job description shared with the health care provider.

Working with Doctors

The Eastern Washington centers were established following a survey of 300 Washington state employers in 2001 that indicated information from physicians needed to be timelier and include more detailed information regarding work capabilities, restrictions and return-to-work options in other words, fitness for duty. Typical comments from employers included:

  • We need explicit instructions on recovery, work limits, etc. We need to know what the worker is capable of doing.
  • We need better definitions of light duty. The doctor should say what the employee can do instead of what he can't do; we need positive information.
  • We need an accurate assessment of the employee's physical capabilities upon return to work.
  • We need diagnosis and treatment plan information.

The centers offer mentoring, educational resources and financial incentives to doctors who treat injured workers but don't have a background in occupational health. Dr. Daniel Hansen, a chiropractor who directs the Eastern Washington COHE, said the centers are all about getting injured workers the quality treatment they need to recover and get back to a job they are capable of doing as quickly and as safely possible. Workers can return to work are "fit for duty" when there are jobs available that they can do.

"Beginning with the first visit to the doctor, and at each subsequent visit, we reinforce the message that workers' compensation benefits are temporary," says Hansen. "The goal is to get injured workers back to their job, back with their friends at work, back to being a productive citizen."

The program is working out for doctors, employees and employers. A UW study found COHE doctors were satisfied with the support they received, and were more likely to treat injured workers as a result. Workers also expressed satisfaction with the care they received from COHE doctors, and Drylie adds anecdotal information found employers appreciate the program.

The Renton center was established in 2002 and the Spokane center opened a year later. The community-based centers are part of a cooperative effort by business, labor, health care providers and L&I to expand access to physicians who understand occupational health best practices.

The sucess of the centers has lead to a request for proposals for additional Centers of Occupational Health and Education around the state, and two communities will be chosen for new centers. In addition, state legislators will be asked for more funding for studies on the efficacy of the program and, possibly, for additional centers.

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