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Training doctors about workers comp can cut costs

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A Missouri health care system has managed its workers compensation costs by training doctors in the community about treating injured workers and handling legal nuances of the workers comp system.

BJC HealthCare, a St. Louis-based health system with 27,500 employees and 5,000 volunteers at 12 hospitals as well as several medical facilities, uses a “workers comp 101” program to teach St. Louis-area physicians about best practices.

The effort includes training doctors about the workers comp process, how to write clear-cut medical reports, what to expect if they're called to give depositions in workers comp cases, and how to identify comorbid health conditions and psychosocial issues, such as depression or diabetes, that can cause simple injuries to devolve into costly comp claims.

Patrick Venditti, executive director of corporate health services at BJC who established the health system's program in 2001, said the training has helped keep workers comp costs at bay while getting BJC's injured workers back on the job.

For instance, just 18 back surgeries have been performed on injured BJC employees since 2005, when BJC began handling its workers comp claims in-house. That's despite BJC having about 900 workers comp claims per year.

Back injuries “can be handled conservatively, and we've got some very good (physical) therapists that we use,” Mr. Venditti said.

“Several hundred” BJC doctors and area doctors with BJC admission privileges — including surgeons, orthopedists, neurosurgeons and sports medicine specialists — have taken the “workers comp 101” program since its inception, Mr.Venditti said. Of those, about 100 have been approved to treat BJC workers comp patients, and about 30 of those see most of the cases that involve uncomplicated injuries and treatments.

Employees who have factors that complicate their recovery, such as comorbid health conditions or chronic pain, are referred to a group of about 16 doctors whom BJC has deemed particularly effective in rehabilitating injured workers, Mr. Venditti said.

“They know our expectations, and they're very good physicians,” Mr. Venditti said.

One of those physicians is Dr. Anthony Frisella, an orthopedic surgeon and private practice partner at Advanced Bone & Joint in St. Peters, Missouri. He took BJC's workers comp training program seven or eight years ago after deciding he wanted to see more workers comp patients.

Dr. Frisella said training with Mr. Venditti taught him about many workers comp-related medical terms that aren't taught in medical school, such as permanent partial disability or maximum medical improvement. He also learned about how injured workers, employers and insurers have a vested interest in returning patients to health in workers comp.

“It's important to understand the needs of those other stakeholders when you're treating a work comp patient,” said Dr. Frisella, who said injured workers from BJC and other employers make up about 30% of his patients.

Dr. Patricia Hurford, a physical medicine and rehabilitation physician at Orthopedic Sports Medicine & Spine Care Institute in St. Louis, also took the BJC workers comp class several years ago. She said the course provided her with a better understanding of Missouri's workers comp system and how her medical reports should be written to accurately reflect an injured worker's condition.

Dr. Hurford said the class illustrated how to complete “a good medical report... that's comprehensive and covers not only the important aspects of treatment, but also answers the questions that are necessary in the management of an injured worker with regard to their work restrictions, their future employment and the relationship between their work activities (and) their work injury.”

Dr. Marcos Iglesias, vice president and medical director at The Hartford Financial Services Group Inc., in Hartford, Connecticut, said training doctors about workers comp can be crucial to help improve the outcomes of comp claims.

He said most doctors don't learn about workers comp in medical school or residency. Therefore, Dr. Iglesias said, it can be tricky for doctors to understand state laws that they should follow for workers comp or that returning a person to work can aid their recovery from an injury.

“All of these things are necessary to understand as someone who treats injured workers, but most people don't encounter those until they've been actually treating them,” he said.

Dr. Iglesias said Hartford relies on medical network providers to train doctors to treat injured workers covered under Hartford comp policies.

He said doctors also can learn more about workers comp by referring to resources from the American College of Occupational and Environmental Medicine and the American Academy of Disability Evaluating Physicians.