BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.
To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.
With the number of obese Americans increasing, employers can help reduce the impact of obesity on workers compensation claims by focusing on wellness and healthy workplace initiatives. Kevin Glennon, vp at Jacksonville, Fla.-based MSC ComplexCare, discusses approaches that can ease the burden.
Like prescription drug abuse, obesity is a societal problem that impacts workers compensation medical care and costs. And here is a scary statistic: Obesity increases health spending even more than smoking cigarettes or drinking alcohol do.
More than one-third of adult Americans are obese, and many of them are in the workplace. A new study even lays some blame for obesity on the workplace itself, specifically the decline of calorie-burning activities expended there. Jobs requiring moderate physical activity accounted for 50% of the labor market in 1960; now they account for only 20%. This means that 80% of jobs are sedentary or require only light activity, according to the study, which was cited in a May 26, 2011, New York Times article and published in the journal PLoS One.
Morbidly obese employees file twice as many workers compensation claims, and these cost nearly three times as much as comparable claims for “normal-weight” workers, according to a Duke University study. Nearly everything in a “fat” comp claim costs more, from the bariatric durable medical equipment (40% more than DME for normal weight people) to drugs that are dosed by body weight. Obesity-related complications of diabetes, hypertension and vascular disease slow down the healing process, especially for wounds.
Recently a payer asked what could be done to heal wounds that had been actively treated for two years yet still had not healed. “The patient needs to lose weight” is the right answer, but not one most payers want to hear. The body needs good nutrition to heal, and the claimant's diet of corn dogs, cola and chips just wasn't doing it.
So what can comp do about obesity? Preventing obese claims in the first place through healthy workplace initiatives is a good first step. Many companies provide and pay for weight-loss programs and on-site fitness centers, stock low-fat snacks in vending machines, offer heart-healthy fare in the cafeteria, and design their campuses to encourage walking and taking the stairs.
Employers should extend these healthy initiatives to injured employees. Encourage physicians to write scripts for physical therapy that takes a functional restoration approach and adds calorie-burning workouts to the regime. Providers need to stress weight-loss programs. For every 10 pounds of body weight, there are 30 to 60 pounds of force on the joint. Dropping 50 pounds could prevent knee or back surgeries in the future.
Yet, is weight loss medically necessary and causally related? Comp needs to rethink its obsession with treating only injured body parts. Yes, the right leg was injured, but if the extra 200 pounds the claimant is carrying causes circulation problems that prevent wounds from healing for two years, doesn't it make sense to address the elephant in the room? Or should we just keep paying for wound vacs and home health nursing?
The human body is an interrelated system, and obesity has a major impact on just about every injury. There is no easy fix, and obesity needs to be addressed on a case-by-case basis. Some people have no understanding of basic nutrition; many more don't understand how to use nutritional labels. Many obese claimants have never exercised. Some eat to manage stress or for comfort, causing them to dive into mashed potatoes and fried chicken when they're hurt and in pain.
Case managers should evaluate each obese claimant to determine the cause and lay out an individualized plan that includes some or all of the following: nutritional counseling, health and fitness education, exercise training with a specialist who knows how to avoid re-injuries, and possibly bariatric surgery.
Weight-loss programs do not have to be expensive. A home health nurse could add nutritional counseling and blood sugar monitoring to the services already being provided once or twice a week. Physical therapy sessions could add calorie-burning exercises to the regimen.
If there are underlying psychological problems causing overeating, enlist a behavioral counselor to address them. To keep costs from spiraling out of control, set a limit on the number of sessions, review progress at set intervals, and reassess extending or discontinuing treatment.
While no payer wants to own a mental health claim, the medical part of the obese claim in fact already contributes to costs three times that of a normal-weight claimant with the same injury. And, that's just Year 1. Obese claims cost more as they age, growing to 4.5 times more expensive at Year 3, according to the Duke University study.
I know that many of these suggestions sound like heresy to work comp carriers. By its nature, comp care focuses on body parts, causing treatment to be solely related to the injury. However, medical care does not occur in a vacuum. The extra 100 pounds the claimant carries is hindering the healing of the affected body part; shouldn't we treat that? It is short-sighted to ignore the impact of a comorbidity like diabetes, and just as short-sighted to pretend obesity has no impact on circulation, wound healing, back pain or joint deterioration.
Kevin T. Glennon, is vp of clinical workers compensation services, overseeing complex care services for Jacksonville, Fla.-based MSC ComplexCare, a division of MSC Care Management. He also is the vp of the Central Florida Assn. of Rehabilitation Nurses, past president of Florida State Assn. of Rehabilitation Nurses and an instructor for the Workers Compensation Claims Professional Board Certification Program-Advanced Medical Anatomy. He can be reached at (407) 831-7331 or firstname.lastname@example.org.