Rethinking Return-to-Work

If there were a proven way to help injured workers return to health quickly and safely, wouldn’t it be in everyone’s best interest to make it a treatment protocol?

Keeping workers employed while they’re recovering from a work-related injury or illness is just one approach to rethinking the role of return-to-work guidelines, a hot topic of discussion several recent conferences, and the main focal point of the webinar presentation “Changing Perceptions About Return to Work Confirmation,” hosted by the International Association of Industrial Accident Boards and Commissions (IAIABC) in conjunction with the National Institute for Occupational Safety and Health’s Center for Workers’ Compensation Studies (CWCS).

Return-to-work guidelines provide disability duration expectancies and objective estimates of how long a person may take to recover from injury or illness, based on data and expert clinical consensus for a particular treatment option. This helps decrease health care costs by actively reducing unnecessary use of medical services, in-patient days and long-term disability. With objective duration information in hand, workers’ comp physicians can discuss and set realistic expectations for an employee’s medical or surgical recovery, and avoid common missteps, such as making unnecessary activity restrictions, wasting time and resources on treatments unlikely to contribute to recovery, and preventing employees from returning to activity prematurely, which could cause further injury.

Traditionally, workers’ comp looks at return to work as an outcomes-based success metric. In other words, we know a particular treatment protocol works if a patient goes back to his or her job in a certain number of days. But rather than see it as an endgame or benchmark, return to work can — and should — be part of the treatment process itself because the longer an employee stays at home, the more difficult it is to bring him back to the work environment.

Research shows that after a six-month absence, the probability of an employee returning to work is less than 50%, and for those more than one year, less than 25%. Early return-to-work programs that include temporary transitional work, or a modified version of the original job while the employee is recovering, can reduce delays in recovery and help transition an employee back to full duty at his original job.

Sound radical? There is precedent.

The practice has been met with success in Texas, where efforts to keep workers employed while recovering from work-related injuries and illnesses has resulted in a drop in lost-time claims from 165,000 in 2000 to fewer than 90,000 in 2014. In addition, while return to work is an important metric of performance, ensuring that employees are able to remain employed once they return is perhaps a more accurate measure of success. On this note, the state also improved with roughly 75% of employees injured in 2013 who initially returned to work within the first six months of their injuries and remained employed for three consecutive quarters, compared to only 66% in 2004.


“Several components of the 2005 legislative reforms placed significant focus on returning employees to work, including a requirement that Division of Workers’ Compensation adopt return-to-work guidelines; institute a return-to-work reimbursement program for employers; improve coordination of vocational rehabilitation referrals between DWC, the Office of Injured Employee Counsel and the Department of Assistive and Rehabilitation Services (DARS); improve return-to-work outreach efforts; and implement changes in the work-search requirements for injured employees who qualify for supplemental income benefits (SIBs),” explains the State’s Biennial Report to the 85th Legislature, published last month.

Using solutions like MDGuidelines, providers and employees can better understand and determine recovery plans for injured employees — plans that can include return to work. For instance, if an employee could usually lift 50 pounds but has broken his foot, providers can use predictive tools and protocols to return him to work faster, perhaps lifting only 15 pounds until his foot is healed. This creates an ideal balance, not only for employers (as it returns employees to work faster without further risk of injury) and providers (since they can now track against evidence-based metrics and analytics to ensure their patient receives the best recovery treatment), but, most importantly, the employees.

The sooner an injured employee returns to activity — and work — the better, not only in terms of lower claims costs and higher productivity, but also for the long-term well-being of the person. Research shows that among the positive benefits of work, it:

  • Helps to promote recovery and rehabilitation.
  • Leads to better health outcomes.
  • Minimizes the harmful physical, emotional and social effects of long-term absence.
  • Reduces the risk of long-term incapacity.
  • Reduces poverty.
  • Improves an individual’s quality of life and well-being.

On the other hand, unemployment is associated with higher mortality, poorer health outcomes, psychological distress, higher use of medical services and hospital readmission rates.

Based on what I’m seeing and hearing around the nation at conferences and on webinars hosted by reputable institutions, I have a strong suspicion that down the road, as states begin to implement drug formularies and treatment guidelines — as many have already begun to do— regulating return-to-work standards will be the next step in the process of ensuring better health care for injured workers, improved outcomes and reduced costs for everyone else.

Categories: Evidence-Based Medicine (EBM), State Workers' Compensation Standards

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