Risks of Hearing Loss Remain Flat, With Exceptions
The prevalence of hearing loss among U.S. workers has remained at 20 percent for the last 30 years. Researchers say there have been improvements in most areas, but certain sectors continue to put workers at risk.
Occupational hearing loss is permanent and potentially debilitating but preventable, according to government experts. They looked at audiograms for 1.8 million workers between 1981 and 2010 to estimate hearing loss trends in various industries.
“The adjusted risk for incident hearing loss decreased over time when all industry sectors were combined,” according to their report, published in the American Journal of Industrial Medicine. “However, the risk remained high for workers in healthcare and social assistance, and the prevalence was consistently high for mining and construction workers.”
Some 22 million workers are exposed to noise hazards at work. Hazardous noise, a single instantaneous high noise exposure, or exposure to chemicals that damage hearing can result in occupational hearing loss. The study from researchers at the National Institute for Occupational Safety and Health is said to be the first to offer a broad look at hearing loss risks to workers over a 30-year period.
The construction industry had the highest number of new hearing loss cases during the study period, possibly due to less stringent hearing conservation requirements compared with other industries. Also, the seasonal nature of work involving independent contractors makes it difficult to implement preventive measures.
Mining has the highest percentage of noise exposed workers than any other industry, the report said. A small fraction of workers in the health care and social assistance sector are exposed to hearing risks. However, the vast majority report not wearing protection.
“There is no industry where workers can be considered ‘safe’ from hearing loss.”
Seatbelt Noncompliance Linked to Other Unsafe Actions
Crashes are the leading cause of occupational deaths among U.S. truck drivers, says the government. Many of those might have been preventable.
The Centers for Disease Control and Prevention has issued a Vital Signs report detailing the latest statistics.
“After dropping to 35-year lows in 2009, the number of crash fatalities of truck drivers or their passengers increased between 2009 and 2012,” the report stated. “Approximately 700 drivers of large trucks or their passengers died in crashes in 2012, and an estimated 26,000 were injured. About 65 percent of on-the-job deaths of truck drivers in 2012 were the result of a motor vehicle crash. More than a third of the drivers who died were not wearing a seat belt.”
The CDC is calling on employers and government agencies to step up seat belt use among truck drivers through strong safety programs and better enforcement of state and federal laws.
Included in the report is data from the National Survey of U.S. Long-Haul Truck Driver Health and Injury conducted by the CDC at 32 truck stops along interstate highways in 2010. Key findings include:
- An estimated 14 percent of long-haul truck drivers reported not using a seat belt on every trip.
- More than one-third of long-haul truck drivers had been involved in one or more serious crashes during their driving careers.
- Long-haul truck drivers who reported not wearing seat belts also tended to engage in other unsafe driving behaviors such as speeding and committing moving violations. They were also more likely to work for an employer that did not have a written workplace safety program.
- Long-haul truck drivers who lived in a state with a primary seat belt law that allows police to stop motorists solely for not wearing a seat belt were more likely to report often using a seat belt.
Want Better Outcomes? Use the Right Tools for the Job
When Dr. William Gaines started his career, indemnity was “king.” But the emphasis in workers’ comp has changed in the decades since.
“It’s focusing on the right medical care at the right time for the right reasons,” Gaines said. That’s why having the proper resources to manage claims is essential.
“That has not changed one bit,” he said. “What has changed is we’re using much more sophisticated tools to guide these injured workers back to work.” Gaines is credited with helping to implement the following tools during his 12 years with Liberty Mutual:
- Data analytics. The company says it was the first property/casualty insurer to use the “sophisticated data analysis long standard in the group medical industry” in the workers’ comp space, according to a statement.
- Predictive models. Generated through the company’s data analytics capabilities, a variety of predictive models have been created that impact claims. For example, one “quickly identifies workers’ compensation claims likely to become more expensive than the average cost of similar claims. Claims managers are notified of these claims and the resources required to better manage them.”
- Outcomes based networks. The company uses its data analytics to build networks of providers more likely to use evidence based medicine.
- Prescription management. The company says its strategies helped reduce the amount it spends on narcotics by 13 percent last year.
As the newly appointed medical director of Liberty Mutual’s Commercial Insurance strategic business unit, Gaines sees himself as both a player and a coach. In addition to managing the company’s nine regional medical directors, he will continue many of the day-to-day functions he’s been doing in his 12 years with the company.
“I’ll be talking with providers, working with our nurses and claims managers,” Gaines said. “I have to be involved in working claims if I’m going to have the ability to work with medical directors and guide them.”
“When I talk about trends, [working] in the trenches and working with data, one thing that’s huge is the issue of … the inappropriate use of opioids in workers’ comp,” Gaines said. “There’s a lot more awareness on the part of treating providers in the workers’ comp system and employers that opioids have a very negative impact on injuries. But we have a lot more work to be done to develop a consistent basis and medical treatment guidelines.”
Gaines said getting the message to all providers is no easy task.
“Comp is a subset of group health,” he said. “We focus on group health and on workers’ comp with the hope that all of us drive provider awareness [to a] more conscious evidence-based prescribing of opioids.”
Gaines said identifying claims involving prescriptions from multiple physicians is a red flag. Working with pharmacy benefit managers is key to reining in opioid abuse.
“The only way you can manage opioids effectively is [by having just] one person prescribing them, confirming they are taken appropriately, and [that the opioids are] not creating adverse effects,” Gaines said. Having “multiple people is a prescription for failure.”
Another hurdle to achieving superior outcomes is psychosocial issues. “If you look at where problems occur in work injuries, the underpinning of why they don’t get better or return to work, it all revolves around an employee’s psychological makeup or social situation away from work,” Gaines said. “Not every injury is going to have the same response or outcome.”
Working in claims on a daily basis gives Gaines the opportunity to see differences in how injured workers are affected. One person with low back pain deals with it and doesn’t miss any work while another develops catastrophic thinking.
“Our challenge is to be able to recognize this early and intervene early with the right resources,” he said. “In the old days of comp, we talked about claims managers who could smell these early on. Now, with the complexity of workers’ comp issues, you just can’t rely on people to pick up on that.”
Gaines said that’s why Liberty has developed tracking tools — data analytics and predictive models — to enable claims managers and nurses and medical directors very early to identify if a claim is going off track.
Part of the answer lies in working directly with employers and helping them understand the importance of having supervisors communicate with employees. The insurer acts as a bridge between providers and employers.
“The way it is, there are a whole lot of providers that don’t understand occupational medicine is different from group health,” Gaines explained. Our “medical providers may be talking to the provider about things they are seeing and working with them, but at the same time, we may be talking with the employer to help them understand the person is still functionally able to come back to work.”
Predictive models supported by data analytics have been the single most important key to help spot a problem in a claim early on. While some of the more experienced claims managers can do that, newer ones typically cannot.
“It’s tragic if someone has a simple back strain and they never go back to work because we didn’t treat the psychological issues. You have to develop more of a specialty mindset. You can’t look at every claim the same way. You have to combine experience, data analytics, and predictive modeling.”