The growing labyrinth of laws allowing some form of marijuana use has made crafting corporate drug-free policies a real buzzkill. The task is becoming nearly as complex as drafting strategies for complying with the Family and Medical Leave Act, and that law’s numerous state offspring.
I’m exaggerating. Creating a company policy on drug use and drug-testing procedures can’t be as nightmarish as leave-law compliance.
But after reading “Marijuana in the Workplace: Guidance for Occupational Health Professionals and Employers,” I have two overriding thoughts.
One, I hope the writers saw the pun in beginning the paper’s subtitle with “Joint Guidance Statement …”
When it comes to marijuana, the days of a one-size-fits-all zero-tolerance policy are slipping away.
Two, when it comes to marijuana, the days of a one-size-fits-all zero-tolerance policy are slipping away. This is particularly true for those with operations across multiple states with varying cannabis laws.
Societal, legal and medical forces are driving a need for a greater assessment of each employer’s attitude and policies regarding marijuana use. Rapidly shifting dynamics have also increased the need to seek the guidance of legal and health care professionals when crafting corporate policies on marijuana use and drug testing.
The broader forces at play include shifting public attitude toward marijuana; increased adoption of medical or recreational marijuana laws, including some with limits on employer treatment of cannabis users and a few with discrimination protections; the federal government’s inconsistent enforcement stance on state marijuana laws; and evolving scientific evidence of marijuana’s efficacy for treating certain ailments.
At least 23 states now have medical cannabis laws, four others have legalized recreational use, and that trend is expected to continue. Meanwhile, marijuana remains the substance most often detected in workplace drug-testing programs.
The new hodgepodge of state laws includes a few protecting marijuana use outside work hours, others limiting drug-testing practices, and still others raising unknowns, including how some state regulations will interact with disability laws.
Yet employers must still protect worker and public safety, comply with regulations regarding zero tolerance for safety-sensitive positions, and guard themselves against worker impairment, productivity losses and job performance problems, etc.
Fortunately, no state law requires employers to permit workplace drug use or tolerate impairment at work, allowing companies to implement drug-free-workplace policies.
The recent jurisdictional variations in laws, coupled with the desire of many employers to use drug testing to maintain safe work environments, leave companies in a thornier weed patch than before.
“Reconciling varying and dynamic state laws in regard to legality, permitted use in the workplace, and lawful drug testing can be challenging,” the paper stated. “Every employer should consult with legal advisors to ensure that they comply with any applicable state or local laws and design their testing programs to withstand legal challenges.”
Every employer wanting to better understand marijuana, review related state and federal laws, and learn some suggestions for monitoring workers for marijuana use, might want to start by reviewing the guidance paper.
Because while marijuana users often cite relaxation and euphoria as reasons for consuming the drug, it’s obvious that employers have less to relax about.
Experts Advise More Focus for Ergo Efforts
Companies that limit their ergonomics efforts to promoting employee safety are missing an opportunity, say experts. In fact, employees in these situations may feel stressed to use a new system that may result in lower production levels.
Instead, ergonomics environments should equally promote worker well-being and improvements to organizational productivity. The result is a synergy that maximizes both outcomes.
“Implementing ergonomic principles in an occupational environment can directly benefit the worker and the organization by reducing physical and mental strain, lowering the risk of occupational-related injuries and illnesses, and improving work performance,” stated a new report.
“By embracing the principles of ergonomics, and establishing a positive ergonomics climate, organizations can enhance both operational performance and employee well-being.”
The findings are included in a study from researchers at Colorado State University and were published in the journal Applied Ergonomics.
While previous research has focused on the relationship between an organization’s value for employee well-being and workers’ self-reported pain, the authors said few, if any, studies have compared how the values for performance in addition to well-being can work together to predict work-related outcomes.
Researchers from Colorado State University conducted two rounds of questioning at a large manufacturing facility. After an initial pilot test, the authors asked questions of more than 1,000 workers. One year later, they returned to see what, if any, changes had occurred. More than 700 workers participated in the second round of questioning.
Questions reflected the ergonomics concept of designing and modifying work to improve the focus of interest, performance or well-being.
Performance-focused ergonomic climate, or PE, included things such as maximizing productivity and efficiency, quality of product or service, sustainability as a company, maintaining a competitive edge in the market, and completing the tasks necessary for the organization to succeed.
Well-being focused ergonomic climate, or WE, referred to a focus on ensuring the employees were healthy and happy, including reducing their injury and illness risks, addressing quality of work and life issues, improving job satisfaction and supporting work-life balance.
“Employees may resist a new tool or process that reduces injury if they think it will cause them to work more slowly and miss production targets.”
“Through a series of steps we developed the ergonomics climate assessment,” they wrote, “then piloted, refined and obtained preliminary validation evidence for this new assessment.”
Four common factors identified as central to organizational climates that involve ergonomics were management commitment, employee involvement, job hazard analysis, and training and knowledge.
The questions consisted of an equal number targeted to PE and WE, placed side by side. The workers were also asked if they had experienced work-related pain within the prior 12 months. The researchers hypothesized:
- Both WE and PE facets of an ergonomics climate assessment will be negatively related to work-related pain.
- If both WE and PE facets were rated low, self-reported pain would be higher, and vice versa. They looked at situations in which each was higher than the other.
- When employees perceive a discrepancy between the facets, those who said PE was promoted more would report more pain than if the situation were reversed.
“Good ergo practice involves understanding that the whole is usually greater (more useful, powerful, functional) than the sum of the parts,” the authors wrote. “This understanding is consistent with our findings that PE and WE facets of ergonomics climate were conceptually distinct but interrelated so much so that incongruence between the two resulted in poor outcomes.”
The perception that either well-being or performance was favored can result in work-related stress and create symptoms of work-related pain, according to the study. For example, a company that emphasizes facets of performance sends a message to workers that production is more important than their own well-being. Emphasizing well-being over performance can be equally as stressful.
“This may cause stress if an improvement is seen as a threat to productivity,” the study said. “For example, employees may resist a new tool or process that reduces injury if they think it will cause them to work more slowly and miss production targets.”
Companies should employ ergonomics improvements that look equally at a worker’s performance and his overall well-being, the authors advised. This systems approach to occupational ergonomics designs and implements productivity gains concurrently with worker well-being goals.
As an example, they said that manually attaching hydraulic hosts to a subassembly with a hand wrench can be performed faster by increasing the expected yield of the worker, which would likely lead to greater hand fatigue, work stress, and poorer quality.
By using a systems approach to ergonomics, a redesign may include the use of a power driven wrench that results in greater output, less physically demanding hand motions, and less worker stress.
Creating and implementing such a system can help companies identify areas for improvement. In the case of the manufacturing facility used for the study, the first round of questions revealed a poor ergonomics climate assessment score in one production department. The company undertook an intervention of engineering and administrative changes to correct the problem.
Personnel involved included a team of production operators, maintenance and engineering staff and management.
The results of the second round of questioning indicated “a significant increase in both PE and WE facets of ergonomics climate for that production department,” the authors wrote.
“Thus the ergonomics climate assessment may be a practical and useful tool for organizations looking to understand and improve their ergonomics climate. This tool can be used as a baseline to assess the effectiveness of organizational efforts focused on improving ergonomics as well as a measure to assist in the prioritization of ergonomics interventions during periods of limited resources.”
It’s all in the Code: Five Essential Characteristics of HCPCS that Influence Outcomes
Payers are no stranger to codes. Claim and policy administration systems are filled with them. Moreover, whether designating claim type, feature, branch office, policy term, type of injury, or another classification, their use facilitates consistency and understanding. Codes also guide clinical and financial decision-making. At the foundation of medical cost management are three code sets. The International Statistical Classification of Diseases and Related Health Problems (ICD) diagnostic and procedure codes, ICD-10-CM and ICD-10-PCS respectively, are used to classify diseases, disorders, injuries, infections, and symptoms. National Drug Codes (NDCs) help ensure claimants received the correct strength, dosage form, and type of medication. Their use also helps pharmacists recognize the difference between products that may look or sound alike. Yet another useful code set is the Healthcare Common Procedure Coding System (HCPCS) created to identify services, products, and procedures rendered for the condition. It is on this code set we will focus.
When processing ancillary benefits in workers’ compensation and auto no-fault, HCPCS can determine whether the item is considered medically necessary and therefore, available to the claimant and otherwise related to the compensable condition. Codes can also affect the reimbursement amount. Thus, if a coding error is made, there can be significant adverse impacts to payers and claimants alike. For example, the vendor could stop supplying the item based on insufficient reimbursement, or the payer could deny the product or service completely. Both are detrimental to the claimant or overall claim outcomes. Coding errors may also result in claim leakage if applied incorrectly or misunderstood in the review process. It is therefore essential that payers be mindful of five essential characteristics of HCPCS.
#1 – HCPCS are generic
Like pharmaceuticals, there are many different providers and manufacturers of similar durable medical equipment (DME) items. However, HCPCS are not specific to brand and usually hundreds of different products can fall under the same HCPCS. In addition, some codes include certain services, such as evaluations and fitting fees, whereas some codes do not. For example, some health HCPCS rarely indicate the actual services being provided in the home, such as wound care or home infusion, but instead simply indicate an RN or LPN visit.
#2 – Unit of measure influences coding
Some supply codes have very specific units of measure, which can result in HCPCS quantities that are not whole numbers and can result in mathematical errors or rounding. For example, HCPCS code A4450 has a unit of measure of ‘per 18 square inches’ and is assigned to a roll of tape that is 2 inches by 5.4 yards, equaling 388.8 square inches. The quantity for this HCPCS code would therefore be 21.6. Additionally, some HCPCS codes specify ‘per pair’ or ‘each,’ so understanding the actual supply is important to determine the appropriate quantity.
# 3 – Sometimes, there is not a specific code
Centers for Medicare and Medicaid Services (CMS) has created a number of miscellaneous codes that have generic definitions and can be used when no other CPT or HCPCS code matches the description of the product or service provided. Miscellaneous codes can be easily abused either unintentionally due to lack of time and knowledge, or intentionally by a provider seeking a higher reimbursement rate. This is because miscellaneous codes typically do not carry a fee schedule due to their versatility and, therefore, may be reimbursed at higher amounts than a non-miscellaneous code. For example, K0108 defines a ‘wheelchair component or accessory, not otherwise specified;’ however, most wheelchair parts have a specific code outside of this one which could be more appropriate while also carrying a lower allowable amount.
#4 – Supplemental modifiers are useful
A supplemental modifier or identifier is a billing value that further clarifies the HCPCS/CPT code by telling the payer more about the billed product or service. Their application influences reimbursement because fee schedules largely differ depending on which modifier is reported. A rental (RR) for example, does not warrant the same reimbursement as a purchase (NU) yet both a purchase and rental of the same product carry the same HCPCS. Consider the following codes, K0001 = ‘STANDARD WHEELCHAIR’, K0001 RR = ‘STANDARD WHEELCHAIR’ that has been rented, and K0001 NU = ‘STANDARD WHEELCHAIR’ that has been purchased. Depending on the fee schedule, reimbursement could be $45 or $500.
Modifiers are also useful because they can define the unit of measure. By default, a HCPCS with a modifier of ‘RR’ is a rental per month. However, in some cases a provider may bill for a device daily and therefore interpret the fee schedule as daily rather than monthly. In this scenario, the provider may bill with a daily unit of measure, billing a quantity of 30 instead of the allowable amount of one. For devices that are rented daily, such as a negative pressure wound therapy device or continuous passive motion device, it is important to understand the unit of measure being used (monthly or daily) and be mindful that the daily billing exceeds the monthly allowable.
# 5 – The diagnosis influences allowable amounts
Some HCPCS change based on the diagnosis of the injured person and therefore, the allowable amount may fluctuate. For example, depth-inlay shoes are coded as an Orthotic (L – code) if the patient does not have a diabetic diagnosis and is using the shoes for orthopedic reasons. The same depth-inlay shoe may be used for a diabetic patient, but it would warrant an A-code, which can have a higher reimbursement level.
The use of coding assists claims professionals in compensability decisions, guides clinical decision-making, informs point-of-sale utilization controls, influences claim handling policies and procedures, and provides a valuable data point in statistical and analytics models. Moreover, their use facilitates better clinical and financial claim management in terms of payments that are more accurate, greater processing efficiency and consistency, and improved clinical management as a result of better understanding the medical condition(s) associated with the claim and the various therapies in use. Remaining mindful of the aforementioned five essential characteristics of HCPCS can therefore not only mitigate claim leakage but also achieve a better outcome.