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By STEVE YAHN, who has written for and edited national trade magazines for more than 30 years

Going to top management has been a hallmark of a greatly expanded and rejuvenated workers' compensation and disability program at St. Louis-based BJC Healthcare, one of the largest nonprofit healthcare organizations in the United States, with 13 hospitals delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions.

That was when Pat Venditti, director of corporate health services, and Nancy Gemeinhart, program director of occupational health services, were hired to revamp the workers' comp and disability program for the 27,000-employee system.

In recognition of its overall success since then, BJC earned the 2009 Theodore Roosevelt Workers' Compensation and Disability Management Award in the nonprofit category.

"We began to work with some of the higher-level people in the organization to get them to take workers' comp and disability for employees more seriously," said Venditti, who has 20-plus years of experience in workers' compensation and disability management. "At most hospitals, top management is really concerned with their patients. They're concerned with their employees, but at the end of the day, they're looking at how well they're doing with their patients. That's their product."

Perhaps the greatest challenge that Venditti and his new team faced was creating an in-house workers' comp injury claims system. Prior to 1995 when the BJC system took the shape that it is today, workers' comp injuries were handled by several third-party administrators. Those TPAs were consolidated into one regional TPA in 1995.

In 2002, shortly after coming aboard, Venditti and his team began to look at the data. "We were faced with the inability to capture and review meaningful detailed data from their claims system," recalled Venditti. "In claims review sessions, we could uncover a disturbing trend of seemingly modest injuries undergoing multiple medical referrals with increasing severity of treatment regimens and numerous surgeries. Most of these cases were left with unrelenting pain and a dependency on narcotic prescriptions."

So in 2004 Venditti and his team, with support from top management, dismissed the regional TPA.

"In 2004, when we decided to develop the ability to self-administer our workers' comp claims, we leveraged the size of our contract with the TPA and implemented a policy and procedure for the handling of our claims and instituted a more extensive oversight function by us for the referral to medical specialists," said Venditti. "This had an immediate effect, and our incurred costs in the 2004 policy year dropped by $1.2 million."

BJC's historical claims costs for its type of industry, size and potential for injury were considered relatively modest, but the programs the organization initiated in 2004 through 2008 saved the health system $7.4 million compared with the previous five-year period.

Claims costs were down for the health system despite a payroll that increased at a rate of 5 percent a year and workers' comp medical severity trends going up by an average of 6.7 percent annually, said Venditti. Mirroring an industrywide trend, workers' comp claims frequency dropped, from 1,022 in 2002 to 602 in 2008.

BJC has an extensive centralized loss prevention and safety program with localized programs and personnel. Each hospital and service organization (HSO) has its own environmental health and safety, and loss-prevention program.

They are administered by a safety officer and a risk manager who have dotted-line reporting relationships to the BJC vice president of risk management and corporate safety officer.

"Standardization of prevention interventions and occupational health practices, timely assessments and effective solutions create a safer work environment," said Gemeinhart. "Keeping our employees safe allows them to provide safe, high-quality care to the communities we serve."

A standout program at BJC, and one other companies large or small could benefit from, is BJC's "Ergo Rangers" program, created by ergonomics expert Lori Wolf, who joined the organization from a major automaker in the mid-1990s.

Operating under the corporate health group division, this cadre of Ergo Ranger specialists see to the needs of employees without any kind of prejudice as to whether or not the employee might be trying to defraud the program.

"The Rangers are trying to teach the employees that, when they leave the ergonomics care group, they're empowering them to help themselves," said Venditti.

"There are a lot of companies that hear about this program and think, 'Oh, we have to redesign our jobs,' " added Venditti. "And I say, 'No, you're looking at it wrong. You don't have to be high tech, high dollar. You can go as simply as finding employees who already work for you who have a passion for helping others.' A lot of ergonomics is common sense."

BJC is not spending a lot of money on its ergonomics program. "You can hire outside trainers to help train your people without bringing on any more full-time people," noted Venditti.

BJC spends about $150,000 on supplies and materials, including cost of labor, for its Ranger program. Beyond that, Rangers may have special budget requests at some of the 13 hospitals in the system. All in all, total costs are no more than $250,000 annually.

Using an elaborate measuring system, BJC came up with $1 million in potential cost avoidance generated by this program. "What we don't know," added Venditti, "is how many of the people treated might have actually filed a claim. Well, maybe nobody. But maybe 10 percent, maybe 50 percent."

BJC's return-to-work program is another exemplary part of the organization. The BJC system's workers' comp policy sets the groundwork for the RTW program and defines the expectations and limits for injured employees who return to transitional duty work.

"The employee must have an authorized physician's orders for reduced capacity to work," said Venditti. "The available work placement is not confined to their primary department. This part was pivotal in promoting an appropriate RTW practice. The employee's primary department will be charged for transitional duty time regardless of where the modified duty is performed. After 12 weeks, the employee must return to unrestricted duty, accept another position with or without reasonable accommodation or apply for a leave of absence."

The workers' comp administration staff conducts presentations annually in each of the hospitals in the group to educate managers about policy. They also assist managers in developing "modified duty job/task lists" for those cases where transitional duty within a defined job position is unavailable.

Orientation for new managers includes sessions on safety and workers' comp. Hospitals and doctors chosen to care for injured employees are informed of the RTW program and are asked to list the functional capabilities of the injured employee to allow the occupational health departments to place employees in modified duty work.

The RTW program has enabled BJC to reduce and sustain the number of lost-time cases by 52 percent from 2004 to 2008, compared with the 1999 to 2003 period. It has also allowed BJC to reduce the amount of lost wage benefits paid by 73 percent from 2004 to 2008 compared with the 1999 to 2003 period.

The total temporary total disability (TTD) benefits paid from 2004 to 2008 was $738,976, compared with $2,747,314 paid in the 1999 to 2003 period, a reduction of $2,008,338.

Maintaining objectivity is a constant goal for Venditti and his team, and his biggest aid on that score is the data.

"We use our data to make sure we are asking the right questions and that we are serving the needs of the employees as fairly and objectively in all cases and not play into any of the politics that can sometimes happen in a large organization," he said. "We have to apply the same standards across the board. I have to be aware at all times that, if I bend the law for you, I could set a dangerous precedent. I'd have to do it for everybody now."

His biggest challenge is to determine what kinds of resources to put toward an individual out on workers' comp and disability leave, and how to predict which employee will turn out to be the highest-risk case.

The highest-risk cases are the ones where workers are not likely to get any better no matter what.

"That's something we've always faced," noted Venditti. "It's like the Holy Grail. If we could identify the people who are high risk early rather than later, say three or four months down the road--where you have already put out 75 percent of your incurred costs--that would be optimal. So trying to identify which behavior problems can help us predict which ones are going to be more difficult to get back to work and get their medical stuff resolved, those are the ones we need to identify."

Thorough data gathering and data mining has always been at the heart of Venditti's work.

"You've got to let your data tell you where you need to make your adjustments and continue your focus," he said.

Good data mining allows managers to figuratively peer into the soul of disabled workers. "When I was a consultant, I used to say I could tell you which hospitals were having issues with morale--you can tell by the numbers," he said. "By capturing data, I can tell you something's going on over here. I don't know what it is, but I can tell you something is going on."

BJC's case risk assessment (CRA) program captures 18 pieces of information to help the workers' comp claims administration try to identify high-risk cases, those defined as cases that would be susceptible to delayed recovery.

Developed as part of a brainstorming session to determine what factors would cause delayed recovery and thus be identified as a potentially high-risk case, the CRA program identifies four categories that affect the rate of recovery: medical severity, pain behavior, behavioral factors, and comorbidities like diabetes, prior injuries or even post-traumatic stress disorder.

At the various BJC locations, their healthcare services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

November 1, 2009

Copyright 2009© LRP Publications