A Spokane-based pilot project aimed at getting injured workers back on the job more quickly is achieving significant results, and the state now wants to expand the programs reach from three counties here to much of Eastern Washington.


St. Lukes Rehabilitation Institute, of Spokane, was the successful bidder and contractor for one of two pilot Centers for Occupational Health & Education (COHE) funded by the Washington state Department of Labor and Industries more than two years ago. The Spokane projects results in reducing the duration of workers compensation claims has prompted the state to expand its coverage area, which has included just Spokane, Stevens, and Grant counties, to 13 additional Eastern Washington counties effective July 1.


Meanwhile, the project has been getting national and international attention, says Dan Hansen, project director for the Spokane COHE. He says the local COHE has been getting phone calls daily from all over the U.S., Korea, and New Zealand seeking information about the program.


Nothing like this has ever been done on a large scale like what we are doing here in Eastern Washington, says Hansen.


Data already have been collected documenting as high as a 63 percent reduction in the length of longer workers comp claims, as well as a major improvement in the time lapse between a workers on-the-job injury and the reporting of a claim to L&I.


The Spokane COHE received a $970,000 appropriation for the next biennium from this years Legislature, and it is to use that money to expand its services to those 13 additional Eastern Washington counties.


The first Washington state COHE project was launched in Renton months earlier than Spokanes program and also has been funded for the next biennium, but the magnitude of the two projects now differs markedly, says Hansen. He says the Renton COHE project was renewed without expanding it either geographically or in the number of doctors in its system, and more importantly, the Western Washington-based project doesnt have the Web-based information tracking system that Hansen says makes the Spokane COHE unique.


The Spokane COHE has created an Internet management system thats accessible by physicians, employers, retrospective ratings groups, employees, L&I, and labor unions. Retrospective ratings groups are industry groups that self-insure for workers comp.


The Spokane COHE system streamlines information and helps to get injured workers back to work more quickly, thus minimizing workers compensation claims. It concentrates its efforts on claims for carpal-tunnel syndrome, lower-back injuries, and upper and lower extremity fractures, which account for more than 80 percent of disability costs in Washington state, says Hansen.


By far the largest expenditure of workers compensation dollars among those three is for carpal tunnel, he says.


Hansen says that business and labor, which are often at odds on workers comp issues, have been strong proponents in both initiating and supporting the project.


Business and labor support has been vital in the organization and success of this project that they began working together on in 1997, says Diana Drylie, L&Is senior project manager for both the Spokane and Renton programs.


Employees not only heal faster when they get back to work, but such an outcome has a definite positive impact on the bottom line of the employer, says John Silano, a return-to-work specialist at Spokane-based SL Start & Associates Inc., which employs about 1,200 people and operates five retirement communities and provides in-home services in three states.


Workers compensation premiums paid by the employer are based on the number and extent of claims made by their own employees and on ratings for the industry an employer is in, says Hansen.


Theres also an argument that workers compensation claims are longer in duration and are more expensive than they need to be.


Last year, an article submitted jointly by the University of Washington and L&I to Milbank Quarterly said patient outcomes are worse and costs are higher for workers compensation patients than for patients who receive similar care for non work-related injuries.


Operating with an introductory $675,000 two-and-a-half year grant from L&I, the Spokane COHE created a network of 268 doctorsor 30 percent of the available physicians in the three county areanine hospitals, 16 mentor physicians, 260 employers, and more than 70 labor unions.


The participating doctors, recruited because they were most likely to handle workers compensation claims in the three injury areas of focus, were trained to submit injury reports into the Web-based system within two working days of seeing an injured worker, then phone the workers employer regarding the status of the employee, and follow up every two weeks with the employee.


Hansen says that conventionally, doctors have waited four to 24 days to file an initial injury report, had limited contact with the patients employer, and routinely checked up on the patient just once every four weeks.


L&I has added several incentives for physicians to participate in the program. For every workers compensation claim reported within two days after a doctor has treated an injured worker, L&I pays the doctor an additional $12. Time spent telephoning employers or other parties to coordinate return-to-work steps can earn a physician an additional $14 to $42, and follow-up visits with injured workers at two-week intervals can earn a physician $21 above the standard allowed office charge, Hansen says.


Prior to COHE, an employer could go two to three months before he knew a workers compensation claim had been filed, says Hansen. Now, a participating employer has access to that information in two days.


A critical piece of information included in the Web system, called the Occupational Medicine Information Tracking System (OMITS), is the physicians assessment of when, and in what capacity, an injured employee can go back to work.


Injured employees are tracked by the system and can be denied workers comp benefits if they fail to comply with physician orders, such as by not returning for scheduled doctors appointments, says Hansen.


The system works in other ways, as well. COHEs current staff of eight full-time and part-time employees, working at St. Lukes, can respond to color-coded alerts that show up on the computer and remind physicians that its time for a follow-up contact with an injured employee.


A change in philosophy


The idea that an injured employee must be 100 percent recovered before returning to work is one notion employers need to start rethinking, says Hansen. Silano agrees.


Workers compensation costs go through the roof if the employer demands that an employee be 100 percent healed before coming back to work, he says.


Light duty can significantly reduce the employers workers compensation premiums, says Hansen.


Silano says an SL Start committees function is to define tasks, often outside the standard work load, that injured employees can perform when returning to work on a part-time basis. For the benefit of both the employee and the employer, Silano stresses the importance of seeing the injured employee as a resource, instead of sick, lame, or lazy.


The sooner one returns to work, the better, says Silano. He adds that only 30 percent of injured workers who have been off the job for six months return to work, and only 10 percent of those who have been off for a year or more return.


Educating the employee on the monetary loss he or she is experiencing while receiving workers compensation benefits is another way to get workers back to work sooner. Hansen says that workers comp benefits can vary by the number of dependents a worker has, but average about 60 percent of a workers wage. Silano says a worker employed at the states median wage will lose about $500 for each month on workers compensation.


The physicians in the Spokane COHEs three-county area, though only 30 percent of all doctors there, have been responsible for reporting 70 percent of all workers comp claims in this area over the last about 18 months that COHE has been tracking claims, Hansen says. He says the project has tracked 13,000 claims in that time, and now is accepting 280 new claims a week.


The time loss for injured workers cared for by the doctors participating in the project here, according to a January 2004 to October 2004 study done by the University of Washington, has dropped significantly. According to that study, the number of claims lasting between 30 and 90 days was 38 percent lower in October than in January, and the number of claims extending longer than 90 days was reduced 63 percent.


The speed at which information is available to all parties also has improved.


The percentage of workers compensation claims reported by COHE emergency room doctors within the first two days following an injury has gone up dramatically. While only 2 percent of such claims were reported in the third quarter of 2003 by doctors participating in the program, that number rose to more than 80 percent by the first quarter of 2004 and remained above 80 percent through the rest of the year.