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I think everyone reading this blog has been touched by alcohol or substance abuse in their lifetime, whether personally or through the experience of an acquaintance, a family member, a close friend, a classmate or a colleague. We know the dangers of illegal drugs and overindulging in alcohol, but not as many of us understand the dangers of misusing prescription drugs. We rely on our pharmacists and our doctors to educate us on the medications we take. But what if we receive prescriptions from multiple doctors or fill our prescriptions at multiple pharmacies – maybe one close to work and one close to home? What percentage of the population reads the drug warnings that come with medications?

CDC-for_one_death_600w-ns

Recently I was very surprised to learn that an acquaintance is a recovering addict. She doesn’t fit the description of what I would consider a drug addict (not that there really is a profile for a drug addict); she comes from a supportive middle-class family, she’s educated, pretty, active, has a good job, lives in a nice community and loves animals. She talked about her past drug abuse, the people in her Narcotics Anonymous meetings and her seven years sober. Although she knew that I worked as a product manager doing something in the “medical field,” she was equally surprised to learn that part of my job is to develop narcotic management strategies for employers. She asked me how prevalent prescription painkillers are in the United States, so I shared with her the following facts:

  • The Centers for Disease Control and Prevention reported that enough narcotic painkillers are prescribed in the U.S. to medicate every adult American 24 hours a day for 1 month. Said another way, enough narcotic painkillers are prescribed to medicate 1 in 12 adult Americans around the clock for a year.
  • More people die from accidental prescription drug overdoses than car accidents.
  • More people die from accidental prescription drug overdoses than heroin, cocaine and all other illicit drugs combined.
  • The U.S. consumes 80-90% of the world’s supply of prescription painkillers, yet represents only 4.4% of the world’s population.
  • The street value of Oxycontin can reach up to $1/mg so an 80mg pill can fetch up to $80, making it significantly more expensive than heroin.
  • The #1 prescribed medication in the U.S. in 2012 was hydrocodone/acetaminophen (Vicodin).
  • 70% of all Americans who took a prescription drug for non-medical use obtained the drug from a friend or family member.

With every statistic, her jaw dropped lower. I will spare you all the details of our 45-minute conversation, but I will share with you her immediate response: “What can I do?” She wanted to help. Here’s what I told her:

  1. Don’t give your family or friends your unused medications.
  2. Keep all medications in a locked cabinet away from children, teenagers, family members and friends.
  3. Properly dispose of old prescriptions. The Drug Enforcement Agency created a national take-back program where Americans nationwide can dispose of unused, unwanted or expired medications on the last Saturday in April and the last Saturday in September/October. The program’s website also lists ways to dispose of medications properly if one of the 6,072 collection sites is not convenient.
  4. Assist elderly relatives in disposing of unused or expired medications.
  5. Educate others on the risk of combining alcohol with opioids. Alcohol and opioids are respiratory depressants, meaning they reduce our drive to breathe and can cause breathing to stop. Combine alcohol, opioids and benzodiazepines and the risk of accidental overdose increases significantly.
  6. When in doubt, ask your doctor or pharmacist about drug, food and vitamin interactions.
  7. Read the labels on medications; there is valuable information about the risks associated with the medication and how to take it safely.
  8. Don’t take expired medications or medications prescribed to others.
  9. Answer your doctor’s questions honestly.
  10. Only take medications as prescribed.

When taken properly, prescription painkillers can greatly reduce pain while the body heals after an injury or surgery. However, they can have unintended consequences if used improperly. We all have a stake in controlling the prescription painkiller abuse epidemic – from the drain on our emergency rooms, the cost to our healthcare system and, most importantly, the tragic loss of human life.

So I ask what are you going to do to be part of the solution?

Additional information can be found on the Centers for Disease Control and Prevention website.

Jamie Harer, Managed Care, Specialty Products Manager

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stress-in-the-workplacePost-traumatic stress disorder (PTSD) has gotten a lot of national attention lately due to several disturbing events on military bases. However, PTSD is not limited to veterans and those who have been exposed to war. It is a complex disorder that can affect anyone who has been involved in or witnessed a serious life-threatening event. Recently, the Center for Employee Health Studies at the University of Illinois at Chicago (UIC) released the results of a study on the consequences of stress in the workplace. Their research indicates that “while PTSD is most frequently associated with veterans, approximately 3.5% of American adults in the civilian population suffer with PTSD in any given year (NIMH, 2013). Women are twice as likely to be affected as men; the lifetime prevalence of PTSD among men is 3.6% and is 9.5% among women.” It is obvious that PTSD has become a major public health issue since the massive traumatization caused by September 11, Hurricane Katrina, and events like the Asian tsunami and the earthquake in Haiti.

According to the Mayo Clinic, PTSD is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. Additionally, this disorder can affect the memory and nervous system, emotional responses, and the ability to think. It can lead to chronic pain, depression, sleep disturbances, nightmares, and relationship issues including divorce, violence, and employment problems. Individuals suffering from PTSD commonly experience episodes of anger, stress, and some may even turn to drug or alcohol abuse. Symptoms can be triggered by an anniversary of the event, loud noises that remind the individual of what happened, or they may experience persistent thoughts and memories of the event.

From a workers’ compensation and disability perspective, these situations can often go unrecognized and appear as other conditions in a claim. Consider a retail situation where a store employee is robbed at gunpoint and injured in a physical struggle. We immediately recognize the employee’s physical injuries, but may fail to aggressively address their emotional issues. Healthcare workers encounter life threatening events every day. We have grown to expect these workers to confront life and death, and try their best to save the lives of their patients. Ask any healthcare worker (firefighter, paramedic, nurse, physician, etc.) and they will tell you about a patient they will never forget. That patient is forged in their memory forever and likely caused them many sleepless nights due to PTSD. These situations can also exist for individuals in other industries, such as truck drivers who have been involved in an accident or factory employees who have witnessed a severe injury.

PTSD can be treated; however, we need to be mindful that any trigger can cause the symptoms to re-occur. Fireworks, for example, can be a reminder of an explosion or a severe thunderstorm can be a reminder of a hurricane. The treatment options are limited, and may or may not be effective. Examples include:

  • Cognitive behavior therapy, family and group therapy, and exposure therapy where the person is slowly reintroduced to the setting where the event occurred
  • Eye movement desensitization and reprocessing therapy where a therapist guides the individual’s eye movements when the thoughts occur and works with them to change their thoughts to positive
  • Anxiety medications such as Zoloft and Paxil (please note, as I mentioned in my recent post, Mental health prescriptions pose workplace worries, employers need a clear plan of action to manage employees taking these medications. Dependency and addiction are real issues without easy solutions.)
  • Magnetic resonance therapy, which is a newer area for research

PTSD is a serious health concern and the data is clear that there are many people in the workforce today who are not combat veterans, but have been diagnosed with the disorder. What steps are you taking to address this in your organization? I look forward to hearing from you and of course encourage you to contact me for additional information on this important topic.

Dr. Teresa Bartlett, SVP, Medical Quality

Read more in our “stress in the workplace” series:

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US_Soccer_LogoIn just a few hours the United States men’s national soccer team will take on Belgium in the knockout round of the 2014 FIFA World Cup. With this global sporting event combined with a short work week (with the July 4th holiday falling on Friday) for most of the United States, employers may be wondering how this will impact workplace productivity all week.

Forbes reporter Susan Adams wrote that during last week’s match against Germany, conference calls were down 7% during the first half and continued to decrease as the game came down to the final five minutes. However, in the other net – so to speak – Forbes had a guest post by Neal Taparia, Co-CEO of Imagine Easy Solutions, who wrote that watching the World Cup will increase office productivity. Mr. Taparia discusses how encouraging employees to watch the matches can boost morale in the workplace. Is this similar to March Madness in the United States where the sentiment of employers sometimes is if you can’t beat them, join them?

The black and white answer to the question is yes. In pure terms of work getting done, many people will probably be watching the match or following on their smart phones or via social media. This means productivity will not be at its highest level during the three hours the match is occurring.

The bottom line is you as an employer have to decide if your workplace environment can embrace World Cup madness for a few hours. As pointed out by Mr. Taparia, there is a good case for building good will and embracing the event. Of course there will be environments where safety and other factors prevent taking this approach.

So today, when you hear “gooaaaaaal” erupt in your workplace, we at Sedgwick hope it is followed by chants of USA…USA, as we wish the USMNT good luck against Belgium.

And we wish each of you a safe and happy Fourth of July weekend.

Jonathan Mast, Director of Social Media

July 2, 2014: A follow up note. Some of our own Sedgwick colleagues in our King of Prussia, PA, office held their own world cup celebration. They hosted a ladder ball tournament and a cookout. This is just another example of how you can chose to build morale around various national or global events.

KingofPrussia-WorldCup2014-Sedgwick

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stress-in-the-workplaceThe University of Illinois at Chicago (UIC) research paper on Stress in the workplace highlights the costly impact of stress and mental health issues on workplace injuries and illness, including higher risk of injury, medical treatment, lost time from work and presenteeism. We also know that mental health issues, including depression, have been found to have a much higher impact on presenteeism than other chronic illnesses.[1] Mental health disorders often have symptoms that are not readily apparent; employees may attend work, but their underlying health condition affects their ability to do the work or even distracts them from safe work behavior.

Many employers already offer health management benefits that provide employees with support for mental health and emotional well-being overall through employee benefit programs. This is partly because of other research, like that of UIC, demonstrating a strong relationship between these health issues and employee presenteeism, lost time from work, overall productivity and risk of injury/illness.

UIC researchers identified three key areas for employer initiatives. With National Post-Traumatic Stress Disorder Awareness Day approaching on June 27, we would like to build on their recommendations by offering some thoughts for additional actions employers can take – using available resources and medical/disability data – to mitigate the impact of lost productivity and presenteeism from stress and other mental health illnesses. We also encourage employers to develop initiatives that cross internal silos to share information and health intervention strategies for occupational and non-occupational injury and illness. Integration can vastly improve results in addressing this issue.

Organizational

  • Develop a broader organizational initiative to not only develop managers who are supportive of employees at work, but also to create a strong organizational culture – with C-suite leadership – that is supportive of employee health and well-being 24/7.
  • Ensure employee access to wellness and prevention offerings such as: employee assistance programs (EAP), disease management, personal financial counseling, stress management and resiliency training. Make sure managers are familiar with them and can talk to employees about using the services. For parents, services like same-day care services for sick children and flexible work schedules can be valuable stress alleviators that increase attendance as well as attention to work tasks.
  • Other stress reducers in the work environment can include offering exercise classes, group walks or walking contests and other social/community events that engage employees in building positive, friendly relationships with colleagues. Having community and shared experiences can reduce perceived stress and isolation.

Screening and supportive services for high-risk individuals

  • Use an employee health risk assessment (HRA). This self-assessment, offered to all employees, is a common employee benefits tool for identifying other individual and population risks. Many companies use employee incentives (cash, gift certificates or health premium reduction) to encourage high engagement levels.
    • HRA individual results are usually kept confidential from the employer. However, independent healthcare management vendors can be engaged to reach out to employees with health risk indicators and help guide them to intervention programs like EAP or provide referrals to mental health providers, etc.
    • HRA summary data information can be used to see the varying risks in the population as a whole; sometimes data can also be broken down by business unit or occupation. Interventions can then be designed – i.e. resiliency training for employees who are under high stress, or more visible communication on EAP resources, stress reduction techniques, crisis intervention initiatives, etc.
  • One data resource often overlooked is Family Medical Leave Act (FMLA) and short term disability (STD) frequency and cause of absence. High absence rates, especially in units that have high-stress environments, can be an important red flag. FMLA summary information can be reviewed in conjunction with summary data from HRA, STD and workers’ compensation reports to identify occupations and business unit populations where stress or depression may be a factor.
    • Integrated Benefits Institute (IBI) research in 2013 showed FMLA usage to care for a family member more than doubles the risk of an STD claim for employee disability[2] due to mental health issues within a year. It seems reasonable to think this stress could show up in other areas, as well, i.e. increased risk of presenteeism, work injury or extended disability while off work due to other health issues.
    • For many employers, FMLA intermittent leave has a high absence rate for mental health and depression, and often the reason for leave is available to the leave administrator. This is an area where referral to employee health resources can be a valuable intervention.

Managing the risk of prescription drugs that impair performance

  • Many employers have access to their prescription drug usage in summary data. Usually this data includes drug names, frequency of prescriptions and costs, as well as break-out by business locations or zip codes.
  • Use of this summary data to identify drug use in employee populations that may increase the risk of injury is a first step to understanding what risks may exist and what methods can be used to ensure all employees are safe to perform work tasks.
  • Use of the company medical director or a trusted physician consultant as an advisor to assist in this data review and in development of alternative intervention strategies is recommended. Interventions could have high impact on employees, as well as operations and safety. Incorporating legal and human resources into this process is also highly recommended.

Many employers are realizing that mental health and emotional well-being can greatly impact overall health issues, employee presenteeism, lost time from work, overall productivity and risk of injury/illness. Is this a growing concern for your organization too? I look forward to hearing your perspective.

Denise Fleury, SVP, Disability and Absence Management

Read more in our “stress in the workplace” series: part 1, part 2


[1] IBI Chronic Disease Profile, Depression, IBI, 2013
[2] “Early Warnings: Using FMLA to Understand and Manage Disability Absence,” IBI, 2013

 

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Prescription-drug-concerns

Imagine a young father of two (Jim) who goes to work one day and sustains a minor back injury. He sees a doctor and is told he can work, but could not lift over 25 pounds. Jim’s employer would not take him back unless he could perform all essential job functions without restrictions. The doctor gives him a few pills to reduce his back pain, but he is unable to easily play with his children or do household chores. Repeat doctor visits end up leading to more pain pills, and then antidepressants to help manage his mood and disappointment. Soon, the pain becomes a daily component of his life. He continues to take the medications and grows more anxious as time goes on. He wonders if he will lose his job. Do his family, friends and co-workers believe he has a condition? His physician had no plausible explanation for his pain. The diagnostic testing and physical examinations were normal, yet Jim still has pain. Should a surgeon be consulted? His doctor is stumped.

Jim’s life becomes very different due to the failure of many systems. The medical community let him down by over-treating his minor injury. He had multiple tests that never amounted to anything. He was sent to specialists who treated the “pain,” and was eventually given more and more medications. Off work for more than a year with essentially a minor back strain, Jim gains weight and is mostly inactive. No one ever spoke to him about healthy lifestyle choices, good nutrition and functioning with pain. Soon, he sits on the couch all day, does not participate in family functions and becomes more disconnected from family and friends. The pills begin to consume his life. He is constantly thinking about when he can take his next dose.

Each day, 22 people in the U.S. die from overdoses due to prescription pain pills or opioids. We know that pain medication and other medications cause great concern from a health and safety perspective once an employee returns to work. Many employers are not aware of the medications workers are taking until there is an accident. These drugs can inhibit sleep patterns, make employees drowsy during the day, impair judgment and lead to addiction. The risks associated with them are too numerous to count. The family dynamic is altered; the injured employee feels isolated and depressed, and is not functioning at optimal levels.

Opioids can be very dangerous when combined with other medications to treat anxiety, depression and sleep disorders, and patients must understand the risks. Physicians rarely take adequate time to explain all the risks, and the dos and don’ts associated with these medications. For example, all pills should be kept in a lock box to prevent others from accessing them. Also, no other medications should be taken with prescriptions unless first discussed with your doctor. Over-the-counter pain medications like acetaminophen or ibuprofen are usually components of prescription pain medications, and high doses can be toxic to the kidneys and liver. Allergy, cold and sleep medications should be avoided as combining them with opioids and anti-anxiety medications can result in overdose or death.

Proper attention should be given to the total morphine equivalent dose (MED) each day. Doctors can become overwhelmed with a patient who has pain and no real diagnosis. There are countless examples of physicians prescribing MEDs exceeding the daily maximum recommended. They often treat the symptoms and forget to treat the person by addressing healthy alternatives, such as exercise programs, smoking cessation and nutritional counseling, and explaining that each pain medication should be treated as a short trial. When the medication does not increase functional abilities or eliminate the pain, it is not working and should be discontinued immediately. 

Anti-depressants, anti-anxiety drugs, and managing employees who take them
Stress, depression and anxiety are consistently ranked among the top five causes of time away from work. These conditions are often undiagnosed, under treated, or over treated. Depression in particular is a major contributor to other conditions, such as diabetes, heart disease and muscle strain. It is well documented and known to delay healing in post-operative cases, which extends durations beyond the expected recovery time.

Anti-depressants require close monitoring and management to increase doses, add adjunct medications and ensure optimal therapeutic levels are maintained. Three to nine percent of individuals who sustain an accident or injury have taken or are taking these medications.

Anti-anxiety drugs are commonly prescribed to block pain and can also cause work-related issues. They relieve anxiety by slowing the central nervous system and reducing brain activity, and are used to treat sleeplessness or as a muscle relaxer. They may create unwanted side effects like sleepiness, a sensation of fogginess and a lack of coordination – all of which can make working and driving dangerous or difficult. Anti-anxiety drugs are often associated with and can cause depression, and long term use should be avoided.

Employers need a clear plan of action to manage employees taking these medications. Dependency and addiction are real issues without easy solutions. The best strategies include prevention and monitoring. Best practices for healthcare providers include:

  • Completing baseline urine drug screenings (first prescription not given if patient tests positive for opiates or barbiturates)
  • Conducting a risk assessment to understand if the patient has any risk of addiction, overdose or dependency
  • Signing an opioid agreement – with both provider and patient – prior to the first prescription to ensure the patient understands all health risks and side effects, as well as expectations including not taking other medications, avoiding alcohol and other illicit drugs
  • Counting pills and patches on every visit
  • Conducting random unannounced drug screenings
  • Focusing on function and return to normalcy
  • Reducing and eliminating the medications as soon as possible

A large-scale effort is needed to help employees obtain the most appropriate care for their injuries. Education and good communication are the keys to preventing misuse and avoiding addiction and dependency.

Dr. Teresa Bartlett, SVP, Medical Quality

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medical-tech-privacyA commercial ran recently where a man getting in his car sees a sticky note on his window. When he reads the note it says, “you are going to have a heart attack today.” The voiceover states, “It’s too bad we aren’t notified when we are going to have a heart attack.”

I look at the amazing world of healthcare and the changes taking place to help us and our physicians monitor and manage our health. Is the scenario played out above going to become reality? I don’t know the answer, but I wouldn’t want to discount it. So what does this all mean when it comes to the coexistence of medical technology and privacy?

Technology advancements in medicine and electronic records bring greater awareness and enhanced abilities for healthcare providers and patients to monitor and improve health. The discussion around radio-frequency identification technology and implantable radio frequency transponder systems for individual safety, cost, privacy, security and regulatory controls has been evolving over the last decade and more. The Food and Drug Administration began working with U.S. companies at least as early as 2002 to monitor marketing and approval of micro- miniature transponders to be encapsulated in medical grade glass that could be inserted by hypodermic needles under the skin of the upper arm in humans. Anticipating possible misuse of technology, Missouri enacted state labor law V.A.M.S 285.035 in 2008, prohibiting employers from requiring employees to be implanted with microchip technology.

In the increasingly technology-connected world, privacy by design – including notice and consent – must be incorporated at all levels of development and use in order to protect individuals from theft of medical information for possible wrongful use or malicious control of medical devices.  I recently attended this year’s International Association of Privacy Professionals conference and heard George Savage, Chief Medical Officer at Proteus, present about his company’s fascinating new medical technology. Mr. Savage highlighted digital medicine and healthcare innovation with the demonstration of ingestible micro-sensors the size of a grain of sand that, when swallowed, emit a signal to be detected by a patch monitor worn by the patient. The micro-sensor can track heart rate, sleep pattern, activity levels and other physiological parameters. Many new, groundbreaking medical technology monitoring devices like this are being introduced to the marketplace. The excitement new technology brings to healthcare will also create healthy discussions on its future impact on privacy and security. Given the current legislative and case law discussions on how to harmonize the 46+ state laws on security breach notification, cyber security, FTC oversight and more…it is expected that much future discussion will center on applications of use for the data gathered from this modern technology.

Jarrod Magan, VP of Client Technology Services for Sedgwick, wrote a blog titled “Staying ahead of the risk management technology curve,” where he talked to other technology leaders in the risk insurance field about this topic. Jarrod addressed the issue very well when he said, “Companies should develop solutions with a ‘privacy by design’ approach and not wait to address issues once a product has been deployed.” Sedgwick will continue to monitor the landscape and how decisions and developments may affect insurance programs, state workers’ compensation and healthcare in general.

What medical technologies are you already using in your daily life? How is medical technology changing the way you manage your healthcare? Please tell us as we continue to look at the evolution of technology, healthcare and privacy.

Brenda Corey, SVP, Compliance, Government Relations & Regulatory

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Tazic_Kathy111213-blogI grew up on the south side of Chicago and am 100% Lithuanian. This was very difficult in a world where everyone else seemed to be 100% Irish. My friends had names that started with O’ and they all had green satin jackets with “south side Irish” in white script on the back. I literally begged for the jacket, but my parents would hear nothing of it. In fact, my mom and dad made me wear red on St. Patrick’s Day – because St. Joseph’s Day is the next day and our heritage was “closer to Polish than Irish.”  Combine that with my love of reading novels in second grade and my inability to properly climb a fence, and my early years could be considered unique – different if you will…

I think about the experience of feeling “different” a lot as an adult and definitely at work. We all bring different perspectives.  Maybe you weren’t Lithuanian in an Irish world – but maybe, like me, you read a lot and that wasn’t cool, or you had a family that taught you different ways to look at things because of your culture or family structure. As an adult, you learn that all of that divergence of opinion has significant value to solving problems and creating new approaches to opportunities. Without it, we only see the world as we did when we were kids – that five mile radius that was our neighborhood.

Diversity matters at Sedgwick and it’s one of the reasons I am proud to work here. It is what helps us mirror those we serve on a daily basis. The Sedgwick neighborhood allows us to go beyond a limited view and pull in resources from all walks of life. We may not all wear the same names on our jackets, but that’s what gives the collective “us” the range of perspectives we need to deliver the right solutions to our clients.

Our client partnerships require us to know what works so that we can offer a variety of options to fit specific situations. We know that we can’t keep individual client programs insulated because the next great idea for that program might be outside of the program itself. It’s a pretty easy thing to do at Sedgwick because we have amazing resources we can access to get the best, most creative options for what we’re building or solving. And because our client base is so diverse, we’ve learned that the differences in the models employed for them help us see what might be. Our client partners expect us to know and use what works based on the diversity our organizations bring to the table.

I would like to challenge you this week to reach out to someone and ask their opinion or experience about something you are doing or need to do. I promise you that the range of thought you receive will be well worth it and you will find that each person has something valuable to offer, regardless of their background. Get a different perspective; get out of your comfort zone. And if you are bold enough to take my challenge, I would love for you to post what you learned right here so that others can learn from the experiences we all gained.

Kathryn Tazic, SVP, Client Services

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stress-in-the-workplace$317.5 billion – it’s a figure that gets employers to sit up and take notice. According to the Centers for Disease Control and Prevention (CDC), this is the total for direct and indirect costs of treating mental health disorders annually. Numbers like this – and the growing interest after our “stress in the workplace” post in April – prompted us to dig a little deeper on the topic.

Not only are employers paying the medical expenses for employees who suffer workplace injuries resulting from stress and mental health disorders, there are also productivity-related costs that can have a significant impact on their bottom line.

The Center for Employee Health Studies at the University of Illinois at Chicago (UIC) recently released the results of a study on the consequences of stress in the workplace. It revealed key information that may help our industry guide employers as they manage this critical issue.

Several types of mental health disorders are tied to increased injuries in the workplace and are described in the study as dimensions of stress, including depression, anxiety and post-traumatic stress disorder (PTSD). The medications prescribed to treat these disorders can also impact injury rates and productivity.

Statistics in the study from CDC and the National Institute of Mental Health show that over 25% of all adults in the United States currently have a mental illness and nearly half will develop at least one during their lifetime. Injury rates are two to six times higher among individuals with a mental illness than in the overall population.1

Absenteeism related to mental health disorders is among the biggest costs for employers, and the study reported that stress, depression and anxiety were repeatedly ranked as three of the top five causes.

According to the UIC study, if untreated, consistently high stress can become a chronic condition, which can result in or exacerbate mental health conditions as well as chronic physical conditions like cardiovascular disease, cancer, diabetes, obesity, hypertension, asthma, muscle pain or a weakened immune system. These conditions not only diminish the well‐being of workers and increase the employer’s health benefits expense, they contribute to injury incidence rates and outcomes.2 The study also found that healthcare costs are nearly 50% greater for workers reporting high levels of stress due to substantial increases in health service utilization.

Employers in all industries must be prepared to manage the various types of employee stress and mental health issues, while ensuring the safety and productivity of their workforce. With over 40 years of experience in the workers’ compensation industry, Sedgwick understands the impact stress can have on businesses.

The study outlines several steps employers can take to control costs and reduce injuries, such as promoting the value of the employee’s work and showing them how it contributes to the company’s mission, testing for legal prescription drugs within potentially impairing categories and offering temporary jobs for employees who reveal using certain types of prescription drugs.

In the coming weeks, our Sedgwick Connection blog will include a series of articles on stress and mental health concerns in the workplace. Our experts will provide information and guidance on key topics, including:

  • Issues related to employees who take anti-depressants and anti-anxiety medications, and those who over-medicate or do not take their prescriptions at all
  • The correlation between stress, productivity and absenteeism
  • Military and non-military PTSD
  • The legal, moral and ethical concerns for employers

Sedgwick has developed a summary of the full research conducted by the Center for Employee Health Studies at UIC. Our summary and the UIC study are both available on our website.

As we continue to address mental health and stress-related issues in the workplace, I invite you to share your thoughts.

Darrell Brown, Chief Performance Officer

1 Centers for Disease Control and Prevention, 2011.
2 Dopkeen, J.C.; DeBois, R. (March 2014). Stress in the workplace. A policy synthesis on its dimensions and prevalence. The Center for Employee Health Studies at the University of Illinois Chicago.

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central-info-system-adaaaEmployers struggle with the question of “How do you begin to wrap your arms around this thing called ADA?” – facing challenges from the Americans with Disabilities Act and the ADA Amendments Act (ADAAA).

Often, employers face two common compliance gaps. The first gap is the lack of a well-defined accommodation process and/or neglect in following the process consistently. Denise Fleury addressed this important issue for employers in a three-part ADA/ADAAA series on our blog: part 1, part 2, part 3.

The second common gap deals with the ability of the employer’s information management platform to support the previously discussed accommodation process. Here there is a wide range of practices, often inconsistent even within the same organization. Some departments may collect and track needed data using an Excel spreadsheet, some may inconsistently report employee requests to human resources and some managers may just act on the spot, without any documentation. Any of these options can leave the organization unable to completely implement its formal processes, and open it to costly legal action from employees and regulatory enforcement agencies.

The need for an effective, centralized information platform begins when an employee requests a job accommodation because of a disability that impedes their ability to perform all required job functions. This request sometimes arises as part of a claim for short term disability, long term disability benefits, FMLA, or workers’ compensation, or can stem from a condition which never qualifies for any of these other benefits.

What happens once an employer is notified of a request for accommodation critically impacts how they are viewed in regard to good faith compliance with required government mandates, including ADA. A centralized information platform which supports the accommodation process gives an employer a significant advantage in the current regulatory environment. Ideally, all conversations and communications are recorded with date and time stamps within the platform. Compliance is both easier to achieve and, perhaps more importantly, clearly able to be demonstrated when an employer has this kind of system.

A centralized information management system tracks and documents each step in the accommodation process. This begins with an employee’s request for accommodation and continues until a decision is made regarding the ability to accommodate the employee. Extensive documentation is required as part of the process:

  • Conversations with the employee
  • What and how accommodations were analyzed and considered in the response to the employee’s request
  • Medical documentation substantiating the accommodation
  • Acceptance of the accommodation including length of time and specifics of the accommodation
  • In the case of a denial, strong rationale supporting the reasons for denial including why the request was not reasonable

Much of this information is highly sensitive and needs to be tightly managed from an accessibility standpoint in order to comply with privacy laws especially those under the Health Insurance Portability and Accountability Act (HIPAA).

Often during the accommodation process, FMLA or other leave benefits may come into play. Ideally, having all of that information available within the same platform ensures better concurrent monitoring for the employer and employee. Any system should be easily and appropriately accessible to managers, human resources and to the employee.

The manager tasked with the case needs to be able to look back historically to see what has happened. The best platform is not just a way to document the case, but can become an action tool. The system should coordinate multiple mandates and identify specific milestones in the process where the employer should take action. This use ensures not only compliance, but also an opportunity to plan.

The case for an effective central information platform touches upon a variety of issues:

  • ADA regulations have continued to evolve based on new legislation and court decisions. The employer needs to use a platform that can easily and reliably adjust to support process changes in light of these developments.
  • Employee benefit policies are intertwined and probably affect ADA compliance issues. A central platform can create “hooks” into the processes of multiple benefits and mandates to identify important events that could spur action.
  • Employer policies, federal and state regulations continue to become more intertwined and dynamic. Relying on manual tracking methods may be a formula for compliance violations and increased risk. A robust, multi-faceted, centralized information platform that supports multiple operational processes and enables comprehensive documentation can greatly reduce that risk.
  • The potential for internet-based interactivity between employees and employers will improve the platform and make it more accessible. Many employers are insufficiently aware that FMLA and ADA regulations expect the employee to participate in good faith and take some initiative on their own. Sedgwick’s viaOne® suite of tools including mobile technology is an example of an interactive internet-based tool that is easy to use for both employees and employers.

The heart of a successful ADA/ADAAA compliance program is ensuring you have the right resources to provide a consistent, compliant process supported by a dynamic centralized information platform which addresses the increasingly complex government accommodation regulations faced by all organizations. We’d like to understand more about the challenges you face and the ways you address ADA/ADAAA compliance. Join the conversation by leaving us a comment below.

Shawn Johnson, SVP, Disability Services

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RiskResource-CopyPasteBlog051514Reprinted from Sedgwick’s Professional Liability Risk Resource newsletter, second edition 2014

As the Meaningful Use incentive program forges ahead, the tide has shifted for electronic health record (EHR) adoption in both acute care and outpatient settings. According to a recent CDC report, in 2013, 78 percent of office-based physicians used any type of EHR system, up from 18% in 2001.¹ More than 83 percent of hospitals are at Stage 3 or higher in electronic medical record (EMR) adoption, based on the Healthcare Information and Management Systems Society (HIMSS) EMR Adoption Model.² Those who have successfully navigated through “go live” have improved their efficiency in using the technology, and have likely learned some of the shortcuts to get around the system they are using.

One of the more common shortcuts is “copy and paste.” As reported in the September 2013 American Health Information Management Association (AHIMA) report, “74 to 90 percent of physicians use the copy/paste function in their EHRs, and between 20 to 78 percent of physician notes are copied text.” ³ Statistics like this beg the question if providers and nurses are actually listening to what a patient is saying and memorializing the conversation in a clearly unique note, or if they are just trying to get through their day efficiently, and using copy/paste computer functions to document what, to them, may sound like similar patient complaints and plans of care.

Risk managers shudder when they think about the potential fallout from this practice. First and foremost, the opportunities to negatively impact patient care and cause harm are increased. Copy and paste can contribute to incorrect or inaccurate information being relayed in the patient’s record or important information being left out. Information may not be updated with the most current data, information could be redundant, making it difficult to determine the patient’s current state, or there could be over-documentation because the note that was copied was not reviewed completely. Furthermore, risk managers must consider potential privacy breach – records of one patient may be cut into the records of another and then improperly disclosed in a medical record request.

For providers who work in more than one EHR system, some are able to copy information from one system (for example, the office practice EHR) into another system (such as the hospital EHR), which can leave the question of authorship up for grabs. When was the original entry actually made, and by whom? As noted by AHIMA, “In some settings, copy and paste may be acceptable for legal record purposes but not for others (clinical trials data, quality assurance data, pay-for performance data). In the hybrid environment, audit tracking of copy and paste may not be available because it involves different systems.”⁴

Beyond patient safety concerns, the Office of the Inspector General has noted copy and paste as one of the two most common documentation practices to commit fraud.⁵ Multiple encounters using the same documentation, as well as the potential for over-documentation previously mentioned, has the potential to create the appearance of support for billing higher level services with the irrelevant documentation that was brought forth from a record of another patient or another encounter of the same patient. This false documentation places an organization or individual provider at high risk for trouble.

What mitigation efforts should we consider? Realistically, turning copy and paste functionality “off” would be difficult in many organizations, and likely met with significant resistance. However, certain boundaries still must be set, with the creation of an approach that can be used to consistently manage clinical content, and outlining what is acceptable and what is not. In addition, limitations on copy and paste for legal record purposes may need to be outlined, such as for documentation in clinical trials data, and pay-for-performance data.⁶ A reliable chart audit function must be established and should contemplate an audit of a representative number of records by specialty and provider on a monthly basis; this could be centered around certain diagnoses or treatments, which is where copy and paste activity is typically found.

As we move toward achieving a fully electronic documentation system across the country – a goal of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 – we must continue to evaluate the impact of EHRs in the patient care environment, how this form of documentation may be affecting patient safety for the better and the worse, and continually work to make EHR technology a valuable tool in support of safe patient care.

Ann Gaffey, RN, MSN, CPHRM, DFASHRM, SVP, Healthcare Risk Management and Patient Safety

References:

  1. Hsiao C-J, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2013. NCHS data brief, no 143. Hyattsville, MD: National Center for Health Statistics. 2014.
  2. HIMSS Analytics: EMR Adoption Model, found at: https://www.himssanalytics.org/emram/emram.aspx
  3. Bowman, S. (2013). Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications. Perspectives in Health Information Management. Available at: http://perspectives.ahima.org/impact-of-electronic-health-record-systems-on-information-integrity-quality-and-safety-implications/
  4. Amatayakul, M., Brandt, M. and Dougherty, M. (2003) Cut, Copy, Paste: HER Guidelines. Journal of AHIMA,74, (9), 72–74.
  5. Healthcare IT News, January 9, 2014. CMS called out for EHR fraud failings. Available at: http://www.healthcareitnews.com/news/cms-called-out-ehr-fraud-failings
  6. Ibid.