Emidence, Enabling Industry Professionals to Rethink Soft Tissue Injury Management
According to the U. S. Bone and Joint Initiative, 126.6 million adults in this country (that’s 1 in 2) areaffected by musculoskeletal /Soft Tissue Injuries (STIs). The same source estimates that annual costs for medical treatment and lost wages resulting from these types of conditions exceed $874 billion. Alarming, well that’s only part of the equation. Just imagine what the total comes to when the impact of opioid dosing practices is considered.
Accurate, Equitable and Consistent Evaluations of Soft Tissue Injuries (STI) is not the Norm
If suffering from a chronic soft tissue injury or becoming permanently impaired isn’t hard enough, the industry’s inability to apply findings, rules and benefits in an equitable and persistent manner only creates more problems. The following two real life examples illustrate the quandary facing our industry today:
“What disturbs me the most is when two long-term employees, roughly the same age, doing the same job and suffering from the same type of injury get two drastically different impairment ratings? One gets a low rating, the other gets a rating considerably higher”
A seasoned Risk Manager from a large U.S. corporation
By the way, co-morbid conditions did not play a role and his beef was simple: Did one get cheated and the other win the lottery, or was the high rating correct and the employee with the low rating treated unfairly. “Isn’t accuracy and consistency what we are all looking for?”
“Our ability to do a fair and impartial job relies heavily upon medical information provided. First, if the report is light, how can their determinations be accurate? Garbage in, Garbage out. Next, given the time lag between when reports are generated and when the proceedings occur, is what we are reviewing really an accurate depiction of the injured employee’s current state. Did they get better, or did they get worse? Either way it’s a real problem.”
A group of judges who adjudicate both workers’ compensation and disability benefits during a major industry conference
The Emerging Consensus on “The Way-Forward”
While care delivery, claims and leave management professionals have yet to figure out the right combination to manage soft tissue injuries on a consistent and wide-scale basis. There seems to be a consensus that at a minimum, any dynamic and effective solution(s) must incorporate:
Evidence-based Medicine (EBM)
- The judicious use of the best current available scientific research in making decisions about the care of patients. Evidence-based medicine (EBM) is intended to integrate clinical expertise with research evidence and patient values.
ACOEM, ODG, Medical Disability Advisor (MDA), AMA, MEDLINE and a host of other nationally recognized guidelines and search tools are already being put to good use, but uniform application, systems integration and even outcomes vary.
Enhanced Methodologies to Appropriately Cope with Psychosocial Issues:
- Although the effects of anxiety, depression, catastrophizing and fear avoidance are frequently talked about, medical interventions, just as with other Evidence-based Medicine techniques, are not uniform. Given that no two patients are alike, and study after study confirms the importance of managing patient characteristics and preferences, a holistic approach that effectively deals with individual thought processes is no longer just a nice to have.
Emidence, Xybion’s next generation solutions that augment the capabilities of all professionals found along the STI care, claims, and leave management continuum. Our cloud and evidence-based solution affords the ability to:
- Via unparalleled Enterprise Content Management (ECM) incorporate into the decision- making process data from disparate sources and systems
- Make use of embedded nationally recognized and state-specific guidelines when evaluating the appropriateness of care on concurrent and retrospective basis’
- Integrate Statutory, Federal, ERISA and other specific guidelines into the approval/denial process
- Make duration approvals/determinations and evaluations based on employee/claimant specific capabilities – including psychosocial and comorbid conditions
- Determine the reasonableness of medical fees and other specials based on objective mandated or usual and customary data
- Create requisite documentation that assists greatly in the appeal, hearing and litigation process.
- Accurately transfer original data across multiple processes and users ensuring data and process integrity.
We look forward to demonstrating how our comprehensive and unique process generate unparalleled efficiencies, accuracies and controls while easily integrating with existing systems platforms.
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No time is better than the present to rethink Soft Tissue Injury Management