UMass Memorial Hospital Self-Administered OH Program Q&A

This article presents an interview with Denise Nadler, the Director of Occupational Injury Management UMass Memorial Health Care (UMMHC). Denise describes the self-administered OH program she spearheaded at UMMHC which improved DART rates and Workers’ Compensation costs at an impressive rate.

What is your leadership role with UCare.

Director of Program.

How many covered lives is your team responsible for servicing?

UMMHC is a private, non profit academic health care system that is a clinical partner of UMassMedical School (UMMS). UMMHC has 13,764 employees.

Can you please provide a brief introduction to your program?

I believe the main purpose of the provision of medical care to our injured workers is to achieve optimal patient outcomes. Our relatively new program provides the addition of a specialized medical consultant and providers specifically dedicated to our injured workers.

Can you provide us some background on your program over the last few years?

UMMS eliminated their occupational medicine residency program in 2001. There were no board certified occupational medicine physicians who saw our patients . We saw this as a crucial gap in expertise ... in an important medical specialty.

What I helped build, was a self-administered worker's compensation program for UMMHC. This program covers all of UMMS Health care, just under 14,000 personnel. The program team consists of claims adjusters, nurse case managers, vocational rehabilitation specialists, loss control and the UCare clinic. (The UCare clinic provides OH health services to our employees. It works closely on the team and all the other team members to form an integrated program.)

What makes this program unique?

What makes this program unique is the Occupational Health integration into the Worker's Compensation program. Also, that it is self-administered -- all key personnel are on-site, they all work together as a team. We review cases with the team every six weeks when all the information and people needed to make good decisions are available.

UMMHC is one of only three hospital systems in the state that has a self administered program.

What were the challenges in building this program?

As I previously stated, UMMS had eliminated their OH residence program in 2001 and we did not have any OH physicians to see our employees on-site. We felt that in order to best manage our cases, we needed an Occupational Medicine doctor available to see our patients, and to consult with us on cases. Of course, it was a challenge recruiting an Occupational Health doctor, but in July of 2008, we were lucky to have Dr. Lee Okurowski, a member of OEHN's network begin seeing our patients. Since then, we have also utilized the services of Abe Timmons, D.O., and Pat Kent, who is a full-time Nurse Practitioner.

Other challenges included finding the space to locate the program and, of course, selling the program to our leadership.

What are the major achievements of the program?

When we began the program in 2007, our DART rate was 5.07. In 2007 we used Dr. Okurowski to just do case reviews and provide medical direction. Even so, our DART rate dropped to 4.43 in 2008, and in 2009, with the addition of our on-site clinic, it dropped to 3.55. Other important statistics include:

Our lost time days are down 19% 2008 to 2009.
Our restricted days are down 45%.
OSHA reportable cases are down 6% from 2007.

Another key achievement is that we now are able to see patients almost immediately after they report their injury. It used to take approximately 9 days after an injury was reported for an employee to be seen. The reality is, we see a vast majority of patients that day or with 24 hours. Because of this achievement we can start the medical interventions sooner, and these interventions lead to more effective outcomes.

In order to improve the program even more, we started querying patients for patient satisfaction information. The results were, out of a score of 5 we regularly get a score of 4.72. We believe this is because the model we use is a little different: the nurse case managers do the intake and acquire the patient information for the visit. The Case Manager is also usually in the room when the Physician is seeing a patient, so there is no chance of there being different information about what was said. Everyone is on the same page.

Have you developed key metrics to assess your measured value?

Yes, as I previously mentioned, we keep a close count of our DART rate, and periodically create the following reports:

Analysis of Claim Count
Claim Count Comparison
Number of Claims with Lost and Restricted Days
Average Lost Days in All Claims Received
Average Lost Days in Lost Day Claims
Largest Number of Lost Days in a Single Claim
Average Restricted Days in all Claims Received
Average Cost of Workers’ Compensation Claim
Workers’ Compensation Costs as a Per Cent of Payroll

What are the unique attributes of your program?

Besides what I have mentioned above, some of our more unique program attributes include:

Allotting sufficient time for appointments. Our goal is not to have the patients feel rushed.
We have the nurse case managers be present in the clinic with the providers, so everyone is on the same page.
Because the UCare and Claims Teams work together, when the provider wants to order, let's say physical therapy, the service can be approved right away. We can fast track referrals for diagnostics, etc. There is a network of specialists to refer the patients. This gives us faster results and better patient outcomes.
The Vocational Rehabilitation specialist is on-site as well. When we have an employee who needs to return to a job that is not their regular job, our Voc Rehab specialist, is able to identify transferrable skills and place them in a position that fits their skills and abilities. In this way, they are able to return to work more quickly.

Denise Nadler is an RN with an MBA who has been with UMMHC as the Director of Occupational Injury Management since 2002 and in the occupational health field for over 20 years. Her previous management experience includes Executive Director roles in home health care and directing Employee Health Services. She has also worked as an occupational health nurse and Workers’ Compensation Case Manager. Denise holds certifications as a COHN-S, CCM, ARM and CPDM.

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