Work comp doc: ‘Look at patients holistically’

Counseling, coaching help patients overcome ‘behavioral barriers’ to recovery

By Tony Gottschlich, Public Information Officer

The human body is more than a machine. And when it breaks down, simply repairing the parts won’t get it running again, especially when fear and poor coping skills are involved.

That was the message Friday from the chief medical officer for the Ohio Bureau of Workers’ Compensation (BWC) during a lecture entitled, “Integrating Behavioral Health into Injury Treatment,” at the Greater Columbus Convention Center.

“We need to look at patients more holistically and we need to have the tools to do that effectively,” said Terrence Welsh, MD, speaking at the fourth annual Ohio Workers’ Compensation Medical & Health Symposium. “If we don’t do that we are missing the boat, and we’re not going to accomplish what we set out to accomplish – getting our patients healthy again and back to work and life.”

Speaking to an audience of health care practitioners from across the state, Welsh said health care providers must incorporate a multifaceted approach to better understand and treat patients struggling to recover from injury. He said a “bio-psycho-social” model of care, “accepts that the mind and body influence each other.”

Welsh spoke of a tool BWC initiated last year called the Health and Behavioral Assessment and Intervention services rule, or HBAI. Under the rule, the agency will pay for counseling and coaching sessions that help injured workers overcome negative thinking, poor coping skills, lack of motivation and other behavioral barriers to recovery.

“These things actually work,” said Welsh, who is board-certified in physical medicine and rehabilitation, electrodiagnostic medicine and pain medicine. “There is evidence these services can improve outcomes.”

He cautioned the rule does not apply to mental illness and psychological disorders, but to naturally occurring emotional responses that many people experience following a serious injury.

In an interview before his lecture, Welsh said research shows behavioral barriers have three times or more the impact than pain alone in slowing an injured person’s recovery. That’s why it’s important to address barriers before they spiral into something more serious, such as depression and substance abuse.

Barriers that have the greatest impact on delayed recovery include:

  • Catastrophic Thinking: The tendency to ruminate about irrational worst-case outcomes. This can increase anxiety and prevent the injured worker from taking action, such as completing their rehabilitation treatment program.
  • Perceived Injustice: The injured worker’s belief that nothing will ever make up for what happened to them, and they didn’t do anything to deserve their situation.
  • Fear/Avoidance: The avoidance of movement and activity in an attempt to reduce pain. Studies show that this barrier generally results in both chronic pain and a disengagement from meaningful activities, which prolongs disability and may lead to depression.
  • Disability Beliefs: Injured workers’ expectations about recovery and their ability to manage returning to work. Studies show that an individual’s perceptions of the impact of their condition can have more influence on lost time, levels of impairment and activity levels than actual physical or medical indicators.

HBAI covers one health and behavioral assessment and up to six hours of intervention sessions per 12-month period. A number of licensed health professionals may provide the treatment, including physicians, chiropractors, psychologists, social workers and counselors.

For more information, click here.

Is marijuana medicine?

By Mark Pew, Senior VP, Product Development & Marketing at Preferred Medical. He will present Is Marijuana Medicine? at BWC’s Medical & Health Symposium Saturday, April 27 at 7:30 a.m.

As society and workers’ compensation try to answer that question, there are some clarifying questions that need answers first. That’s especially true on such a polarizing subject where state policy and public opinion continue to have their say.

The initial question should be:how is “medical marijuana” defined? Which then takes you to a list of sub-questions:

  • Is it the whole plant?
  • Is it extracts of specific chemicals like THC or CBD?
  • Is it organic (“natural”) or synthetic (“man-made”)?
  • Is it smoked, vaped, eaten, or an oil that is ingested or rubbed on a body part?
  • Is it just for a specific list of qualifying conditions or open to interpreted needs?
  • Does a physician need to recommend it as “reasonable and necessary” treatment or is it up to the patient (injured worker) to determine for themselves?
  • Is it grown at home, advised by a budtender at a dispensary or tightly controlled from seed to sale?
  • Is the dosing, duration, frequency and formulation determined by the patient or a clinician?

Every state has its own answers, whether on program website FAQs or from how it works in everyday practice. States with more recent programs, like Ohio Medical Marijuana Control Program[i], generally have more attempts at controls. But if you have seen one state medical cannabis program, well, you have seen one medical cannabis program. In other words, every state is different.

Once past that initial question, the next is whether “medical” is a scientific or anecdotal adjective that precedes “marijuana.” Some physicians, pharmacists and policymakers (including the National Institutes of Drug Abuse[ii]) believe the science has not clearly proven the medical benefit. The DEA still believes it is yet unproven because, given the chance in August 2017 to re-classify marijuana from Schedule I (i.e., illegal),the agencyaffirmed that “right now, the science doesn’t support” it[iii].

Other physicians are demonstrating by their recommendations they believe it is medicinal. The FDA believes that at least CBD is medicinal by approving Epidiolex in June 2018[iv]. And then you have people with various medical conditions, including chronic pain, that offer anecdotal proof it helps them or someone they know where FDA-approved medications and treatments do not. Their evidence is compelling, especially to mainstream and social media. Similar to the various definitions of medical marijuana, opinions vary greatly whether it is a proven medical treatment. It is obvious that preconceived biases – for or against – heavily influence individual opinions.

Clear as mud? Good. Because that is our country’s current crossroads. Setting aside individual opinions, 46 of 50 states[v] have decided in favor of medical use, and that is unlikely to be reversed. So the answer to the original question –is marijuana medicine? – is a very firm … maybe.

[i]https://www.medicalmarijuana.ohio.gov/
[ii]https://www.drugabuse.gov/publications/research-reports/marijuana/letter-director
[iii]https://ww3.workcompcentral.com/columns/show/id/0e042b1bfc0820f83bd3e33dabf6001f38e8a066
[iv]www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm
[v]http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

BWC’s Medical & Health Symposium begins today

Attendance increases more than 350% in four years

By John Annarino, Chief Medical and Health Officer

Our 2019 Ohio Workers’ Compensation Medical & Health Symposium with its theme, Comprehensive Care for Injured Workers, begins today and runs through late Saturday afternoon.

We’re pleased that more than 800 health care practitioners, staff and legal professionals statewide will be attending our two-day event at the Greater Columbus Convention Center.

We’ve been planning our multi-disciplinary event for about a year. We can’t wait to connect with our attendees and exhibitors! This year’s symposium offers continuing-education opportunities with credits, taught by well-respected experts on leading health and medical issues that affect us all – at work and at home.

Our 2019 symposium brings medical and health specialists together with legal professionals to learn how we can better solve far-reaching issues such as managing pain and opioids, chemical dependency and how to recognize traumatic brain injury symptoms before it’s too late. Improving collaboration and trust with our health-care community is another vital issue, as is chiropractic medicine’s role in workers’ comp and occupational medicine.

How we got started

The journey to today’s successful symposium began four years ago. I challenged our Medical and Health division’s leadership to plan an event for health care providers focusing on pain. My vision for this educational event came after a quarterly pharmacy meeting and an in-depth discussion on pain medication. Most of the original planning team members worked on our 2019 Medical & Health Symposium.

Our goal for the symposium – then and now – is to address health care issues facing Ohio’s injured workers. For example, we know the overuse of opioid medication affects Ohio’s workers and their families. To learn more, listen to Chris Hart, an Ohio pharmacist, tell his story of chemical dependency and recovery on Friday followed by a question-and-answer session on Saturday.

In addition, Saturday’s provider clinical education sessions discuss medical marijuana with Mark Pew, who is better known as the Rx Professor; Reggie Fields of the Ohio State Medical Association and Robert Stutman, one of America’s highest-profile Drug Enforcement Agency special agents. Former judge Jodi Debbrecht-Switalski reviews the paradigm of liabilities for the medical profession with the drug epidemic.

How far we’ve come

Debi Kroninger, our chief of medical operations, leads the symposium’s planning team. I’ve learned our first symposium in 2015 had 177 providers registered, with continuing education opportunities for a limited number of professions.

Today, we offer continuing education for attorneys, chiropractors, nurses, occupational and physical therapists, rehabilitation counselors (CCM, CDMS and CRC*), physicians and psychologists. Experts nationwide are learning about our innovative approaches and programs in caring for Ohio’s workers. For example, we already have eight speakers who are asking to present at next year’s event.

For increased learning opportunities, the symposium offers two educational tracks – the provider staff forum (Friday) and provider clinical education (Friday and Saturday). We feature the session Becoming a World-Class Carrier – BWC Medical Initiatives that will Take Us There in both tracks. Freddie Johnson, chief of medical services and compliance, along with Dr. Terry Welsh, chief medical officer, and Debi lead the session.

In addition, take time to network with the symposium’s exhibitors that include health care companies, state agencies, boards, associations and others.

How to contact us

Registration is free. If you have questions, call the provider contact center at 1-800-644-6292, option 0-3-0, or email medsymposium@bwc.state.oh.us.

Together, join us in our journey of providing innovative and quality health care for Ohio’s injured workers, their families and communities. We look forward to seeing you today and/or Saturday at our 2019 Medical & Health Symposium!

*Certified case manager, certified disability management specialist, certified rehabilitation counselor

Learn fall protection and prevention! Attend a BWC stand-down event

By Erik Harden, BWC Public Information Officer

In 2017, there were 971 construction fatalities nationwide; 366 of them resulted from falls from elevation.

Additionally, the Occupational Safety and Health Administration (OSHA) again lists fall protection in construction as its most frequently cited standard.

To raise awareness and reduce injuries and fatalities, OSHA promotes its annual National Safety Stand-Down to Prevent Falls. The stand-down encourages employers across the nation to hold events in conjunction with the multi-day event, May 6-10 this year. As always, the stand-down encourages employers to pause during their workday for topic discussions, safety demonstrations, and trainings in hazard recognition and fall prevention.

We have scheduled four FREE training events open to the public during the week of the stand-down. We’ve listed information for each below.

Garfield Heights event

  • When: 8 a.m. to Noon May 7
  • Where: BWC’s Garfield Heights Service Office – 4800 E. 131st, Garfield Heights, OH 44131
  • Event details: Presentations by experts from T. Allen Incorporated, The Albert M. Higley Co., Werner Ladder, Honeywell and the Cleveland OSHA Area Office
  • Register: Visit the BWC Learning Center and enter Stand-Down Event in the search field then enroll for the Garfield Heights event.

 Mansfield event

  • When: 9 a.m. to 12:30 p.m. May 7
  • Where: MHS Industrial Supply – 70 Sawyer Parkway, Mansfield, OH 44903
  • Event details: Presentation by experts from FallTech; co-hosted by MHS Industrial Supply
  • Register: Visit the BWC Learning Center and enter Stand-Down Event in the search field then enroll for the Mansfield event.

 Pickerington event

  • When: 9 a.m. to 12:30 p.m. May 10
  • Where: BWC’s Ohio Center for Occupational Safety and Health – 13430 Yarmouth Drive, Pickerington, OH 43147
  • Event details: Presentations by experts from Guardian Fall Protection, LBJ Inc. and the Columbus OSHA Area Office
  • Register: Visit the BWC Learning Center and enter Stand-Down Event in the search field then enroll for the Pickerington event.

Youngstown event

  • When: 7:30 – 9 a.m. May 7
  • Where: Boak & Sons, Incorporated – 75 Victoria Road, Austintown, OH 44515
  • Event details: Presentation by experts from 3M and a drop demonstration truck; co-hosted by Boak & Sons, Incorporated
  • Register: Email David Costantino or call 330-301-5825; email David Loughner or call 216-538-9720

We may add more events in the coming weeks. Also, don’t forget the BWC Library offers an extensive collection of audiovisual materials related to fall hazards and fall prevention. Additionally, we offer year-round classes throughout Ohio to address fall protection requirements.

It’s not too late for your company or organization to plan a stand-down event. We’re here if you need help planning your activity. Just call 1-800-644-6292 for assistance.

Better health, straight from the tap

By Melissa Vince, BWC Public Relations Manager

There are few things in life more important to us than O2 and H2O. Air and water. We can’t survive without them.

Let’s focus on water. Its benefits are innumerable, as long as it’s clean and safe. That’s the goal of Governor DeWine’s H2Ohio water quality initiative. The initiative is part of the governor’s budget and seeks to invest in long-term solutions to ensure safe and clean water across Ohio.

Clean, safe water is such an important part of our overall health that it’s one of the areas we encourage Ohioans to focus on when they join Better You, Better Ohio!™, our health and wellness program for Ohio’s workforce.

The free program offers health and wellness coaching and other resources for employees of businesses that have 150 or fewer workers. Healthy employees are less prone to injury. And, when they are injured, they’re usually able to recover more quickly.

You can learn more about the program and register here. If you’re eligible, you’ll have access to:

  • Free health assessment and biometric screening.
  • Disease management and health coaching.
  • Monetary incentives for participating and more!

ActiveHealth Management – our partner in offering the Better You, Better Ohio! program – also has many free health and wellness resources available to anyone. This includes items like a monthly newsletter and webinars covering a variety of health and wellness topics, including the importance of H2O.

The fact sheet below covers the benefits of H2O, how much you need and tips for drinking enough every day.

Better health – it starts straight from the tap.

Drones are in demand

A Q&A with BWC’s drone guru Joshua Grappy

By Adam King, BWC Public Information Officer

Joshua Grappy wasn’t surprised by the standing-room-only crowd in March at his 2019 Ohio Safety Congress lecture “Drones: Safety tools in the sky.”

Companies are clamoring to figure out how to use drones to save time, resources and manpower. Used properly, drones can positively affect the bottom line while potentially improving a business’ safety record.

Grappy is most interested in the latter as the Ohio Bureau of Workers’ Compensation Unmanned Aircraft System (UAS) program coordinator. Anytime workers don’t have to face a dangerous situation to do their jobs is the easiest way to avoid accidents. That’s why Grappy is happy to talk to any company that wants to explore starting a drone program.

“Drones really are an exciting new technology,” Grappy said. “Commercial drone usage is in its early stages, but the Federal Aviation Administration estimates as many as 450,000 commercial drones will be in the air in just a few short years.”

Efficient. Cheaper. Safer. We got some one-on-one time with Grappy to talk about these drone-related words that are making companies drool.

How has drone use improved safety in the workplace?
JG: Drones are often advertised as being able to perform the dull, dirty and dangerous jobs. For instance, confined-space inspections for pipes or ballasts can easily be done with a drone, without the need of a human ever having to climb down into potentially dangerous environments.

There are similar examples in construction, public safety and agriculture use. The drone industry is still in its infancy, and we will continue to see a lot of unique and innovative ways businesses can use drones to keep their workers safe.

How does BWC use drones in its work?
JG: We document workplace accident scenes. We fly our drones to capture pictures of a scene and then use photogrammetry software to build 3D models. This enables our investigators to essentially take the accident scene back to the office with them. The models we produce are fully measurable and you can rotate or fly through them to see things from any angle.

Have we seen a significant savings in workers’ comp or other areas by using drones?
JG: I don’t have any specific statistics related to monetary savings, but BWC views its drones as a safety tool. With that in mind, we can use this relatively inexpensive equipment to comprehensively document accident scenes in a way that was previously not possible. I feel that leveraging cutting-edge technology while keeping our investigators safe is worth every penny spent. Additionally, from a time perspective, the savings can be significant. The image collection from some of the more complex investigations can go from hours to minutes with the use of our drones. In many other industries there are examples of the work done by drones being accomplished eight times faster than traditional methods.

Are you seeing employers hiring out drone work or are they beginning to establish jobs for drone operators within their companies?
JG: It seems there is still a mix of both. However, it certainly depends on the type of work that needs done. Some jobs that are difficult to do technically might be more of a fit for a drone contractor with experience in the specific type of flight environment. More simple uses of drones for basic image capture can be easier to manage in-house.

Part of BWC’s drone program is to consult with employers who would like to start using drones. We help them navigate all the regulations, training and operational knowledge needed to use drones commercially. A lot goes in to putting a program together.

We can get companies up to speed quickly so they can make an informed decision on whether it makes sense to push forward with their own program or to hire it out. If a company has one pilot and just needs an aircraft to produce decent photos and video, you could get started with equipment and training for around $2,000.

What should an Ohio employer do if it is interested in starting a drone program?
JG: Reach out to me for more information. I will meet with them one on one, by phone or by email and help in any way I can. Drones are an incredible safety tool and I’m happy to share the expertise I’ve developed through the BWC drone program.

Contact Info:
Joshua Grappy
Ohio Bureau of Workers’ Compensation
UAS Program Coordinator
Desk: 419-227-6907
Mobile: 614-332-7343
Email: joshua.grappy@bwc.state.oh.us

Visit the Federal Aviation Administration (FAA) website on Unmanned Aircraft Systems for rules and regulations regarding the commercial use of drones, how to obtain your commercial certification, how to register your drone and much more.

Ducking workers’ comp coverage costs Mansfield freight hauler $144K

The owner of a Mansfield freight hauling and trucking company must pay $144,400 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) following his sentence Monday for his conviction on four felony charges related to workers’ compensation fraud.

A Richland County judge also ordered Robert Tate, owner of Elite TNT Enterprises, to serve two years of probation for his conviction Feb. 20 on two counts of workers’ comp fraud, fourth-degree felonies, and two counts of tampering with records, third-degree felonies. Tate must bring his BWC policy into compliance with state law and pay the agency $137,447 in unpaid policy premiums and $6,953 for the costs of its investigation.

“We reached out to Mr. Tate several times to follow the law and protect his employees with workers’ compensation coverage, but he chose to ignore us and it cost him,” said BWC Administrator/CEO Stephanie McCloud.

BWC’s special investigations department discovered in 2017 that Tate was operating his business without BWC coverage. After several attempts to work with Tate, agents subpoenaed bank records and audited his business, finding Tate under-reported his payroll over several payroll periods in an attempt to lower the amount he owed the agency. They also found he falsified new applications for BWC coverage by failing to list previous policies with the agency and he under-reported the number of workers he employed.

In other news:

  • A Reynoldsburg woman must pay BWC $5,010 in restitution after pleading guilty April 4 to a misdemeanor count of workers’ compensation fraud. BWC investigators discovered Amanda Treadway working as a swimming pool attendant at a condominium complex in 2017 and also as a phlebotomist while collecting BWC disability benefits.
  • A Cincinnati man found working as a truck driver while collecting BWC disability benefits was convicted of a fifth-degree felony charge of workers’ compensation fraud April 3. Antoine Harris paid BWC $7,963 in restitution prior to his guilty plea. A judge subsequently terminated Harris’s sentence of one month of probation.
  • A Cleveland Heights woman found working as a restaurant hostess while collecting BWC disability benefits pleaded guilty to a misdemeanor count of workers’ compensation fraud March 28 in Franklin County Municipal Court. A judge ordered Morgan Hines to pay BWC $4,089 in restitution, $88 in court costs and a $250 fine. The judge also sentenced her to two years of probation.
  • BWC has reinstated the policy of a Columbus day care center after the owner paid the $9,442 he owed the agency in back premiums. Ali Ismail, owner of Helpful Hands Children’s Centers, pleaded guilty March 20 to a misdemeanor count of failure to comply.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov.